FAQs on Group Medical Insurance:

Q1. Are all important aspects of our medical insurance plan for FY19 being retained
in the policy for FY20?

Yes, below are the important aspects of the policy which will continued :

The Premium cost for Policy 1 Self, Spouse & 2 Children continues to be
borne by Accenture

You will continue to have the option of covering your Parents & Additional
children under Policy 2.

You will also continue to have the option of Top up Policy under Policy 3,
Critical illness covers under Policy 4

You will continue to have the option of covering your Parents In-Laws under
Policy 5

The Premium for above mentioned Voluntarily Policy will need to be borne
by you (Policy 2, 3, 4 & 5)

Pre-existing diseases continue to be covered

The co-payment remain same as below for this year

• Policy 1, 3 & 4 @ 10%
• Policy 2 & 5 @ 20%

The maximum eligible amount will be the sum insured less the co-pay
percentage amount i.e. you will be required to pay a defined percentage of
each medical insurance claim

Maternity Limit continues to be INR 60,000 with employee co pay of 10%

Corporate buffer is applicable only for the employee & dependents as

declared under policy 1.

Q2. What are the important highlights of the policy?

Policy 2 & 5 are renewed for 18 months (17th Oct 2019 to 31st Mar 2021)

Policy 3 & 4 are renewed for 6 months (17th Oct 2019To 31st Mar 2020)

Corporate Buffer limit has been increased from INR 1.5 Lakh to INR 5 lakhs
Per Family
 Physiotherapy expenses upto 6 month post hospitalization is payable

Mental Illness/ Sleep Apnea upto INR 5K per consultation is covered only
for employee

Bariatric surgery (only for life threatening conditions) is covered

No co-pay applicable in case of employee death during hospitalization and

policy continuity for family until end of policy date

399 day-care procedures are covered

The ailments covered under domiciliary treatment such as HIV and

Parkinson will be continued this year as well.

Expenses related to gender reassignment surgery is also included as part

of the coverage.

Autism is covered for employees and dependents (spouse and 2 children)

who have been diagnosed with ASD by a registered medical practitioner. Limit
of up to 100,000 as part of the sum insured per year/person for treatments like
behavior management/modification therapy/medication/speech/occupational
and physical therapies.

Assistive Disability Aid and Personal Attendant Care Allowance /Expenses

which an employee or their dependents (spouse, 2 children) needs with
temporary/ permanent/ progressive disability upon prescription of the treating
registered medical practitioner for a cap of INR 50,000 will be covered as part
of the sum insured per year/ per employee and dependents.

LGBT Partner Benefit – extending Mediclaim benefit for partners of LGBT

employees: At Accenture in India, we endeavor to support our employee with
inclusive benefits for all, irrespective of their sexual orientation and gender
identity and expression. To further this, Mediclaim benefit can now be availed
by the partner of employees who identify themselves as Lesbian, Gay,
Bisexual and Transgender. To understand more about this benefit, please log
in to https://tips.vidalhealthtpa.com/AcnLogin → ‘LGBT Partner Benefit’ section.

All these benefits are part of the overall medical cover an Accenture employee
in India is eligible for and is not over and above the same.

Q3. I want to decide on the insurance cover for my parents/ In-law & additional
children depending on the premium cost of cover. Where can I find the same?

The premium amount you will have to pay will depend on the combination
of the sum insured that you opt and the age of your parent, parent-in-law or
 child. This amount will be available to you on the TPA link shared with You
where you can select and decide the sum insured.

Q4. If I opt for insurance cover for my Parents/In-law & Additional children, how will
the premium be deducted?

At the time of opting for insurance cover for your Parents/In-law &
Additional child on the provided TPA link, you will be required to click on an
online declaration consenting for the method of deduction of premium to be
made from your salary.

You can now opt to pay the premium for covering your parents, parents-in-
law & additional children either in lump sum or in 4 equal instalments by
selecting the appropriate option in the website. The premium will be deducted
from your salary based on the enrolment date as given below. If you leave the
Organization during the course of the insured year, the premium paid by you
will not be refunded.

Enrolment Period Lump sum Option Instalment Option

4 equal instalments starting

17th Oct to 15th Nov 2019 November 2019 Payroll
November 2019 Payroll

Q5. If I want to cover my parents, parents-in-law & additional children under the
medical insurance plan, How do I go about the same?

Once you decide to enrol, login in to the TPA site as per the login process
shared with you and follow the Instructions to enrol your parents, parents-in-
law & additional children for the medical insurance plan. Detailed instructions
are available in the TPA website home Page

The premium amount will be deducted from your salary either at one
instance or in 4 equal instalments. You have to select the option for lump sum
or Instalment in TPA website while declaring the dependent details.

Q6. What are the min/max sum insured I can opt for Parents/In-laws policy?

You can cover both your parents/In-law separately for a sum insured
ranging from INR 50,000 to INR 500,000
Please remember, this is not a floater policy. The premium has to be
separately paid for each of the parents, parents-in-law and additional children
based on the sum insured as selected by the employee on the website.
Q7. Will the premium that I pay be refundable if I exit from the company ?

No the premium for the voluntary policies will not be refundable if you exit
the company.

However your policy cover will continue to be active until the end of the
policy period.

Q8. How do I calculate the Perquisite value on premium for availing the instalment
option on the policy for parents, Parents-in-law & additional children?

Note the premium amount displayed on the TPA website once you decide
the sum insured
Enter the premium amount in the file “Perks calculation.xls” shared with you
to calculate the perquisite Value

Q9. What are the main features of Voluntary policies (Policy 2, 3, 4 & 5)

Kindly refer the below table for Voluntary policies features

Features Policy 2 Policy 3 Policy 4 Policy 5

Portability Yes Yes Yes Yes
Tax
Yes Yes Yes No
benefit
Co pay 20% 10% 10% 20%
Policy
Individual Floater Floater Individual
type
Policy 17-Oct-19 To 17-Oct-19 To 17-Oct-19 To 17-Oct-19 To
period 31-Mar-2021 31-Mar-2020 31-Mar-2020 31-Mar-2021
Sum 1 Lac, 3 Lacs , 5 Lacs , 1 Lac, 3 Lacs , 5 Lacs ,
insured 50K to 5 Lacs 10 Lacs - (MD only) 10 Lacs - (MD only) 50K to 5 Lacs

Q10 Do we have Mobile App for Vidal Health TPA?

Yes you can search My Vidal Health in Google Play Store (for Android
Users) & App Store Apple (for iOS Users)

User can login with credentials [combination of date of birth and date of
joining e.g. (DDMMYYYYDDMMYYYY)].

For more detail on Mobile App you can login to

https://tips.vidalhealthtpa.com/AcnLogin search for Mobile App tab.

Q11 How will claims be settled in case of Cashless Process ?

In case where TPA has a tie up with hospital, Insurance company will settle
bills based on the defined claims % for each claim e.g.: If the total bill value
for treatment of Employee’s parent or parent-in-law is INR 10,000:
 80% of the claim will be settled directly with hospital by the Insurance
Company – i.e. INR 8,000 will be settled by the insurance company

20% of the claim needs to be settled directly by the employee – i.e. INR
2,000 will need to be paid by the employee to the hospital directly

Q12 How will claims be settled in case of Reimbursement process (No tie up with
hospital)?

Reimbursement to employee will be to the extent of defined claims % for

each claim e.g.: If the total bill value settled for treatment of Employee’s
parent or parent-in-law is INR 10,000

80% of the claim will be settled by the Insurance Company – i.e. INR 8,000
will be settled by the insurance company. This amount will be reimbursed to
the employee.

20% of the claim needs to be borne by the employee – i.e. INR 2,000 will
need to be borne by the employee and the same will not be reimbursed to him

You will be reimbursed only 80% of the total sum insured you have opted
for your Dependents (parents, parents-in-law, additional children) & 90% of
the total sum insured under Policy 1 (self, spouse and 2 children)

Q13. Who should I submit my claims to?

All medical insurance claims need to be directed to the Insurance team at

the below mention address through the mail room service.

Please do not hand over the Claim documents to anyone in Accenture or

drop them in any drop box or courier them directly to the TPA.

Accenture Solutions Pvt. Ltd., (Insurance team)

Plant Number 3, M2B - Bay 49,
Godrej and Boyce complex, L B S Marg,
Vikhroli – West, Mumbai 400079

It is mandatory to mention your SAP ID and the number of supporting

documents being sent for verification, on the envelope.

Q14. Who should I reach out to in case of questions?

For any queries kindly contact TPA via below option

• Vidal Toll Number: 1860-4250-258
• By raising Query in TPA Portal (Query Tab)
• By raising query in Service Now -
https://support.accenture.com/support_portal