EMPLOYEE

BENEFITS
GUIDE
2021-22

INSURANCE BENEFITS

Policy Period:
April 1, 2021 to March 31, 2022

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

Objective

 Objective of this presentation is to build the knowledge & familiarize you with the benefits & process of Insurance
 Members are requested to raise their individual concerns to following email id
 General Queries: [email protected]
 Claims related: [email protected]
 Annual Enrollment Technical quires: [email protected]
 Enrollment has been opened for employees joined EY Group on or before 31 st Mar 2021 and members joined on or after
1st Apr 2021 will be receiving enrolment mailer after 10 th of subsequent month.
 Check your email box, you would have received web enrolment mailer from [email protected] to
complete the enrollment and If you are facing any issues in the web portal, please reach out to
[email protected]
 Claim documents check list provided in this presentation are indicative, insurer / TPA will call far additional documents
basis the claim received by them.

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

GROUP MEDICLAIM COVID-19 COVERAGE MEDICAL

INSURANCE (GMC) POLICY (GMC) 2021-2022

EY MEDICAL INSURANCE GROUP PERSONAL ACCIDENT

DIFFERENTIATOR (GMC) 2021-2022 POLICY (GPA) 2021-2022

GROUP MEDICAL CRITICAL ILLNESS GROUP TERM LIFE POLICY (GTL)

COVERAGE POLICY (GMC) 2021-2022 2021-2022

POLICY CLAIMS CONTACT DETAILS

GROUP MEDICLAIM VOLUNTARY

MODULAR TOP UP POLICY

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

OVER VIEW

GROUP MEDICLAIM INSURANCE (GMC)

EY Insurance policy provides a wide range of coverage to secure your
finances against sudden medical expenses. It has extensive coverage
to cater to hospitalization needs for your family and yourself under
floater sum insured basis your eligibility. You also have an option to
enhance your sum insured by opting for a top up policy staring INR 3
Lacs to INR 15 Lacs. It takes care of medical needs such as
treatment for diagnosed ailment at the hospital, maternity, OPD,
critical illness cover, donor expenses cover, etc. and its features
include room rent & co-pay buyback with nominal charges.
Importantly, a claim can be made from day 1 for all declared
members, no pre-medical check-up to enrol your dependents and
yourself.

GROUP PERSONAL ACCIDENT (GPA)

Personal accident policy that can reimburse your medical costs,
provide compensation in case of permanent disability or death caused
by accidents; it also pays a certain amount towards partial disability
depending upon the nature of the disability and weekly benefits to
compensate loss of pay for working professionals.

GROUP TERM LIFE (GTL)

Life insurance policy guarantees to pays a sum of money to
nominated beneficiaries in the event of an unfortunate death of an
employee/member.

For more information, please contact: [email protected]

What’s changing this year (2021-22)?
GMC/GPA/GTL

1
Cancer test overseas
2
Critical illness cover
3
Premium amounts
4
Covid-19 waiver
• Coverage to take opinion • Critical Illness cover of INR • Sum Insured INR 4,00,000 - • Co-pay for parental claim -
abroad for cancer patient for 500,000 INR 2,685 (increased by INR waived
self/nominated dependants 48)
under the base policy • First-time detection under the
policy year/period • No restriction on room rent;
• Sum Insured INR 6,00,000- INR
• Limit per family - INR 25,000 PPE Kits, & Consumable as per
5,117 (increased by INR 90)
base policy terms
• Sum Insured INR 8,00,000-INR
6,307 (increased by INR 112)

► No change in GPA and GTL

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

Group mediclaim
insurance (GMC)

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

GROUP MEDICLAIM BENEFITS SUMMARY (GMC)

Policy Parameters
Insurer/TPA/Broker The New India Assurance Co Ltd
• Medi Assist India TPA Pvt Ltd
• Prudent Insurance Brokers Pvt Ltd

Family Coverage Employee + 5 Dependents

• (1+5) Self + Spouse/domestic partner + 2 dependent children (maximum 4 children - 3rd and 4th child
covered in case of twins and triplets) + 2 dependent parents / parents-in-law
• Combination of parents or in-law not allowed (for both male & female employees)
• Dependent children can be covered up to the age of 25 years, however, exceptions are provided for
unmarried female children/specially-abled children with EY HR & insurer’s approval

Mid-Term Enrolment Applicable only for newly wedded spouse/newborn child

• Existing dependents cannot be enrolled midway through the policy period
• Employees should enroll baby/spouse details on Prudent Plus portal within 30 days from the date of such
events (date of marriage or date of birth)

Sum Insured • Employees aged below 35 years: Family Floater Sum Insured of INR 400,000
Parental sum insured restricted to INR 300,000
• Employees aged above 35 years: Family Floater Sum Insured of INR 600,000
Parental sum iinsured rrestricted to INR 300,000
• Ranks 21 & 62 (irrespective of the age of the employee): Family Floater Sum Insured of INR 600,000
Parental sum insured restricted to INR 300,000

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

EY Medical
insurance
differentiator
(GMC) 2021-2022

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

COVERAGE DIFFERENTIATOR

 Wide coverage and it is combination of both

hospitalization & OPD benefits
 Covers advanced treatment such as Oral
Chemotherapy Treatment, Cyberknife Treatment,
Robotic Surgery
 Women & Child Care covers Well Mother Care
Expenses
 Vaccination of Newborn Child, Infertility Treatment
 LGBT- Coverage for same-sex partner/spouse/domestic
partner of an employee as a dependant is allowed
 Multiple Sum Insured under Top up with options to
choose Flexi Add on benefits to minimize the financial
burden on employee/family
 Coverage has been extended to the second set of
parents, apart from the first set of parents/parents-in-
law under base policy
 Covid-19 wavier: Co-pay for parental claim, no
restriction on Room Rent, PPE Kits, & Consumables
 Critical illness covers for employees - INR 5,00,000

* Refer the benefits manual for more details & coverage is subject to admissibility
as per the policy terms.

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

Group medical
critical illness
coverage policy
(GMC) 2021-2022

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

CRITICAL ILLNESS

First time Detection

Critical illness covered for 22 ailments listed below - up to INR 500,000 one-time settlement.
It covers employees for first time detection of the below-listed ailments.

 Ailments Covered  Angioplasty

 Cancer of Specified Severity  Benign Brain Tumor
 Myocardial Infarction  Blindness
 Open Chest CABG  Deafness
 Open Heart Replacement or Repair of Heart Valves  End Stage Lung Failure
 Coma of Specified Severity  End Stage Liver Failure
 Kidney Failure requiring Regular Dialysis  Loss of Speech
 Stroke Resulting in Permanent Symptoms  Loss of Limbs
 Major Organ/Bone Marrow Transplant  Major Head Trauma
 Permanent Paralysis of Limbs  Primary (Idiopathic) Pulmonary Hypertension
 Motor Neuron Disease with Permanent Symptoms  Third Degree Burns
 Multiple Sclerosis with Persisting Symptoms

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

ROOM RENT

For Sum Insured INR 400,000

• Delhi & NCR - INR 6,000 for Normal hospitalization
• Rest of India - INR 4,000 for Normal hospitalization

For Sum Insured INR 600,000

• Delhi & NCR - INR 7,500 for Normal hospitalization
• Rest of India - INR 5,000 for Normal hospitalization
• Room rent is inclusive of duty doctor fee & nursing
charges

Higher Room Rent or Room Category Implication:

• Rooms of a higher category (opted by the claimant) &

revisions in cost for medicals resulting from the higher
category opted for, will be borne by the claimant

For Ranks 21 & 62 - Sum Insured INR 600,000

• Room rent will be restricted to a single private AC room
• No cap for ICU hospitalization across India

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

MATERNITY AND BABY COVER

MATERNITY (IPD) AND INFERTILITY TREATMENT

1. INR 60,000 for Normal Delivery & INR 75,000 for C-Section 6. Infertility Treatment (IVF): Treatment for infertility to be
Delivery (condition for room rent is still applicable, as per covered only for employees/spouse with a sub-limit of
member eligibility) INR 100,000 for both OPD/IPD Claims
2. Benefit is applicable for the first 2 living children only 7. Vaccination of newborn child: INR 10,000 within maternity
limit post-hospitalization
3. Well Mother Care Expenses: Coverage for Room Rent for a
mother who's required to stay in the hospital to take care of
the Baby, until the Baby completes 2 years (within the
Family Floater Sum Insured)
4. Well Baby Care Expenses: Covered for eexpenses iincurred
for a normal baby after the birth till discharge. Automatic
coverage for necessary expenses related to the newborn’s
wellbeing after birth and before discharge. Expenses like
doctors check-up and any other check-up/tests performed
to ensure that the baby is well at birth - covered within
maternity limit
5. Pre & Post-Natal Expenses: Covered within the Maternity
Limit up to INR 5,000 (60 days prior to admission & up to
90 days after discharge)

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

CUSTOMIZED BENEFIT: VISION

BABY COVER 1. Cataract restricted to INR 35,000 per eye
(ILLNESS- 2. Lasik Surgery: Covered if the power of the eye is
above +/-5, restricted to INR 50,000 for both eyes
RELATED) FROM
DAY 1 -
COVERED CAPPING AILMENTS
Capping applicable only for parents; not applicable for
Newborn child having employees, spouse, & children
complications that would warrant
the baby’s admission/
Cataract INR 35,000
hospitalization is covered from
Day 1 up to family floater sum
Cancer INR 300,000
insured (which requires a
minimum of 24-hour
Kidney INR 300,000
hospitaisation).

ADD-ON COVERAGE Gynaecological

INR 200,000
issues

Oral Chemotherapy Treatment Covered for all INR 300,000 -

Bone non-accident
For knee replacement per leg
Cyberknife Treatment Covered up to 50% of sum insured
Hernia INR 100,000

Robotic Surgery Covered for all

Appendicitis INR 60,000

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

AYURVEDIC TREATMENT
Expenses incurred for Ayurvedic Treatment are admissible up to
25% of the sum insured provided the in-patient treatment for illness
or injury is taken in a government hospital or in any institute
recognized
By government and/or accredited by Quality Council of India/National
Accreditation Board of Health.

LGBT
Coverage for same-sex partner/spouse/domestic partner of an
employee as a dependant is allowed.
Note: Employee has to declare same-sex spouse or partner during the
enrolment.

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

STANDARD hospitalization: 24 HOURS

Cashless/Reimbursement of expenses related to

 Room and boarding  Hospital miscellaneous services

 Doctors fees (such as laboratory, X-ray,
 diagnostic tests)
Intensive Care Unit
 Dressing, ordinary splints, and
 Nursing expenses
plaster casts
 Surgical fees, operating theatre,
 Costs of prosthetic devices if
anesthesia and oxygen, and their
implanted during a surgical
administration
procedure
 Physiotherapy – follow up post-
 Radiotherapy and chemotherapy
hospitalization & surgical event
only  Organ transplantation charges -
 except donor charges
Drugs and medicines consumed on
the premises

Hospital or nursing home means any institution in India established for indoor care and
treatment of sickness and injuries, and which has been registered either as a hospital Co-payment
or nursing home with the local authorities and is under the supervision of a registered
20% Co-pay on all
and qualified medical practitioner, or complies with minimum criteria, as follows:
Parental/in-law claims.
1. Has a minimum of 10 beds if located in towns having a population of less than (INR 3,000 policy
INR 10 lacs (Class C towns) or a minimum of 15 in-patient beds in other towns excess on all parental
2. Has a fully equipped operation theatre claims only. Not applicable
3. Has a fully qualified doctor in charge and nursing staff around the clock for capped ailments)
4. Maintains a daily medical record for each of its patients

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

DAY CARE PROCEDURES

• Over 140+ day care procedures covered under the mediclaim policy
• Kindly refer to the attachment for a list. This may change from time to
time, hence, please check with the TPA prior to the procedure

General Day Care Procedures.pdf

Click here to Download
NIA Day Care List

PRE AND POST-hospitalization

EXPENSES

60 DAYS 90 DAYS

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

GENERAL EXCLUSIONS
• hospitalization is only for investigation and observation, oral • Any non-medical expenses like registration fees, admission fees,
medication without an active line of Treatment for an any charges for medical records, cafeteria charges, telephone charges,
ailment - not payable in the policy disposable items, and any reusable items consumed on the
• Less than 24-hour hospitalization premises, etc.
• Cost of spectacles, contact lenses, hearing aids
• Circumcision, unless necessary for treatment of disease
• Any cosmetic or plastic surgery except for correction of injury
• All types of dental treatments
caused by accident
• HIV and AIDS (except self, spouse, & children)
• Charges incurred primarily for diagnostic, X-Ray or laboratory
• Venereal diseases examinations or other diagnostic studies not consistent with or
• hospitalization for convalescence, general debility, rest cure, incidental to the diagnosis and treatment of any ailment, sickness,
intentional self-injury, use of intoxicating drugs/alcohol or injury

• Naturopathy, homeopathy treatment any other non-allopathic • Vitamins and tonics unless used for treatment of injury or disease
treatment which is not approved by the policy • Injury or disease caused directly or indirectly by nuclear weapons
• Any surgeries/treatments could be performed on an out-patient • Injury or disease directly or indirectly caused by or arising from
basis by using local anaesthesia intervention or attributable to war or war-like situations
• hospitalization is for only investigation and observation without an • And all other expenses that are not payable as per policy terms
active line of treatment for an ailment and conditions

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

Enrolment process Don’t’s

 Check your email box, you would have received on web

enrolment mailer from [email protected]
 Connect to URL: prudentplus.co.in
 User Credentials
 Username: [email protected]
 Password: Password was part of welcome mailer sent
separately / use reset password

Enrollment Demo Video - Click here

Note: If you are facing any issues in the web portal, please reach out
to [email protected]

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

CASHLESS hospitalization
Medical expenses
can be claimed in 2 Cashless hospitalization means the administrator may authorize upon a
different ways policyholder’s request for direct settlement of eligible services and its
according charges between a network hospital and the administrator. In
such a case, the administrator will directly settle all eligible amounts to
the Network Hospital and the Insured Person may not have to pay any
deposits at the commencement of the treatment or bills after the end of
treatment to the extent as these services are covered under the policy.

List of hospitals in the TPA’s network eligible for cashless hospitalization

For the latest list, visit https://www
.medibuddy.in/network-hospitals-list
(Select New India as the Insurer to view the list of hospitals)
CASHLESS REIMBURSEMENT
PROCESS PROCESS
Prudent Claims team: 1800 123 9437

2 hours for initial Claims can take up Reimbursement claims: [email protected]

approval, 4 hours for to 21 working days,
General Enquiries: [email protected]
final approval provided on receipt of all
hospital submits all completed Turnaround time for cashless facility approvals is 6 working
required documents documentation hours. Reimbursements on claims can take up to 21 working
days.
Due to Covid-19 pandemic, documents received via courier
will be kept for 48-hour isolation

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

Hospitalization Don’t’s

Cashless – Do’s: Cashless – Don’t:

- Check whether hospital is under Medi Assist Network List - Do not panic (stay calm & ensure patient gets the treatment started).
- Carry following documents and submit it at Insurance / TPA desk. - Going non network hospital
o Doctor, advise for hospitalization. - Employee should not ask the eligibility confirmation from the hospital
o E-Card / TPA Card issued by Medi Assist. staff.
(Currently you can use the existing card issued during policy - Employee/Patient attender should not inform the hospital about the
period 2020-21) Sum Insurer details to the hospital.
o Any Govt ID Proof of the patient. - Employee should not pay extra amount to the hospital without the
o Employee, Pan & Aadhar card for KYC . clarification from them or the TPA.
o Inform about your eligible room rent eligibility.
o Keep proper accounting Medicine / consumables used by the
hospital.
o Cashless discharge process takes around 4 hours, during this
TPA may raise the queries to hospital and ensure they revert
back on a timely basis to reduce the turn around time.
o If hospital asks to pay extra amount beyond agreed tariff (other
than deductions), please question them and request hospital to
check with the Medi Assist before paying the amount hospital.
o If Network hospital is not accepting the cashless, request
hospital to provides the reason for the same.

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

Hospitalization Don’t’s
Non-Network Hospital – Do’s:
- If Non-Network hospital, then following checklist need to be followed.
- Ensure Hospital minimum, has a minimum of 10 beds if located in
towns having a population of less than INR 10 lacs (Class C towns)
or a minimum of 15 in-patient beds in other towns.
- Has a fully equipped operation theatre.
- Has a fully qualified doctor in charge and nursing staff around the clock.
- Maintains a daily medical record for each of its patients.
- Ensure to collate all the documents before discharge.
- Discharge summary
- Final bill & break-ups and payment receipts
- Medical bills with Dr. Prescription
- All original reports with supporting bills
- MLC or FIR copies in case of accidental injury

* Documents listed above are indicative, TPA will call for additional
document's basis the claim evaluation on the initial documents

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

PRE-AUTHORIZATION

Member intimates Medi Assist

Claim Yes TPA authorizes cashless within
of the planned hospitalization
Registered by 6 hours for planned
in a specified pre-authorization
the TPA on hospitalization to the hospital
format 48 hours prior to
same day
hospitalization

No

Follow reimbursement process Pre-Authorization Completed

Click here to Download

Cashless Claim CASHLESS FORM
Form

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

REIMBURSEMENT CLAIMS

Submit all reimbursement bills, original reports, and prescriptions

along with the claim form and checklist within 30 days of the date of
discharge for pre-hospitalization claims and hospitalization claims, and
within 60 days of discharge for post-hospitalization claims.
* Member can submit claim online using Prudentplus.in portal &
courier the physical documents to TPA’s office for further claim
settlement.

Along with the list of documents as mentioned in the checklist,

provide us the details of your bank account details along with
cancelled cheque.

Click here to Download

Claim Submission Checklist Form

Click here to Download

Reimbursement Reimbursement Claim Form
Claim Form

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

NON-CASHLESS hospitalization

Admission Procedure
In case you choose a non-network hospital, you will have to liaise directly for
admission.

Discharge Procedure
In case of non-network hospital, you will be required to clear the bill and submit a
claim to Medi Assist/ Prudent for reimbursement from the insurer. Please ensure that
you collect all necessary original documents such as:
• Medi Assist claim form
• Discharge summary
• Final bill & break-ups and payment receipts
• Medical bills with Dr. Prescription
• All original reports with supporting bills
• MLC or FIR copies in case of accidental injury
• Canceled cheque leaf for online payment
• ID proof of Employee/Patient (DL, Pan Card, Voter ID Card, Aadhaar Card,
etc.)
• Documents shown are indicative, additional documents will be called for by the
processing doctor at TPA

Submission of hospitalization Claim

After the hospitalization is complete and the patient has been discharged from the
hospital, you must submit the final claim within 30 days from the date of discharge
from the hospital. Upon crossing this timeline, the claim is not admissible to honour

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

CLAIMS PROCESS
Member gets admitted in Member/Hospital applies
the hospital in case of for pre-authorization to
emergency by showing the TPA within 24 hours
his ID Card of admission

Yes Yes If document

Claim liable
TPA performs medical received within
(coverage/
scrutiny of the documents 30 days from
applicability)
discharge

No No
Claim
Rejected

Yes Payment to be made to

Documentation TPA performs medical claimant. The discharge
TPA performs medical
completed scrutiny of documents voucher and copy of
scrutiny of the documents
as payment receipt to be
required sent to claimant

TPA sends mail about

deficiency and document
No requirements

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

Group mediclaim
voluntary modular
top up policy

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

MODULAR TOP UP POLICY ENROLMENT

Top-up policy allows the employees to avail a medical insurance cover that is over and above
the medical insurance policy of EY. An employee can opt for a specific amount of additional
floater cover at an affordable premium.

Advantages of How to Buy

Modular Top up the Top up Policy:
policy:
• During the base policy enrolment
• Employees could upgarde their through Prudent Plus portal, select
GMC Sum Insured limit based top up plan for additional INR
on their requirement 300,000, INR 500,000, INR 700,000,
• Premium rates are relatively low INR 10,00,000, INR 15,00,000
when compared to retail
products outside the market
• No medical check-ups required to Important Note:
cover self and dependants 1. Premium towards Top-Up plan will be recovered from the next month’s payroll
• Premium paid towards top up plan 2. On cessation of employment with the company, the master insurance policy will cease to
is exempted under 80D as per the exist as such the Top-Up plan will automatically come to an end
income tax regulations 3. Under Top up policy, maternity coverage is not applicable, however, employee will get
enhanced maternity limit of INR 15,000 under top up policy sum insured starting INR
7,00,000 & above
4. Member will remain in the same Top Up sum insured/can increase Top Up sum insured
with a 2-year lock-in period starting 2020-21 policy period

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

MODULAR TOP UP
PLAN
TOP UP 3 LAKHS (PLAN 1) TOP UP 5 LAKHS (PLAN 2)
Family Floater Sum Insured of INR 300,000 Family Floater Sum Insured of INR 500,000

ESCP or PIL ESCP or PIL

• AS per Base Policy Terms • PRE AND POST-HOSPITALIZATION COVERAGE: Post-hospitalization

for critical Illness and accident cases enhanced to 120 days
Sum Insured Premium Premium • HOSPITAL CASH: Hospital cash of INR 1,000 per day in excess of 7 - day
Amount Excl. Amount Incl.
admission and paid in excess of hospitalization payable amount
Tax Tax
Family Floater INR 3,300 INR 3,894
Sum Insured of Sum Insured Premium Amount Premium Amount
INR 300,000 Excl. Tax Incl. Tax
Family Floater Sum Insured INR 7,000 INR 8,260
of INR 500,000

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

TOP UP 7 LAKHS (PLAN 3) TOP UP 10 LAKHS (PLAN

4)
Family Floater Sum Insured of INR 700,000 Family Floater Sum Insured of INR 10,00,000

• MATERNITY BENEFITS - LIMITS AND • MATERNITY BENEFITS - LIMITS AND COVERAGES: Additional
COVERAGES: Additional INR 15,000 for maternity INR 15,000 increased for maternity
• PRE AND POST-hospitalization COVERAGE: Post- • PRE AND POST-hospitalization COVERAGE: Post-hospitalization for
hospitalization for critical illness and accident cases critical illness and accident cases enhanced to 120 days
enhanced to 120 days • HOSPITAL CASH: Hospital cash of INR 1,000 per day in excess of 7 - day
• HOSPITAL CASH: Hospital cash of INR 1,000 per admission and paid in excess of hospitalization payable amount
day in excess of 7 - day admission and paid in excess • INVESTIGATION COVERAGE: Investigation prescribed by Dr. like
of hospitalization payable amount MRI, CT Scan, PAP Smear, EEG, Biopsy, PET scan, Endoscopy &
• INVESTIGATION COVERAGE: Investigation Colonoscopy with the limit of INR 10,000 for employee only
prescribed by the Dr like MRI, CT Scan, PAP Smear, • AUTISM OR DEVELOPMENTAL DISABILITY COVERAGE: Autism
EEG, Biopsy, PET scan, Endoscopy & Colonoscopy covered for children only, including all kinds of therapy and sessions on
with the limit of INR 10,000 for employee only IPD as well as OPD basis
• AUTISM OR DEVELOPMENTAL DISABILITY • INTRAVITREAL & INTRA ARTICULAR INJECTIONS: Covered up to
COVERAGE: Autism covered for children only, INR 50,000 for employees
including all kinds of therapy and sessions on an IPD
as well as OPD basis • OPD BENEFITS APPLICABLE FOR EMPLOYEE , SPOUSE AND
CHILD ONLY (OPD Consultation & Investigation Only)
Sum Insured Premium Premium • PERITONEAL DIALYSIS : Covered for all
Amount Excl. Amount Incl.
Tax Tax
Family Floater Sum INR 13,000 INR 15,340 Sum Insured Premium Amount Premium Amount
Insured of INR 700,000 Excl. Tax Incl. Tax
Family Floater Sum INR 20,000 INR 23,600
Insured of INR 10,00,000

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

TOP UP 15 LAKHS (PLAN 5)

Family Floater Sum Insured of INR 15,00,000

• MATERNITY BENEFITS - LIMITS AND COVERAGES: Additional INR 15,000 increased for maternity
• PRE AND POST-hospitalization COVERAGE: Post-hospitalization for critical illness and accident cases
enhanced to 120 days
• HOSPITAL CASH: Hospital cash of INR 1,000 per day in excess of 7 - day admission and paid in excess of
hospitalization payable amount
• INVESTIGATION COVERAGE: Investigation prescribed by the Dr. like MRI, CT Scan, PAP Smear, EEG,
Biopsy, PET scan, Endoscopy & Colonoscopy with the limit of INR 10,000 for employee only
• AUTISM OR DEVELOPMENTAL DISABILITY COVERAGE: Autism covered for children only including
all kinds of therapy and sessions on an IPD as well as OPD basis
• INTRAVITREAL & INTRA ARTICULAR INJECTIONS: Covered up to INR 50,000 for employees
• OPD BENEFITS APPLICABLE FOR EMPLOYEE, SPOUSE, AND CHILD ONLY (OPD Consultation &
Investigation Only)
• PERITONEAL DIALYSIS Covered for all
• PROSTHETIC DEVICES: Covered for all
Sum Insured Premium Amount Excl. Tax Premium Amount Incl. Tax
Family Floater Sum Insured of INR 30,000 INR 35,400
INR 15,00,000

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

VOLUNTARY SECOND PARENT POLICY

Family Floater Sum Insured of INR 3,00,000

Married employees have the option to add second set of Parents/in-law for a Sum
Insured of INR 3 Lakhs on a voluntary basis
• Co-pay of 20% is applicable, including capped ailments
• Policy excess of INR 3,000 is applicable, and not applicable on capped ailments
• Employees don’t have the option to buy back Co-pay and Room rent enhancement & Covid wavier on this plan
• Does not cover cancer care investigation costs, done abroad for tests not available in India covered up to
INR.25,000/- per family per year
• Policy does not cover Covid-19 wavier (for parental claims, waiver of 20 % co-pay and for all other claims including
employee, spouse, children, and parents/parents-in-law claims waiver of charges incurred due to room rent
restrictions, PPE kits & consumables will be processed as per policy term). * All terms as per the base plan
• Premium inclusive of GST of 18%

Type Premium Amount Floater Sum Insured

Single Parent INR 10,366

INR 300,000
Both Parents INR 14,809

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

Covid-19
coverage medical
policy (GMC)
2021-2022

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

COVID - 19
hospitalization - Process & Pay Ability

Covid-19 is covered for positive cases within

the Available Sum Insured of the member
• Requires a minimum of 24-hour hospitalization
• For parental claims, waiver of 20% co-pay and for all other
claims including employee, spouse, children and
parents/parents-in-law claims waiver of charges incurred
due to room rent restrictions, PPE kits & consumables are
covered as per policy terms
• Parents claims are restricted up to INR 300,000 of the
available sum insured and remaining can be claimed under
voluntary top up policy, if opted

* Point 2 & top up policy is not applicable for second set of parents
**Bottom excess INR 3,000 will be deducted as per policy

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

COVID-19
Home care treatment

Home Care Treatment means Treatment availed by the Insured Person for
Covid on a positive diagnosis of Covid in a Government-authorized diagnostic
Centre, which, in normal course, would require care and treatment at a
Hospital but is actually taken at Home or Authorised Home Care Centres or
Authorised Covid Care Centres, maximum up to 14 days per incident and INR
25,000 per member, provided that:  
 
a) The Medical practitioner advises the insured person to undergo treatment
at home
b) There is a continuous active line of treatment with monitoring of the health
status by a medical practitioner for each day through the duration of the
home care treatment
c) Daily monitoring chart including records of treatment administered duly
signed by the treating doctor is maintained
d) Insured shall be permitted to avail the services as prescribed by the
Medical Practitioner. Reimbursement facility shall be offered under Home
Care expenses 
e) In case the Insured intends to avail the services of non-network provider
claim shall be subject to reimbursement, prior approval from the Insurer
needs to be taken before availing such services
f) No co-payment applicable for parental claims

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

COVID-19
Home care treatment

In this benefit, the following shall be covered if prescribed by the treating

medical practitioner and is related to the treatment of COVID:  
 
a. Diagnostic tests undergone at home or at diagnostics centre  
b. Medicines prescribed in writing  
c. Consultation charges of the Medical Practitioner  
d. Nursing charges related to medical staff  
e. Medical procedures limited to parenteral administration of medicines  
f. Cost of pulse oximeter, oxygen cylinder, and nebulizer  
g. All expenses to be claimed are on valid GST bills 
 
Exclusions:

A. Self medication
B. Self-quarantine for suspected COVID-19 
C. Diagnosed with COVID-19 prior to commencement of policy  
D. Conveyance of lab technician visiting home for sample collection

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

MEDICAL INSURANCE CLAIM

ASSISTANCE

For cashless claims assistance:

Dedicated EY Hotline : 18001239437

For all reimbursement claims assistance,

please write to us on:
Claims-related queries: [email protected]
General Queries: [email protected]

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

Group personal
accident policy
(GPA) 2021-2022

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

GROUP PERSONAL ACCIDENT BENEFIT

DETAILS
Insurer HDFC ERGO GENERAL INSURANCE COMPANY LIMITED

Policy Period April 1, 2021 to March 31, 2022

Sum Insured Graded Sum Assured

Band 1 (Rank - 65, 66, 56, 57, 58, 44) : INR 10,00,000
Band 2 (Rank - 64, 42) : INR 20,00,000
Band 3 (Rank - 63, 32, 62, 21) : INR 50,00,000

Accidental Death 100% of the Sum Insured

Permanent Total Disability 150% for the Sum insured

Permanent Partial Disability As Per the Schedule of the Policy

Temporary Total Disability 1% of Sum Insured or actual weekly salary or INR 25,000,
(Weekly Benefit) whichever is lower for 104 weeks

Medical Benefits Covered up to INR 25,000

Repatriation of Remains Covered up to INR 5,000

Modification Benefit Covered up to INR 25,000

Emergency Family Travel Covered up to INR 25,000

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

CLAIMS PROCEDURE

Claimant/Assignee notifies
On obtaining all relevant Claim Investigation and Review
HR, who in turn intimates
documents, Prudent sends within 7 days of submission of
Prudent and submits required
it to Insurance Co. who all the required documents by
claim documents within 7 days
begins processing the the Insurer
of the event
claims

Claim
Yes approved No
within 7
days

On approval, the cheque is On rejection of the claim,

sent to Employer (HR) within 3 insurer provides a valid reason
working days, from where it is for the rejection to
given to the Claimant/ Assignee HR/Claimant/ Assignee

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

EXCLUSIONS

• Service on duty with any armed force

• Insanity
• Influence of intoxicating drink or drugs
• Aviation other than as a passenger (fare-paying or
otherwise) in any duly licensed standard type of aircraft
anywhere in the world
• Nuclear radiation or nuclear weapons material
• Any consequence of war, invasion, act of foreign enemy,
hostilities (whether war be declared or not), civil war,
rebellion, revolution, insurrection, mutiny, military, or usurped
power, seizure, capture, arrest, restraint, detainments of all
kings, princes, and people of whatever nation, conditions
and qualities so ever
• While committing any breach of law with criminal intent

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

DOCUMENT CHECKLIST AND FORMS

Weekly Benefit Claims

1. Completed claim form
2. Doctor’s report
3. Disability certificate from the doctor, if any
4. Investigation/lab reports (X-ray, etc.)
5. Original admission/discharge card, if hospitalised
6. Employers leave certificate & details of salary

Dismemberment/Disablement Claims
1. Completed claim form
2. Doctor’s report
3. Disability certificate from the doctor
4. Investigation/lab reports (X-ray, etc.)
5. Original admission/discharge card, if hospitalised
6. Police inquest report, wherever applicable

* Documents list are indicative and additional documents will be called far by the insurer.

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

Group term life

policy (GTL)
2021-2022

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

BENEFIT DETAILS
Insurer PNB MetLife India Insurance Company Limited
Policy Period April 1, 2021 to March 31, 2022
Sum Insured Graded Sum Assured
Band 1 (Rank - 65, 66, 56, 57, 58, 44):3 X CTC with Minimum of
Rs 10 Lakh and max of Rs 40 Lakh
Band 2 (Rank - 64, 42): 3 X CTC with Minimum of Rs
20 Lakh and max of Rs 40 Lakh
Band 3 (Rank - 63, 32, 62, 21): 3 X CTC with max of
Rs 80 Lakh

Cover Details
Coverage The Insured Member (employee) is provided with
Comprehensive Protection coverage for life against any kind of
Death. The coverage is provided 24 hours, 7 days a week
anywhere in the world

Coverage applicable only to the 24/7, Worldwide basis

employee

Basic Life Cover & Covered up to 100% of BLC & terminal illness coverage - subject to
Terminal Illness a maximum of INR 50,00,000

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

CLAIMS PROCEDURE

Employee / Beneficiary notifies

HR, who in turn intimates Insurer Claim Investigation and
On obtaining all relevant
and submits required claims Review within 3 days of
documents, Insurer
documents within 15 days of submission of all the required
begins processing the
the event documents
claims

Claim
Ye approved No
s within 7
days

On approval, the cheque is sent On rejection of the claim,

to Client name HR within 7 Insurer provides a valid reason
working days, from where it is for the rejection to HR /
given to the Employee/ Employee/ Beneficiary
Beneficiary

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

DOCUMENT CHECKLIST AND FORMS

1. Claim form (completely filled)

2. Death certificate (original or attested)
3. Attendance record & salary slips (last 2 months)
4. Identification of deceased (Photo ID with DOB)
5. Beneficiary identification with relationship proof
6. Post-mortem report (if performed)
7. FIR (in accidental cases)

* Document list is indicative and additional documents will be called far by the insurer.

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

INSURANCE COVERAGE FOR GIG PROFESSIONAL

GMC - Modular Top-up Options

GMC GPA GTL

INR 1,00,000 INR 3,00,000  INR 3,00,000 

GMC - CONTRACT MODULAR POLICY PREMIUM

Employee contribution @
Sum Insured: INR 1,00,000
100% (INR)

With Maternity and Room

INR 2,372
rent Enhancement

Additional Premium for 1+3

INR 3,198
(Self + Spouse+ Children)

Insurer for GMC, GPA, & GTL as per the staff employees

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

USEFUL CONTACTS
Escalation Points - GDS India
Toll-free number: 1800 123 9437
Email:
Claims Related: [email protected]
General Queries: [email protected]

1st-level Escalation
Mr. Santosh Kumar
Employee Benefits Practice
[email protected]

2nd-Level Escalation
Mr. Mahendran
Employee Benefits Practice
[email protected]

Final Escalation
Mr. Anil Krishnananda
Vice President - Employee Benefits Practice
+91 90081 00753
[email protected]

For more information, please contact: [email protected]

 EY Employee Benefits Manual
Policy Period: April 1, 2021 to March 31, 2022

W W W . E Y . C O M

For more information, please contact: [email protected]