TCS India FAQs – Health Insurance Scheme

VERSION 12.0
 Frequently Asked Questions – Health Insurance
Enrolment/Deletion Process

1. How can I include my beneficiaries under HIS?

New Joinees:
Please note that enrolment of beneficiaries should be completed within first 90 days from the date of
joining TCS to get benefit of the cover w.e.f. from date of joining. Further modifications will be permitted
during the window period every year. For subsequent enrolment of parents/in-laws, pre-existing
ailments or disease/ailments/conditions other than those defined under ‘List of Tertiary / Critical
illnesses will not be covered in the first year of enrolment.

Existing Employees:

Those who have completed 90 days in the organisation can enrol their beneficiaries in the permitted
window period every year announced via Ultimatix. For subsequent enrolment of parents/in-laws, pre-
existing ailments or disease/ailments/conditions other than those defined under ‘List of Tertiary /
Critical illnesses will not be covered for the first year of enrolment. Enrolment of beneficiaries must be
completed via the path below:

Ultimatix  Employee Services  Employee Self Service  Global ESS  Benefits & Taxes 
Health Insurance Scheme  Beneficiary Details.

It takes approximately 15-20 days for the beneficiary details to be updated on the Health Insurance
portal.

Note: As continuity of coverage needs to be maintained in case of Insurance, if details of beneficiaries

are deleted, then you cannot enrol them again throughout your tenure.

2. How do I enrol my beneficiaries for the Floater Cover, who are already covered as beneficiaries
under HIS Link?

The Floater Cover is a family floater i.e. the coverage is defined on a per family basis. Hence as you
are covered under the Floater Cover, it is automatically extended to all the enrolled beneficiaries.

3. Can I cover both my parents and parents-in-law under HIS?

You have the option to cover your parents OR parents-in-law OR a combination of each up to a
maximum of two individuals.

4. I am recently married. I want to cover my spouse/Parents in law under HIS but the option of
spouse and Parents in law is not available under the HIS beneficiary link in Ultimatix?

You have to first update your Marital Status and your Date of Marriage through Ultimatix  Employee
Services  Employee Self Services  Global ESS  My Profile  Basic Details  My Details.

TCS Confidential 2 August 2018

 After the above details are updated, the option to enrol your spouse / Parents in law will be made
available in Ultimatix  Employee Services  Employee Self Service  Global ESS  Benefits
 Health Insurance Scheme (post 24 hours of the update).

Above steps should be completed within 90 days from the date of Marriage. The coverage of your
spouse / Parents in law under HIS scheme will start from the date of Marriage. In case this is not done
within 90 days from date of marriage you will be able to enrol your spouse and parents – in - law only
in the next financial year during the enrolment period. For subsequent enrolment of parents/in-laws,
pre-existing ailments or disease/ailments/conditions other than those defined under ‘List of Tertiary /
Critical illnesses will not be covered in the first year of enrolment.

5. What is the process to delete the details of my beneficiaries under HIS?

Employees are recommended to delete the details only in case of a demise of the beneficiary during
the financial year. Any other deletion will be allowed only during the permitted window which is
announced before / start of the new Policy period.

Note: As continuity of coverage needs to be maintained in case of insurance, if details of beneficiaries

are deleted, then one cannot enrol them again throughout your tenure.

6. Can I continue with the HIS policy for self and beneficiaries even after leaving the organization?

All employees and their enrolled beneficiaries will be covered under the HIS policy till the last working
day in TCS irrespective of premium being paid for the complete financial year.

Coverage will end on the last working day and there will be no refund of premium. To avail continuity
of medical coverage after leaving TCS, you need to approach the Insurance Company for individual
policy. Policy terms and conditions, coverage limits and premium should be discussed with them
directly.

Entitlements/Coverage

7. What are my entitlements under HIS? What is the difference between Base and Floater Cover?

Employees and their enrolled beneficiaries are eligible for Domiciliary and Hospitalisation cover as per
the default plan applicable to them. These benefits are extended on payment of applicable premium as
per the scheme.

As per Policy terms, employees have the flexibility to choose a plan which is one level higher than their
existing default plan during the enrolment period, if needed, by paying the applicable additional
premium plus applicable taxes.

Employees can view coverage and premium details of the default health plan and the next higher plan
that they may upgrade to, if needed, via the path below:

Ultimatix  Employee Services  Employee Self Service  Global ESS  Benefits and Taxes
 Health Insurance Scheme  Beneficiary Details

TCS Confidential 3 August 2018

8. Where can I view my Health Insurance Plan details during the year?

You can view your Health Insurance Plan details in Ultimatix via the path below:

Ultimatix  Employee Services  Health & Wellness  Health Insurance Portal  Policy

Additionally you can also view the details in GESS:

Ultimatix  Global ESS  Benefits and Taxes  Health Insurance Scheme  Beneficiary
Details

9. If I wish to continue with my default plan and not opt for any upgrade, will I be required to take
any action in the system?

If you do not make any change to your default plan during the enrolment period in Global ESS, it will
continue to be applicable. However it is recommended you log on to the Health Insurance portal and
validate the applicable health plan and details of beneficiaries

10. My default health plan is Gold and I wish to upgrade to Platinum Plus plan. How can I do so?

You can upgrade to one level higher plan during the enrolment period. Hence if your default health plan
is Gold, you can either continue at Gold plan or choose to upgrade to Gold Plus plan only.

11. Can I upgrade to a higher plan this year and revert to my default plan next year?

Employees will have a choice to upgrade to one level higher plan during the enrolment window. Once
you have selected a higher plan, you will not be permitted to downgrade the plan throughout your
tenure.

12. Can I choose a different plan for my immediate family and a different plan for my parents/in-
laws?

All employees will have a choice to upgrade to a higher plan during the enrolment window which will
be applicable to the employee as well as enrolled beneficiaries. Coverage under separate plans will
not be possible.

13. I am travelling out of India on official work. Can I claim hospitalisation and domiciliary expenses
abroad?

Expenses on domiciliary treatment incurred outside India will not be covered under the HIS scheme.

Hospitalisation expenses incurred outside India may be claimed by employees travelling for official
work, up to the Base cover limit as per the applicable health plan. In case of a defined benefit, the
amount would be paid up to defined limits or the base sum insured, whichever is lesser. However the
benefits should be first availed against the Overseas Medical Insurance Policy, if applicable. Please
note that these are applicable for official travel only.

E.g. an employee covered under Gold Plus HIS plan in India, travels overseas. He has a base cover of
INR 2,00,000 per insured. He needs to undergo a joint replacement surgery for which an upper limit of

TCS Confidential 4 August 2018

 INR 2,50,000 has been defined in the policy. In this case, post exhaustion of benefits as per overseas
medical insurance policy, the employee would be eligible for maximum upto INR 2,00,000 only.

14. Can I claim benefits under HIS while I am on LWP?

Yes. An employee can claim benefits under HIS while on LWP. The applicable premium for LWP period
will be deducted on reporting back to work and initiation of payroll processing. In case, the employee
fails to report back to work, then the applicable premium will be recovered through FFS.

15. What is Critical Illness – LWP Benefit Cover? Who can avail the same?

It’s an add-on benefit for employees who are on Leave without Pay (Medical reasons) and suffering
from tertiary / critical illness OR who have suffered any bodily injury caused due to accidents/
occupational hazards arising out of and in course of employment as specified in the policy. The benefit
can be availed only once during his/her tenure with the organization. Financial assistance will be
provided for a maximum period of 52 weeks only.

16. What is my eligibility with respect to room type in case of Hospitalization for self or
beneficiaries? Where can I view the details?

Employees on Gold Plan are eligible for double occupancy (twin sharing) AC room. Employees on other
higher plans are eligible for single private AC room.

Single room facility for parents will be provided to employees holding the Platinum Plus Plan. For all
other plans, twin-sharing room for parents will be provided.

You can view room category eligibility for self or beneficiaries in Ultimatix via the below path:

Ultimatix  Employee Services  Health & Wellness  Health Insurance Portal  Policy

In case the employee chooses a room which is higher than the defined eligibility, the additional charges
for the room and other related items would be evaluated proportionately against each of the hospital
line items and the differential amount will be borne by the employee.

Premium Details

17. What is the premium that is borne by the employee?

You can refer to Enrolment links under Global ESS to view the premium payable by you. Links can be
accessed through the below path:

Ultimatix  Employee Services  Employee Self Service  Global ESS  Benefits & Taxes 
Health Insurance Scheme  Beneficiary Details.

TCS Confidential 5 August 2018

Claim Processing

18. Where do I apply for HIS Claims? What is the process to register a claim under HIS?

Employees can submit their Domiciliary or Hospitalisation claims through the Health Insurance portal
in Ultimatix. To access the Insurance portal, employee needs to log in to Ultimatix and access the
below link:

Ultimatix  Employee Services  Health & Wellness  Health Insurance Portal

19. How is the claim amount paid?

The approved claim amount will be credited to the employee’s India bank account (as updated by the
employee in the system) after the claim status changes to ‘Settled’ on the Health Insurance Portal.

Note: It is mandatory for all employees to have an active India bank account updated while raising a
claim.

20. Do I need to submit original documents while raising the HIS claims?

While claiming reimbursement under HIS, it is mandatory to submit all the original documents and
copies of all Lab and other test reports if applicable, for approval and further processing.

21. I have enrolled my beneficiaries. When and how can I receive the HIS Card?

Insurance eCard is available on the Health Insurance Portal, and may be downloaded via the applicable
link on the portal. Employee should also carry Employee ID card (original or a copy) along with a Photo
Identity proof of the beneficiary for verification and identification purpose at the hospital. The beneficiary
should carry a photo identity proof such as Passport/Voters ID card/Driving License/PAN card.

22. What is cashless hospitalisation and what is the process to avail the same?

Employees must opt for hospitals which are part of the network list and avail the cashless facility. The
Insurance Company/TPA has empanelled specific Hospitals through which a cashless facility can be
provided to the employee and the enrolled beneficiaries i.e. the patient can undergo treatment at the
hospital without making a direct payment to the hospital. The payment (upto the entitlement limit) is
made from the Insurance Company to the Hospital through the TPA.

There are two types of Cashless Hospitalisations:

a. Planned Cashless Hospitalisation

b. Emergency Cashless Hospitalisation

a. Planned Hospitalisation: For all planned hospitalisation, it is recommended that employee raises a
Preintimation request through the Insurance portal which enables a provisional authorization even
before the admission to the hospital.

TCS Confidential 6 August 2018

 This preintimation can be given through the ‘Preintimation’ tab on the Health Insurance portal. In the
request form, you are required to update the basic Hospitalization details and upload investigation
reports of diagnosis and consultation note.

In such cases, it is mandatory to intimate the TPA about the details of the hospitalization at least 72
hours in advance. This will enable the TPA to ensure a smooth and hassle free admission process for
the patient. Process to be followed for the same is updated on the Health Insurance portal.

Preintimation can also be given through the eCashless tab on the Medibuddy Mobile app.

b. Emergency Cashless Hospitalisation: Insured Person must contact the casualty desk of the
Empanelled hospital with the TCS Employee ID card or a copy of the Employee ID along with a Photo
ID proof such as Passport/Voter ID card/Driving License/PAN card as identity proof.

For more details, please refer the cashless procedure & Network list of Hospitals available on
TCS Health Insurance Portal

23. Is it mandatory to provide prior intimation to the Insurance Company prior to hospitalization?
Employees are required to mandatorily provide prior intimation (at least 72 hours in advance), in case
of a hospitalization except in case of emergencies / accidents. This is applicable for both cashless and
reimbursement mode. Such intimation must be provided through our Health Insurance portal accessible
via the below path:

Ultimatix  Employee Services  Health & Wellness  TCS Health Insurance Portal 
PreIntimation

In case of Hospitalization, in network hospitals, the cashless facility will be available and must be
utilized. Prior intimation is mandatory to avail cashless facility. The updated list of network hospitals is
available on the Health Insurance portal in Ultimatix. 10% deduction will apply only in case of
reimbursement for hospitalization in a network hospital.

In case of Hospitalization in a non-network hospital, an advance notice of Hospitalization is mandatory

(except in case of emergencies / accidents). Only in case advance intimation of at least 72 hours is not
provided, 10% deduction on the admissible amount will apply.

Additionally you can also provide prior intimation through the ecashless or Reimbursement tab on the
Medibuddy Mobile app.

24. Is it mandatory to avail services from a network hospital? What are the options in case a hospital
is not a part of the network list?

Employees must opt for hospitals which are part of the network list and avail the cashless facility. In
case of Hospitalization, in network hospitals, the cashless facility will be available and must be utilized.
Prior intimation is mandatory to avail cashless facility.

In case of Hospitalization in a non-network hospital, an advance notice of Hospitalization is mandatory

(except in case of emergencies / accidents).

TCS Confidential 7 August 2018

25. Where do I find the network list of Hospitals where I may avail Cashless Hospitalisation?

Network List of Hospitals is available on the homepage of TCS Health Insurance portal.

Ultimatix Employee Services  Health & Wellness  TCS Health Insurance Portal  Cashless
 Network Hospitals

26. How can I avail the Cashless Domiciliary benefit?

The cashless facility will also be available for domiciliary expenses, upto the entitlement limits, as per
the Health Insurance plan opted by you.

This facility can be availed through the Health Insurance portal accessible via the below path:

Ultimatix  Employee Services  Health Insurance Portal  Cashless  Cashless Domiciliary

Additionally you can also avail this benefit by clicking on the ‘Infiniti’ tab on the Medibuddy Mobile app.

27. While raising a claim, is it mandatory to upload scanned copies of the bills on the Insurance
portal?

No, it’s not mandatory to upload the Scanned Copies of the bills as the claim is processed only on
receipt of the original bills/documents. However it is advisable to upload the scanned copies on the
Insurance portal to get provisional approvals and to retain copies of the bills for future reference.

28. Will the Original bills be returned post verification/review of my claim?

Insurance company or TPA is not liable to return the submitted claim documents under any
circumstances. This is applicable even for the claims, which are rejected by the Insurance Company.
We recommend retaining the soft copies of the bills for future reference. It is always advisable to refer
the policy document and claim guidelines before raising a claim.

29. How do I raise Pre/Post Hospitalisation claims as Original bills are sent while raising the
Hospitalisation claim / during Cashless Hospitalisation?

You are required to raise the Pre/Post Hospitalisation claim through the Health Insurance portal and
submit the photo copies of the hospital bills along with covering letter mentioning details of your actual
Hospitalisation Claim for which the original bills were sent by you or Hospital.

Note: A claim made under 'Hospitalisation', would cover medical expenses incurred 30 days prior to
admission to a hospital, during Hospitalisation and up to 60 days from the date of discharge from the
hospital (post hospitalisation) for employee, spouse and children and up to one month from the date of
discharge from the hospital (post hospitalisation) for parents/parents-in-law for the same medical
reason.

TCS Confidential 8 August 2018