WIPRO MEDICLAIM

INSURANCE

BENEFITS MANUAL

INSURANCE
COVERAGE – GMC
(EMPLOYEE POLICY)

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Insurance Coverage – GMC
(Employee, Spouse, Children Policy)
Insurer – United India Insurance Co. Ltd.
Policy Start and End Date: 01st November 2020 - 31st October 2021
Third Party Administrator: Medi Assist India Pvt. Limited

Coverage
Parameters Base Base Plus (Top-up)
INR 200,000 INR 200,000
INR 300,000 INR 400,000
INR 400,000 INR 600,000
INR 500,000 INR 1,000,000
• Default plan offered for Wipro employees is Base Plan.
• The base sum insured will be based on the band of the employee.
Grade Default Sum Insured
Band B3 & Below INR 200,000
Sum Insured INR 300,000
Band C1 & C2
Band D1 & D2 INR 400,000
Band E INR 500,000

• Employees can Top-up during the enrolment window every year. Once the employee tops up, reduction /
opting out of top up is not allowed for 3 years. Employees can only opt for a higher top-up slab. Post
completion of three years, reduction / opt out of top up is only allowed if there are no claims in the third
year.

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 Employee + Spouse + children
Note:
Family Covered (family will be
covered till end of policy period • This is applicable for all employees in India Payroll only
in the event of the unfortunate • No Restriction on number of Children. Children who are 25 years or above will be not covered
death of the employee) • Incase employee’s spouse is also working in Wipro Covered as a full time employee, please write to
[Link]@[Link] to discontinue premium deduction for one of the member.

Policy Benefts Base Plan Top-Up Plan

Standard Hospitalization Covered
Pre & Post Hospitalization • Relevant expenses Covered (30 days & 60 days respectively)
Expenses • Refer maternity benefit for maternity related pre and post limits
Pre-existing & including Covered
internal and external
congenital Diseases
First 30 days, First Year, frst Waived off
two years and First four years
waiting periods
Ambulance Services Covered (INR 2000 per claim for Emergencies only) Covered (INR 3000 per claim for Emergencies only)
Normal Delivery: INR 40,000, Caesarian Delivery: INR Normal Delivery: INR 50,000, Caesarian Delivery: INR
40,000. Pre & Post Natal OPD expenses up to INR 5000 50,000. Pre & Post Natal OPD expenses up to INR 7500
within the Maternity Limit is covered. Maternity beneft is within the Maternity Limit is covered. Maternity beneft is
Maternity applicable for frst two live births only. Any complication applicable for frst two live births only. Any
rising from pregnancy will be covered within the limit. complication rising from pregnancy will be covered
within the limit.
New Born Baby Cover from Within the maternity limit for the normal expenses. Complications which require an admission can be processed under
Day 1 floater.
Maternity Related Covered up to full sum assured Covered upto full sum assured
Complications
Legal Surrogacy Covered up to maternity sub limit Covered upto maternity sub limit

Room Rent Limit across all INR 3500 INR 4000 for 2 and 4 lakhs top-up
cities per day(No limit for INR 5000 for 6 and 10 lakhs top up
Band E employees)

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Policy Benefts Base Plan Top-Up Plan
Nursing charges, if billed 25% of Room Rent Limit 25% of Room Rent Limit
separately upto
No Proportionate deduction Yes (Only difference in Room charges need to be borne Yes (Only difference in Room charges need to be borne
on opting for higher room by the employee) by the employee)
rent.
Co-pay on all claims 10% from the employee for admissible claim amount

Copay on day care procedure 10%

and maternity claims
Additional 2% co-pay applicable for Applicable for all claims
employees who do not pre-intimate
in case of a planned hospitalization
Co-pay for Employees dying No No
in harness.
In-vitro fertilization Covered up to INR 40,000 Covered up to INR 50,000
Oral Chemotherapy is Not Covered Covered
restricted to cancer
treatment only
Hormone Therapy is Not Covered Covered
restricted to cancer
treatment under
hospitalization including pre
and post only.
Treatment for Keratoconus No Up to INR 25,000 for employees only
Covered (INR 10,000 for surgical treatment per family). Out Covered (INR 15,000 for surgical treatment per family). Out
of this, the sub limit for Root canal treatment is INR 5,000 of this, the sub limit for Root canal treatment is INR 7,500
per tooth inclusive of cost of the crown. per tooth inclusive of cost of the crown.
Dental Treatment (Cosmetic treatment like flling, capping, scaling, polishing, dentures, cleaning & treatment of similar nature are
not payable. Detailed prescription, nature of treatment, procedures done, pre-numbered receipts are a must for dental
treatment claims. In addition, X-ray reports may be asked for if required for justifcation of admissibility of
claim.)
Domiciliary Hospitalization As per policy terms and conditions

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Policy Benefts Base Plan Top-Up Plan
Covered (Only list of select procedures like Dialysis, chemotherapy, radiotherapy and other such specifed
Day care Procedures treatments taken in the hospital/ nursing home where the insured is discharged on the same day. Refer the day
care list shared in Annexure 1).
Emergency Air Ambulance Covered for a maximum of frst 10 cases throughout the year with a limit of INR 100,000 per case in absence of
facility multi-specialty hospital in a radius of 50 KM for named ailments only.(subject to approval of insurer)
Covered (INR 5,000 per Employee). Expenses related to external aids used for mobility (like walker, crutches) upon
Mobility Extension
the prescription of the treating doctor and admissibility of the main claim.
Lasik Treatment Covered, if required for correction of power is +/- 6.0D and above. Only spherical power is admissible.
Morbid obesity Treatment for morbid obesity is covered, only if it is life threatening but not cosmetic Purpose
Ayurvedic Hospitalization is covered for treatment taken in Government registered hospital with a justifed
Ayurveda admission or in any Institute recognized by the Government and/or accredited by Quality Council of India/
National Accreditation Board on Health.
Mental ailment In-patient treatment of mental ailment. Latter should be an established ailment –genetic or non- genetic.
HIV HIV covered up to sum insured for self, spouse and children
Stem Cell and Cyber Knife Stem cell therapies and Cyber Knife treatment are covered up to 50% of the sum assured.
treatment
Cochlear Implant Limited up to default sum insured as per employee Grade
Donor Medical Expenses Covered
(Excluding Organ cost)
Genetic Disorders Not Covered Covered upto full sum insured. Only for in patient
treatement
Congenital External Not Covered Covered upto full sum insured. Congenital external disease/
Diseases defects or anomalies is not covered until it is life threatening
or impacting regular life
Pace Maker battery, DBS
battery replacement
Not covered Sublimit of INR. 3 lakhs per event.

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List of Day care procedure (For the full list please refer to the policy on myWipro >
myPolicies)
• Hemo Dialysis • Paracentesis (myringotomy) • Coronary angioplasty

• Parenteral Chemotherapy • Tonsillectomy • Varicose Vein Ligation

• Radiotherapy • Tonsillectomy with adenoidectomy • Sclerotherapy

• Surgical treatment of anal fstulas • Sinusitis
• Eye Surgery
• Dental Surgery • Surgical treatment of hemorrhoids • Hysterectomy
(piles surgery)
• Lithotripsy • Fracture/dislocation excluding hairline
• Operation on a testicular hydrocele fracture
• Tonsillectomy
• Herniotomy / Hernioplasty
• Dilation and Curettage (D&C)
• Treatment of a varicocele and a hydrocele
• Myringoplasty
• Coronary angiography
• Tympanoplasty

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 The day care list with capping inclusive of all charges hospitalization and
implant charges, irrespective of the room category is shared below.
A-class city limit B-class city limit
Ailments Surgery Type Description
(INR) (INR)
Cataract (including cost of 36000 28800
Eye surgery Clouding of vision, common in elderly people
lens)
Inflammation and infection of tonsils/adenoids, glands between 37000 29600
Tonsillectomy Throat surgery
mouth, nose and throat
Abnormal connection between two organs, generally between
42000 33600
Fistula High General surgery the rectum and vagina/rectum and urinary bladder, resulting
due to injury/surgery
General surgery 49500 39600
Fistula Low Same as above
Repair of a fissure (a crack or a tear in the lining of an organ),
39500 31600
Fissurectomy General surgery sphincterectomy is the correction of a tear on a sphincter
(muscle that helps in contraction of an organ)
Hemorrhoidectomy Surgical removal of a hemorrhoid (protrusion of the mucous 50500 40400
General surgery
(Excluding staples & tackers) lining of rectum due to constipation)
Thyroidectomy General surgery Partial surgical removal of a thyroid gland (usually done when 108500 86800
- HEMI suffering from cancer)
Thyroidectomy General surgery 50000 45000
Total surgical removal of a thyroid gland
- TOTAL

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 A procedure done by inserting a fiber optic tube into the joints to 35000 30000
Arthroscopy Orthopedics
study the nature of condition causing inflammation
Arthroscopic surgery Done to treat cartilage tears (cartilage is tissue lining the joints) 103000 82400
Orthopedics
Hydroceletomy – Removal of hydrocele (collection of fluid around testes), one side. 33500 26800
Urology
Unilateral Related to the male reproductory organ
Hydroceletomy – Removal of hydrocele (collection of fluid around testes), both sides. 35000 30000
Urology
bilateral Related to the male reproductory organ
Coronary An x-ray test done to find out the flow of blood into and out of one's
25000 20000
Angiogram Cardiology heart (basically to study the nature of blood vessels). CT Angiogram
(including dye) not payable
Hernia repair – Open (including Correction of hernia (protrusion of internal organs through weak 66500 53200
General surgery
mesh) abdominal muscles)
Hernia repair - General surgery Correction of hernia (protrusion of internal organs through weak 60000 50000
laparoscopic abdominal muscles)
Appendicectomy – open General Surgery Removal of appendix by cutting open the abdomen 35000 30000

Removal of appendix by laparoscopy (insertion of a laparoscope and

Appendicectomy - 69000 55200
General surgery removal of appendix bit by bit, requires just a small incision on the
laparoscopic
abdomen)
Cholecystectomy – open General Surgery Removal of gall bladder upon finding stone formation (by cutting 45000 40000
open the abdomen)
Cholecystectomy – laparoscopic Removal of gall bladder upon finding stone formation (by minimal 63000 50400
General surgery
invasion - using laparoscope)
Hysterectomy – Removal of uterus due to any complications 96000 76800
Gynecology
vaginal /open (by cutting open the abdomen)
Hysterectomy – Removal of uterus due to any complications 91500 73200
Gynecology
laparoscopic (by laparoscopy)

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The following ailments are capped with the below mentioned sub-limits for Top up plan.
These sub limits are inclusive of all hospitalization and implant charges, irrespective of the room category.

Base Plus Policy - Ailment Capping’s

Diseases/Ailments 2 lakhs 4 lakhs 6 lakhs 10 lakhs
Appendicectomy - laparoscopic 75,900 83,500 91,900 111,200
Appendicectomy – open 38,500 42,400 46,600 56,400
Arthroscopic Surgery 113,300 124,700 137,100 165,900
Arthroscopy 38,500 42,400 46,600 56,400
Cataract 39,600 43,600 48,000 58,000
Cholecystectomy - laparoscopic 69,300 76,300 83,900 101,500
Cholecystectomy – open 49,500 54,500 59,900 72,500
Coronary Angiogram 27,500 30,300 33,300 40,300
Fissurectomy 43,500 47,800 52,600 63,700
Fistulectomy - High 46,200 50,900 56,000 67,700
Fistulectomy - Low 54,500 59,900 65,900 79,800
Haemorrhoidectomy 55,600 61,200 67,300 81,400
Hernia repair – laparoscopic 66,000 72,600 79,900 96,700
Hernia repair – open 73,200 80,500 88,600 107,100
Hydrocelectomy - Bilateral 38,500 42,400 46,600 56,400
Hydrocelectomy - Unilateral 36,900 40,600 44,600 54,000
Hysterectomy - Lap 100,700 110,800 121,800 147,400
Hysterectomy - Open 105,600 116,200 127,800 154,700
Thyroidectomy 119,400 131,300 144,500 174,800
Thyroidectomy – TOTAL 55,000 60,500 66,600 80,600
Tonsillectomy 40,700 44,800 49,300 59,600
For planned hospitalizations employees Exclusions under Mediclaim
are requested to write to The company shall not be liable to make any payment under this policy in respect of any
policycoverage@[Link] to expenses whatsoever incurred by any Insured Person in connection with or in respect of:
get TPA clearance on coverage, check if
• Injury / disease directly or indirectly caused by or arising from or attributable to War,
the diagnosis and procedure invasion, Act of Foreign enemy, War like operations (whether war be declared or not)
recommended by doctor is covered as
• Circumcision unless necessary for treatment of a disease not excluded hereunder or as may
per policy or not be necessitated due to an accident
• Vaccination and inoculation of any kind unless it is post animal bite.
• Change of life or cosmetic or aesthetic treatment of any description such as correction of
eyesight, etc.
Enrolment of New Joinees • Cost of spectacles and contact lenses, hearing aids.
/ New Incumbents • Dental treatment or surgery of any kind unless necessitated by accident and requiring
/ Intercompany transfers / hospitalization
Onsite return • Convalescence, general debility; run-down condition or rest cure, obesity treatment and its
complications including morbid obesity, Congenital external disease/ defects or anomalies,
• New Joinees / intercompany transfers / treatment relating to all
Onsite return employees will have the
option to choose Top-up Plans • Psychiatric and psychosomatic disorders, infertility, sterility, Venereal disease, intentional
within the first 30 days self-injury and use of intoxication drugs / alcohol.
of joining. Failure to select an option, • All expenses arising out of any condition directly or indirectly caused to or associated with
will result in auto- Human T-Cell Lymph Tropic Virus Type III (HTLB I-II) or lymphadenopathy Associated
enrollment into the Base Plan with Virus (LAV) or the Mutants Derivative or Variation Defciency Syndrome or any syndrome or
default band-wise sum insured. condition of a similar kind commonly referred to as AIDS.
• Charges incurred at Hospital or Nursing Home primarily for diagnosis x-ray or Laboratory
examinations or other diagnostic studies not consistent with or incidental to the diagnosis
• New incumbents - spouse and child and treatment of positive existence or presence of any ailment, sickness or injury, for which
details need to be added within the 30 confnement is required at a Hospital /Nursing Home.
days of date of marriage, date of birth, • Expenses on vitamins and tonics unless forming part of treatment for injury or diseases as
respectively. certifed by the attending physician

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• Injury or Disease directly or indirectly caused by or contributed • Family planning surgeries are not covered.
to by nuclear weapon / materials or contributed to by or arising
• Change of treatment from one system of medicine to another
from ionizing radiation or contamination by radioactivity by any
unless recommended by the consultant/hospital under whom the
nuclear fuel or from any nuclear waste or from the combustion of
treatment is taken.
nuclear fuel.
• Change of treatment from one system of medicine to another
• Treatment arising from or traceable to pregnancy, childbirth,
unless recommended by the consultant/ hospital under whom the
miscarriage, abortion or complications of any of these including
treatment is taken.
caesarean section, except abdominal operations for extra uterine
pregnancy (Ectopic Pregnancy) which is provided by submission • All non-medical expenses including convenience items for
of Ultra Sonographic report and certifcation by Gynecologist that personal comfort such as charges for telephone, television, ayah,
it is life threatening one, if left untreated. private nursing/ barber or beauty services, diet charges, baby
food, cosmetics, tissue paper, diapers, sanitary pads, toiletry
• Naturopathy Treatment, acupressure, acupuncture, magnetic
items and similar incidental expenses.
therapies, experimental and unproven treatments/ therapies.
Treatment related like Hysterolaparscopy, ovarian drilling, • Any kind of Service charges, Surcharges, Admission Fees/
endometriosis, chocolate cyst, diagnostic D and C, experimental Registration Charges, Luxury Tax and similar charges levied by
and unproven treatments/ therapies are not covered. Treatment the hospital.
including drug experimental therapy, which is not based on
• All non-medical expenses. The list of non-medical expenses is
established medical practice in India, is treatment experimental or
available in the FAQs on [Link]
unproven.
• Treatment for Age Related Macular Degeneration (ARMD),
treatments such as Rotational Field Quantum
• Magnetic Resonance (RFQMR), Enhanced External Counter
Pulsation (EECP), etc.

Contact details | Medi Assist TPA Pvt Ltd

Dedicated Toll Free Line
1800-419-1164 Mail ID for Primary Contact
Dedicated number for cashless and emergency hospitalization wipro@[Link]
8152-850-999

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