Group Health Insurance Manual

For Employees of

Kingfisher Airlines Limited

PRESENTED BY

WILLIS INDIA INSURANCE BROKERS PVT LTD

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Willis India is proud to be associated with Kingfisher Airlines Ltd as their broker in arranging this
Group Medical Insurance Programme. The coverage comprises the following benefits:

a) Group Medical Insurance

COVERAGE SUMMARY

MEDICAL INSURANCE

WHO IS INSURED?
All employees + Spouse + children + Parents of Kingfisher Airlines Ltd are covered against
Hospitalisation expenses.

Any addition to the family by way of marriage or child birth will be covered only on
intimation within 45 days of being married or birth.

WHAT IS THE BENEFIT LIMIT?

Floater Sum Insured for employees and their family depending on their grades

WHERE THE TREAMENT SHOULD BE TAKEN?

Any where in India preferably through the network of hospitals arranged by United Healthcare India
Pvt Ltd. third party administrator.

WHAT ARE THE BENEFITS?

¾ Covers expenses relating to hospitalization for a minimum period of 24 hours (Example:

Room charges, doctors fees, nursing charges, O.T charges, ICU, drugs & medicines,
diagnostic tests)
¾ Employee’s family is defined to include self, spouse, children and dependent parents
¾ First year exclusion waiver
¾ 30-day waiting period waiver
¾ All expenses incurred at the hospital in connection with the treatment would be paid
subject to limits depending on grade.
¾ Pre existing diseases covered.
¾ New born baby is covered from day one
¾ Treatment / medicine taken 30 days prior to hospitalization and 60 days after
hospitalization other than Maternity claims
¾ Maternity benefit to a maximum of Rs 50,000, for both normal and caessarian section
including 9 month waiting period waiver.
¾ Day Care treatment (as per list attached)

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WHAT IS NOT COVERED?

¾ Any Out patient treatment

¾ Voluntary termination of pregnancy
¾ Maternity expenses for third child
¾ Non- Medical Expenses like Registration fees, telephone charges, ambulance charges,
hearing aids, food, etc
¾ Dental treatment or Surgery of any Kind unless requiring hospitalization.
¾ Convalescence, General Debility, Run down condition or rest cure, congenital diseases or
defects or anomalies, sterility, venereal disease, intentional self injury and use of
Intoxicating drugs/alcohols.
¾ HIV/AIDS related treatment
¾ Expenses on vitamins and tonics unless forming part of treatment.
¾ Expenses on Diagnostic, X-Ray, or Laboratory examinations unless related to the
treatment.
¾ Naturopathy
¾ Expenses incurred in connection with medical termination of pregnancy (except where
carried out under medical advice) during first 12 weeks from the date of conception are not
covered.

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CLAIMS PROCESS

On enrolment you and your dependents would be issued an identification card by United
Healthcare, who as Third Party Administrators are authorized by Insurers to handle all your claims.

You are entitled to cashless service in all the hospitals forming part of the TPA network on
production of your identification cards issued by United Healthcare

Hospital admission procedures:

Planned treatment
A pre- authorization form, available at the network hospital to be completed and submitted to the
hospital. Hospital with their remarks and recommendations will inform United Healthcare India Pvt
Ltd by fax, at least 48 hours prior to the planned admission. Authorization is usually granted within
a day. In the rare event of Cashless admission denial, please contact Willis India for their advice on
denial.

DENIAL OF CASHLESS FACILITY DOES NOT MEAN DENIAL OF CLAIM

Unplanned treatment
You may seek admission in any of the network hospital as per the Hospital’s normal procedure.
Subsequently, a pre- authorization form available with the Hospitals is to be completed and sent to
United Healthcare India Pvt Ltd through the hospital. United Healthcare India Pvt Ltd will advise the
hospital within 4 to 6 hours.

The patient or his representative would be required to sign bills and/ or discharge summary before
leaving the hospital. All non- medical bills such as telephone, diet charges etc may have to be
settled direct with the hospital

All pre and post hospitalization expenses (30 days prior to admission and 60 days after discharge)
will have to be submitted to United Healthcare India Pvt Ltd with a completed claim form and
supporting documents.

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Non Network hospital
No cashless facility is available when treatment is taken at hospital that does not form part
of United Healthcare India Pvt Ltd Hospital network. Expenses incurred at non-work hospitals
would be reimbursed on submission of claim form and supporting documents by United
Healthcare. All documents are to be submitted within 70 days of discharge from hospital. Prompt
and complete submission of documents would expedite reimbursement process. All
reimbursements would be made to employees directly.

What documents are required to be submitted under a claim – Reimbursement

You must submit following documents in Original within 70 days of discharge from the hospital to
United Healthcare.
¾ Signed Claim Form of HDFC Ergo General Insurance Company Ltd.
¾ Original Final Hospital Bill along with Payment Receipt
¾ Original Discharge Summary / Card
¾ All Investigation Reports (photocopies will do)
¾ Original Bills & Receipts for investigations done outside hospital.
¾ Doctors Prescription, Pre – Post Hospitalisation bills (in original)
¾ Original Bills of medicines if purchased by you.

Contact Numbers

HDFC Ergo General Insurance Company Ltd.

24 hours toll free no: 1800224545/1800224646

Claim form with the annexures to be sent to

The Claims Department

United Health Care India Pvt. Ltd.
Unit No.39 3rd Floor, B Wing
Gundecha Enclave, Kherani Road,
Sakinaka, Andheri (East)
Mumbai 400 072.

Phone No : 022 30657300/022 66660999

Fax No. 022 28528222

Willis India Insurance Brokers Pvt. Ltd.

Ms. Urmi Munankami Nair

022 - 66592565/ 09930077844

Ms. Vaidehi Desikan

022 – 66592562/ 09967126699