Frequently Asked Questions Related to Insurance

Hospitalization Claims Reimbursements

1. What is Group Mediclaim Insurance Policy?

Group Mediclaim Insurance Policy is a health insurance taken by Wipro on behalf of its
employees under a group insurance program that covers in-patient hospitalization expenses,
subject to certain exclusions, co-pay and limits. To avail this insurance, the hospital stay should
be for a minimum period of 24 hours with active line of treatment. However, there are some
ailments that are covered under the policy even without 24 hours’ hospitalization (day care
treatments). You can contact the TPA (Vidal Medcorp) help desk or customer care numbers
given on the last page for further clarification.

2. Who is my Insurance Company (Insurer)?

United India Insurance Company Ltd (UIIC) is the Insurer who will be providing medical insurance
coverage to Wipro employees and their dependents (if enrolled).

3. Who is my TPA?
Vidal Medcorp Insurance TPA Pvt. Ltd is your service provider - Third Party Administrator (TPA)for the
policy year 2021-22. The TPA facilitates administration of employees Medi-claim Policy (Medical
Insurance) and assists you by providing quality health care. It is not an insurance company; it acts as a
liaison between Wipro and United India Insurance Company Ltd for claims settlement

4. What are the key services for which the Vidal portal/app is to be accessed? The Vidal Health
portal/app can assist with the following services-
a. View and Download network list of hospitals
b. Use e-cashless for pre-authorization
c. Submit your Reimbursement Claims for hospitalization
d. Track claim status for cashless and reimbursements
e. View and Download E-cards for self and dependents

5. Where are the claims from policy year 2020-21 to be submitted?

Any Claims pertaining to previous year policy (2020-21) should still be redirected to Medi Assist only.
In case of hospitalization overlapping between current (2020-21) and next policy year (2021-22), the
date of admission will be the criteria for the policy year. Any hospitalization on or before October 31,
2021 will be paid as per eligibility and balance in the policy year 2021-22.

6. Where are the physical copies of the claim documents to be submitted?

Hardcopies of the claim documents can be sent to the following address. Please write your name,
employee number, corporate name as (Wipro) on the envelope that is couriered.

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 Vidal Health Insurance TPA PVT LTD
Maruthi Industrial Estate
2nd Floor, Phase 1, SY No. 135/1, Unit 3
Rajapalayam, Hoodi, Bangalore – 560048

7. What expenses are eligible to be covered under Group Mediclaim policy?

• Expenses for hospitalization are payable only if a 24-hour hospitalization has been taken with active
line of treatment to the patient. Any hospitalization for diagnosis, investigation, observation or oral
medication is not covered under the hospitalization policy.
• OPD expenses are not covered.
• Only in-patient and specific daycare procedures are reimbursable as per sub-limits defined under day
care list. Please refer to the policy document on myWipro > My Policies > India > My Financials > Group
Mediclaim Insurance Policy for detailed list of ailment sum limits and day care procedures.
• Pre & Post Hospitalization Expenses - Relevant Expenses Covered (30 days pre hospitalization & 60 days
post hospitalization respectively)
• Dental – Root Canal Treatment is covered under Insurance. X-ray reports are a must.
• 10% Co-pay is applicable on all cashless claims. Additional 5% co-pay will be charged on reimbursement
claims.
• Non-medical expenses are not covered under the policy and needs to be borne by employee.
8. What are the key highlights for policy year 2021-22?
Key changes/highlights are as mentioned below. For details please refer to the detailed policy
document on myWipro > My Policies > India > My Financials > Group Mediclaim Insurance Policy

Applicable policy Change Description

All employee Ailment Cap removal Ailment caps removed from all ailments, except
Mediclaim plans for maternity, dental and cataract

All employee Same Sex cover Employees can choose to cover same sex partner
Mediclaim plans in their GMC SI

All employee Day care procedures Additional day care procedures as mentioned in
Mediclaim plans the policy

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 All employee Advanced procedures Advanced Treatment / Procedures covered as
Mediclaim plans mentioned in the policy

All employee No Active Line of Cover for emergency cases with no active line of
Mediclaim plans Treatment treatment upto INR 15,000 (for employee only)

All employee Non-Medical Expenses PPE Kit, Gloves, Mask and such other similar
Mediclaim plans (NME’s) expenditure - 15,000 per person

All employee Rehabilitation Rehabilitation expenses following a major

Mediclaim plans Expenses illness / injury (Employees only). Sub limit of
INR 50,000. Up to 90 days beyond post
hospitalization period

9. What is active line of treatment?

Active Line of Treatment is a continuous medical treatment provided by a medical practitioner to a

patient suffering from a specific ailment under life threating situations. Tests and diagnostics of all kinds
with or without hospitalization for <24 hrs or > 24 hrs would not be considered as active line of
treatment.

10. What is the validity of the group mediclaim policy?

Your policy is effective from 01-Nov-2021 & ends on 31-Oct-2022. The details of GMC
Policy are available in myWipro - myWipro ► App Store ► Information ► My Policies ►
India ► My Financials ► Group Mediclaim Policy

11. I am a new joinee, what am I expected to do to cover myself under Mediclaim insurance coverages?

Once an employee joins, they get 30 days from DOJ to update their dependent details in My
Wipro > My data > Personal Details > Family Details section. Additionally, they need to complete
Group Insurances enrollment for the below mentioned policies within the same timeline. Path is
myWipro > My Benefits > Group Insurance

 Group Mediclaim Insurance Policy (GMC)

 Group Term Life Insurance (GTL)
 Group Personal Accidental Insurance Policy
(GPAI)
 Voluntary Parental / In Laws Group Mediclaim
Insurance Policy

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• Once the enrolment is completed in the system, a temporary E-card will be available within first 60
days from joining for self & dependents from myWipro >> My Benefits >> Group insurance . The same
path will route you to the Vidal portal for downloading the permanent E card for the current policy
year.

• Please note that if you do not update your dependents within the 30 days’ period, then they will not
be covered under insurance for that policy period. Children 25 years and above are not covered in the
GMC policy. There are no exceptions to this rule.

• Please note that no changes in dependent enrolment are allowed till the next policy year.

12. How to add dependents in the middle of the policy period under my group insurance?
Spouse and child details should be added within the 30 days of date of marriage, date of
birth, respectively. Remember to declare your marital status and family members at
Mywipro > My Data at the time of a life changing event like marriage, child birth etc. Please
note that no changes in dependent enrolment are allowed till the next policy year. This also
includes if you are divorced or separated.

13. Can I cover my same sex partner in my mediclaim policy? What is the process?
Yes, you have the option to cover your same sex partner under your Mediclaim policy.

• To cover same sex partner: add your partner details under myWipro > My Data > Additional
Family Details > Under Relation please choose ‘Registered Partner’ and put other details.
Once you log into the Group Insurance portal (path given below), your partner details will be
visible, post submission of self-declaration partner will be covered.
• You can cover either your spouse or same sex partner. Both cannot be covered at the same
time. Sexually Transmitted Diseases (STD’s) are not covered in case you cover your same sex
partner.
• Gender re-assignment is not applicable for the partner, is only applicable for employee as
per policy terms and conditions.
• Adding of same sex partner is only permitted during the enrolment window.

Please read all terms and conditions in the policy (myWipro > My Policies > India > My
Financials > Group Mediclaim Insurance Policy) carefully before opting for same sex cover.
14. Is there any restriction on the age of dependents under this policy?
Dependent Children are covered up to 25 years of age can be covered.

15. Where can I see details of premium deduction?

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 No of units* (only spouse and/or same sex partner and/or children) is considered basis the
information updated by you in myWipro under myWipro >> App Store >> Information>>
My Data >>
Personal Details. The premium is deducted from monthly payroll based on the no of units
(only spouse and/or same sex partner and/or children), your plan and sum insured and
mentioned in the pay-slip.

*one unit=one individual life.

16. What is Family Floater policy?

Family Floater is one single policy that takes care of the hospitalization expenses of your entire
family. The policy has one single sum insured, which can be utilized by any/all insured persons in
any proportion or amount subject to maximum of overall limit of the policy sum insured.

14. Do I have the option to increase my sum insured by taking a top-up? What are the options
available? How is the premium deducted?
Yes you can increase your base sum insured by taking a top-up by paying a nominal premium. You
can enhance your SI by taking top-ups of INR 2 lakhs, 4 lakhs, 6 lakhs and 10 lakhs. Band AA
employees in DOP have the option to take INR 2, 4 and 6 Lakhs top-ups only.
The premium for the top-up will be deducted in equal monthly installments basis your selection on
the myWipro > Group Insurance portal. You have the option to make the payment in 1/2/3
installments.

15. From when is the top-up effective?

Top-up selected by you will only be effective from the date it has been successfully submitted on
myWipro> Group insurance>Group Mediclaim Insurance.

16. Do I have to pay to hospital even when I avail cashless treatment?

Insurance policy covers medical expenses that are reasonable and necessary. However,
nonmedical expenses (NME) shall not be payable under most health insurance policies. You may
have to pay in situations if you have availed a room that is higher than the room category you are
eligible as per your policy in which case you would have to bear differential room rent cost.

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 17. What if a hospitalization is overlapping in two policy periods?
In case of hospitalization overlapping between current (2020-21) and next policy year (2021-22), the
date of admission will be the criteria for the policy year. Any hospitalization on or before October
31, 2021 will be paid as per eligibility and balance in the policy year 2021-22

18. What is Co-Payment? Is Co-Payment applicable in this policy?

A co-payment is a cost-sharing requirement under a health insurance policy where

policyholder/insured person will bear a specified percentage of the admissible costs. Co-payment of
10% will be applicable for the cashless claims by employee, spouse, child/children. The co-payment is
applicable on the total admissible claim amount, pre and post hospitalization for himself or any other
family member (covered in the Policy) till the policy is expired.

There will be an additional 5% co-pay (in addition to the 10% co-pay) for employees who avail
reimbursement.

19. Is non-medical expense covered under the policy?

Your health insurance policy pays for reasonable and necessary medical expenditure. Of the amount
claimed by you, admissible (medical) expenses shall be payable. Non-admissible expense (non-medical
expense) shall not be paid under insurance and needs to be borne by employee.

20. What are pre & post hospitalization expenses & for how many days can they be claimed?

Pre Hospitalization expenses are the medical expenses incurred 30 days prior to date of
hospitalization of the insured person/patient. This implies that the pre hospitalization should be
followed by hospitalization >24 hours with active line of treatment. Also, medical expenses incurred
should be incurred for the same condition for which the Insured Person’s Hospitalization was
required.
Post Hospitalization expenses are the medical expenses incurred immediately after the insured
person/patient is discharged from the hospital. Such medical expenses are incurred for the same
condition for which the insured person’s/patient’s hospitalization was required and the inpatient
hospitalization claim for such hospitalization is admissible by the insurance company till 60 days from
Date of discharge.

21. I already have an individual Medical policy for me and my family and I do not want to have a
Mediclaim deduction in Wipro. How to discontinue?

Since this is a group plan employees are not allowed to opt out of this benefit
22. I am back from Onsite Assignment and I had opted out of India coverage when I travelled Onsite
and now want to have the Insurance coverage for my family in India. What is the process and
whom should I contact?

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You get 30 days from your date return or FTR closure, whichever is latest to enroll yourself and your
dependents in the insurance coverage. Incase if you have any query, please contact the HRSS
Integrated Contact Centre by raising a ticket via helpline.wipro.com or call the Toll Free No 1800 266
6867

23. I have had an inter-company transfer; how many days will I have to opt for insurance cover?
Your Top-up cover gets mapped in case of an inter-company transfer and vice versa

24. My spouse is working in DO&P. can I have the mediclaim deduction done from my spouse
payroll.

If one employee is in DO&P and the spouse is in in WT, at the same/different band, premium will be
deducted from the employee in WT. Both employees should declare that their spouse is working for
Wipro in myWipro> My Data section.

25. My spouse is also working in Wipro. Can I have the mediclaim deduction done from my spouse
payroll.

Premium will be deducted from employee at a higher band, if both employee and spouse are part
of this policy. Premium will be deducted from either one of the employees, if both employee and
spouse are part of this policy and are in the same band. The employee from whose payroll
premium is deducted will be the primary beneficiary.

26. If I opt-out of top-up this year, then can I opt out-in next year?

Top-up will be applicable only from the date it has been submitted on myWipro. The top up plans
have a three-year lock-in period. On completion of 3 policy years in the top-up, you can
optout/change only during enrolment cycle provided you have not made a claim in the last policy
cycle.
In case you opt-out of top-up, you cannot enroll for one policy year. In case you choose to continue
in the top-up (same or reduce or increase), then you have to stay locked in for another 3 policy
years. In case you have made a claim in the last policy year you have to mandatorily stay in the same
top-up for one more policy year.

27. What if I did not get the auto generated mail after opting in for mediclaim top-up?

If your top-up has been successfully submitted, then you will get an auto generated confirmation
mail. In case you do not receive the same, please check myWipro again to see if your request was
submitted or not. If not, try and submit it again. If yes, please raise an HRSS ticket to resolve the
issue.

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 28. How could we undergo hospitalization for myself or my dependents with the help of
insurance?

Hospitalization can either be availed as Cashless – if the hospital is within network of Vidal MediCorp
or Reimbursement – if the hospital is outside the network of Vidal MediCorp.

29. How can I avail “Cashless Hospitalization” in Vidal MediCorp Network Hospital for myself or
my dependents?

• List of network hospital can be taken from the Vidal Medicorp portal
• Please carry the E card of the patient along with any ID proof.
• At the TPA counter next to the billing section in the hospital, ask the representative to raise the
request to Vidal MediCorp for cashless hospitalization.
• On the day of discharge, the final bill with all the tests reports and other documents needs to be
sent by the hospital to Vidal MediCorp. The TAT for Vidal MediCorp is 3 hours to approve the
cashless hospitalization.

30. How can I avail “Emergency Hospitalization” in Vidal MediCorp Network Hospital for myself or
my dependents?
• List of network hospital can be taken from the Vidal MediCorp portal.
• Incase if you do not carry the e card on emergency admission, please inform the TPA counter at
the billing section of the hospital that you are covered under Wipro mediclaim policy and the
Vidal MediCorp is your TPA and you can still get the cashless facility.

31. How can I avail “Planned Hospitalization” or “E Cashless Hospitalization” in Vidal MediCorp
Network Hospital for myself or my dependents?

• List of network hospital can be taken from the Vidal MediCorp portal.

• Pre-authorization or E-Cashless requisition can also be raised by logging in to the Vidal MediCorp
portal , which is available in all Vidal MediCorp network hospitals.

• Submit doctor’s prescription online and select the dates of hospitalization. Pre-approval will be
provided by Vidal MediCorp.

32. How can I reimburse my medical claim under insurance for myself or my dependents?
In the event of an insurance claim reimbursement, you would be required to furnish the following
for or in support of a claim. Please note that all original documents are required to be submitted
in original as photo copies are not accepted.

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a) Duly completed claim form
b) Bills, corresponding receipts and discharge certificate/card from the Hospital

c) Bills from Chemists supported by proper prescription.

d) Test reports and payment receipts.

e) With the claim documents you are required to fill NEFT details in the claim form and give
cancelled cheque and the payment will be credited in your account.
For any claims, please use the claim form available in myWipro ->Finance > My Medical claim -

>Insurance. You will need to fill the form and take a print and drop it with all the supporting
documents in HRSS Drop box in your respective location.

33. How do I get update on the status of reimbursement claim?

As soon as the claim documents are received by Vidal, an acknowledgment mail with the details of
claim reference number is triggered to employee, which can be used for further reference.

You can track your claim by logging in My Wipro->Finance->My Medical Claim-> Insurance -> Claims
History.

34. What happens to my coverage when I decide to move out of Wipro / resign?

Coverage for Employee & the dependents will cease to exist on the last day of the month of exit.
However, employee who makes a claim (partial cover or full cover) and then exits in the same policy
cycle, will have to pay the premium for the remaining months in the policy year through the full and
final settlement.

35. I have resigned from Wipro, however, I would like to continue with my mediclaim insurance
policy. What should I do?
Please drop a mail to wipro.insurance@marsh.com to assist you with portability option.

36. Policy coverage is applicable even when the enrolled member is hospitalized outside India?
No, this coverage is not applicable when the enrolled member is hospitalized outside India.

37. What are the exclusions under the Policy?

Exclusions from policy - Dental treatment or surgery of any kind unless necessitated by accident
and requiring hospitalization , Convalescence, general debility; run-down condition or rest cure,
obesity treatment and its complications including morbid obesity, Congenital external disease/
defects or anomalies, treatment relating to all psychiatric and psychosomatic disorders, infertility,
sterility, Venereal disease, intentional self-injury and use of intoxication drugs / alcohol, medical
tests conducted for establishment of genetic and non genetic mental ailment and genetic mental
ailment expenses, family planning surgeries, cosmetic treatment, Cirrhosis due to alcohol

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38. Is genetic mental ailment covered in the policy?
In-patient treatment of mental ailment. It should be established ailment – whether it is genetic or
non-genetic. If it is genetic, then policy does not cover the expenses. If the mental ailment has
been established as non- genetic, only then it is covered under the insurance policy.

39. Is Ayurveda treatment covered under this policy?

For Ayurvedic Treatment, expenses are admissible only when the treatment has been taken in a
Government Hospital or in any Institute recognized by the Government and/or accredited by
Quality Council of India/National Accreditation Board on Health

40. Are alternative treatments like Homeopathy, Naturopathy, Unani, etc. covered under this
policy?
Treatment under Naturopathy, Unani and other experimental therapies are not covered.

41. Is weight loss program covered?

Weight loss program is not admissible under the policy terms and conditions. However,
treatment for morbid obesity is covered in case it is life threatening but not for cosmetic
purposes.

42. Is planned termination of pregnancy due to personal reasons covered?

No, termination of pregnancy due to personal reasons shall not be covered.

43. Is doctor advised medical termination of pregnancy owing to complications covered?

Termination of pregnancy due to complications and recommended by experts is covered under
the policy. However, final decision on the admissibility of the claim will be done after scrutiny of
documents.

44. Is surrogacy covered under my GMC plan?

Yes, if the surrogacy is legal it shall be covered up to maternity sub limits post scrutiny by insurer.

45. I have got 3 children. Do I get the coverage for all my three children OR is it restricted?
All your children will be covered under this policy. However, the maternity expense benefit is
only available for first two live births.

46. What are the critical illnesses covered under the policy?

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The policy covers the below listed Critical Illness only for the employee-
 Cancer of specified severity
 First Heart Attack
 Coronary artery surgery open chest (CABG)
 Heart valve replacement
 Coma of specified severity
 Kidney Failure
 Stroke resulting in permanent symptoms
 Major organ/Bone marrow transplant
 Multiple Sclerosis
 Motor Neuron disease with permanent symptoms
 Permanent paralysis of limbs
It is applicable for the employee only. The Policy covers critical Illness for a Sum Insured of INR
200,000 only for Employees.

• The Benefit under this clause is in addition to the Floater Sum Insured applicable to the
Employee.
• The cover is not applicable to the Employee’s Spouse or Children.
• The insured must survive at least three months after commencement date of insurance and 30
days after the diagnosis of the ailment for the cover to be become payable by the insurer.

47. Can I get tax exemption on premium paid for medical insurance for my family members?

Yes, you can claim tax exemption for the premium paid by you towards medical insurance for
your family members under Section 80D.

48. Do I get back my original reports in case required for further treatment or in case of critical
illness or for follow-up?
Original reports can be returned to you only with the concurrence of the insurance company.

49. If I go for a sabbatical will I be covered under Wipro’s GMC plan? And can I take a top-up?
While on sabbatical you are not covered under Wipro’s GMC plan and cannot take a top-up. You
will be covered once you resume work and can opt for top-up within 30 days of joining back.

50. In case I want to get a Lasik surgery done, will both cylindrical and spherical combined power be
considered?

No, in case of Lasik surgery only spherical power is considered.

51. Who is my first point of contact in case of a claim or query?

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 Queries Contact Point Contact phone Contact email id
(24/7 support)
Claims intimations TPA-Call center 18604250260 / wipro@vidalhealthtpa.com
/ clarifications 08046267062
Pre-intimation, TPA-Call center 8046267063 wiprointimation@vidalhealthtpa.com
Cashless
Escalation Level 1 Swati, Divya 8951944631, wiprohelp@vidalhealthtpa.com
8951944633
Escalation Level 2 Mohammed 8792922260 mohammed.nyamathulla@vidalhealthtpa.com
Nyamathulla
Escalation Level 3 Mallikarjun Rao 9606934104 Mrao@vipulmedcorp.com

For any policy related queries, employees can raise a helpline ticket in HRSS category / Call
18002666867

52. Can I get ‘hospital discount’ reimbursed if I go for reimbursement in a network hospital?

If an employee opts for treatment in a hospital which is in the TPA network list of hospitals, then
the payment mode opted should be cashless. We strongly advice against selecting
reimbursement in place of cashless in a network hospital as a payment mode. In an event for
any reason whatsoever, the employee has to select reimbursement mode in a network hospital,
then there may be a charge under the header of ‘hospital discount’ which will be deducted from
your final reimbursed amount. This hospital discount value covers the difference in agreed
tariffs between the hospitals and TPA for cashless and for non-cashless payment mode. Hence,
to avoid having to pay the hospital discount out of pocket, we advise you to opt for cashless in
place of reimbursement in a network hospital as a payment mode.

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