Knowledgebase: TiE Suraksha - FAQ's
TiE Suraksha - FAQ's
Posted by Deepak Mendiratta, Last modified by Deepak Mendiratta on 27 November 2020 12:51 PM

TiE Suraksha

Frequently Asked Questions

Program Advantages

  • Benefits of this plan 
    • This plan is specifically crafted for members of TiE - existing and new ( click here to become a new member of TiE - Delhi NCR ). You need to be a member to avail the advantages under this plan
    • This plan comes with the following benefits to you :
      • No Medical tests, typical forms to be filled  or declarations to be made to become a part of this policy  
      • This plan Does Not have any waiting periods for you to avail of the benefits in most plant-types. You are covered from the moment you make a payment and fulfil the eligibility criteria
      • Parents Coverage - Unlike the challenges you face in getting parents cover in the retail market, this plan offers coverage for your parents without any questions
      • Affordable costs - entire family coverage with incomparable benefits versus retail products and at negotiated rates. A startup or a smaller organisation will get the advantages of large group discounts without any underwriting checks which are typical for a smaller company. 
      • Access to the best hospitals across the country on a Cashless basis

Eligibility

  • Construct of the policy - Organisations with less than 7 employees will become a part of the TiE Master policy. Those with more than 7 employees will be given a policy directly in the name of the company directly by the insurer at the same rates
  • What constitutes a company eligible under this plan - 
    • Any entity with a GST certificate mentioning the nature of the entity as a Private Limited, Public Limited, or Proprietorship will be eligible. Individuals at this time will not be covered until the roll-out of the 2nd phase of this plan.
    • If the GST number is recently changed from individual to proprietorship, private limited, or public limited, you will be eligible for availing membership benefits under this plan 
  • Active members -  This program is available for all active members of TiE. This list has been provided to the plan administrator and will be updated on a monthly basis.  In case a member has taken a plan and does not renew the TiE membership, the insurance coverage will be canceled for that member. This is a legal requirement as per policy construct and guidelines. 
  • Principle of Equal Benefits  - this means that as an organisation you will have a choice of opting for any one of the 3 plan types. Whichever plan you choose, will be applicable to all members and will remain constant through the tenure of the policy. To keep the administration simple and due to construct of this cover, different plans for different employees will not be possible in the same organisation. At least not at this point in time 
  • Plan 3 which covers parents, is available to any organisation where the total number of lives ( including employees, spouses, children, and parents, exceeds 150 ). In case you are yet not meeting these criteria, kindly get in touch with us separately using this Link

Plan Features

  • Does this insurance have only one standard plan for purchase?
    • The insurance program has multiple plans for purchase. Please browse the table below for more details. 

Scope of Coverage:

Plan-1

Plan-2

Plan 3

Family Definition

Self only

Self + Spouse + 2 Children

Self + Spouse + 2 Children up to the age of 25 +Dependent Parents/in-laws

Sum Insured

2 lac/3 lac/5 lac

2 lac/3 lac/5 lac

2 lac/3 lac/5 lac

Sum Insured Type

Individual

Family Floater

Family Floater

Age Limit

18 to 55 years

1day to 55 years

1 Day to 80 Years

Pre Existing Diseases/condition

Not Covered

Covered

Covered for Employee Spouse and children. For parents covered after 1 year. Co payment on parents claims @ 10%

First 30 days waiting period

Applicable

Waived off

Waived off

1yr / 2 yr / 4 year exclusion

Applicable

Waived off

Waived off

Maternity Limit

Not covered

50,000 INR for the first 2 children

50,000 INR for the first 2 children

Maternity waiting period

Not covered

9 months

9 months

Newborn Baby Coverage

Covered from Day 1

Covered from Day 1

Covered from Day 1

Pre & Post Hospitalisation

30 day - 60 days

30 day - 60 days

30 day - 60 days

Disease wise capping

Default

No capping

No capping

Room Rent

1% of SI for Normal and 2% of SI for ICU. Proportionate deduction applicable

Single standard AC room for normal and no capping for ICU. Proportionate deduction applicable

Single standard AC room for normal and no capping for ICU. Proportionate deduction applicable

Ambulance charges

Not Covered

Not Covered

Covered up to INR 1,000 per claim

Sum Insured / Premium

Premium (excluding GST )

Per Person

Per Family

Per Family

200,000

1,245

4,410

23,470

300,000

1,310

5,355

28,770

500,000

1,730

7,565

39,450



  • What is the name of the Insurance company?
    • There are multiple insurers we have worked with for launching this plan. The participating insurers are  amongst the top brands in the country 
  • Is there a minimum number of employees needed for this insurance? 
    • There is no minimum requirement of the number of employees required for enrolment in the policy 
  • Will my claims be reimbursed even if I do not get myself treated at a hospital?
    • All health insurance policies will pay for expenses incurred towards the treatment of any specific illness/sickness which requires hospitalisation. Admission in a hospital for a minimum period of 24 hrs is mandatory for any claim from the policy. However, this condition is waived under certain procedures which are called “Daycare procedures” where the expenses are paid even if there is no hospitalisation.
  • Are treatment expenses for Covid-19 covered in this insurance?
    • Yes. Medical expenses incurred for covid-19 treatments get covered in this insurance. Hospitalisation in a hospital is mandatory. Home containment expenses for covid-19 does not get covered under this plan. 
  • Does this insurance cover Pre-existing diseases/conditions and standard waiting periods? 
    • The typical waiting periods include
      • 30 days waiting period  -  except for accidents,  in a standard policy, no coverage is available for the first 30 days. This  is not applicable for Plan 2 and Plan 3
      • 1st  Year / 2nd Year waiting period - certain designated treatment or ailments are not covered for this period viz Cataract, Hernia, Hysterectomy, Fistula, Piles and Stone removal - this waiting period is waived off for Plan 2 and Plan 3  - for this everything will be covered from  day 1
      • Pre Existing Disease / Conditions waiting period - Typically applicable for 3 years or 4 years. this waiting period is waived off for Plan 2 and Plan 3  - for these everything will be covered from day 1. In Plan 3, for parents, there is a waiting period of 1 year for pre-existing diseases. 
    • Plan 1 - Waiting periods are applicable.
    • Plan 2 - All waiting periods are waived off, except for maternity which has a waiting period of 9 months. This means if a covered person gets pregnant on or after taking the policy, with the gestation periods of  9  months, the claim will be paid. Hence, anyone pregnant as on the date of taking the cover, will not be eligible for the maternity benefits.  
    • Plan 3 - No standard waiting periods, except for Pre-existing diseases and conditions for dependent parents which are covered after a waiting period of 12 months. 
  • Is Maternity covered in this insurance? 
    • Plan 1 -  Maternity expenses are not covered.
    • Plan 2 -  Maternity expenses are covered up to INR 50,000/- 
    • Plan 3 - Maternity expenses are covered up to INR 50,000/-  
  • Can I cover my family members under this insurance? 
    • There are three plans that you can select from: 
      • Plan 1 - Available only for employees. 
      • Plan 2 - Covers for the employee, spouse, and up to 2 children. 
      • Plan 3 - You can cover your entire family members including dependent parents only. 
  • Can I buy this insurance for more than 12 months? 
    • No. The policy is annually renewable and valid only for a maximum period of 12 months.
  • Who will receive the claim amount?
    • The insurance plans cover expenses for both cashless and reimbursement claims. Cashless claims are paid directly to the hospital by the insurer. Reimbursement claims are paid to the employee directly through an electronic transfer. In the event of the death of the employee, then the claim will be paid to the beneficiary/legal heir of the employee. 
  • Are there any sub-limits/copayments in the policy? 
    • There is no co-payment on claims in any of the plans. However, Plan 1 has sub-limits for specific diseases and room rent. Other plans allow you unrestricted access to a Single standard AC room 
  • I have only myself to cover in Plan 2 - will I need to pay the entire premium - To keep the administration of the policy simple, the premiums have been normalised across all types of family composition. In case you are to get married during the tenure of the policy, you will not be charged an additional premium. The same goes in case a married couple has a child during the policy tenure. Just upon intimation, they will  get added to the policy
  • I am unmarried and want to cover my parents - in this case, you will be eligible for  Plan 3.  
  • I have a single parent, will I get a discount - As mentioned above, these premiums have been normalised across various combinations of parents - hence you will need to opt for the standardised plan 3 

Enrolment Process & Claims Process 

  • How will eligibility for this plan be confirmed  -  TiE Delhi-NCR has provided a list of all active members. Only those members will be eligible for coverage
  • How do I enroll in the insurance program?
    • Enrollment is the process of getting your employees and their dependents to sign up for the insurance. You have a window period of 45 days from the plan launch date to get enrolled in any of the plans under this program. 
    • We will provide you with the online link for uploading the employee’s database which then will let you know the premium. You can then remit the premiums online. You will also provide the GST details to confirm that the company is either a proprietorship, private limited, or public limited. 
    • Your coverage will start from the date you provide the employee details and make the premium payment or any other designated date. 
    • You and your employees will be provided with individual login Ids
  • Can I add family members to the plan after I have purchased the policy? 
    • Yes.  However, these additions during the midterm will be restricted to natural additions ( newlywed spouse, or newborn baby). You cannot add dependent parents midterm of the policy. 
  • What is the claim process under this insurance? 
    • Both cashless and reimbursement claims are paid under this insurance. The insurer has a wide network of hospitals across India for cashless settlement of claims. Reimbursement claims will be paid within 30 days of submission of all documents. 
  • Will I get health cards for cashless treatments? What are the conditions for cashless claims?
    • Every individual member who is enrolled in the insurance will get an electronic card (cashless health card) that can be used at hospitals for availing cashless treatments. However, cashless treatments are possible only in a network of hospitals. If you take treatment in a non-network hospital, you can only take reimbursement of the claim. 
  • I am a single employee organisation and only want to cover myself - We welcome you to take either Plan 1 or Plan 2. The premiums in plan one are only for Self while in Plan 2  you will need to pay the premium as per the family rates. We know this is inflexible for now but to keep the administration manageable, we have to keep it this way as we launch
  • I already have a health insurance policy. If I purchase, can I claim from this insurance as well?
    • In case you have more than one policy, either a personal cover or coverage through a spouse insurance plan, you can always claim under both policies. This claim typically takes care of unpaid bill amounts due to capping in some policies. Such amounts will be either unpaid due to room rent capping, treatment capping for example in Maternity claims. In any event, the amount claimed from all polices cannot exceed your overall cost of the hospital bill
  • Are Outpatient expenses (OPD) covered under the plan? 
    •  In case of hospitalisation under the policy, all Outpatient expenses - 30 days before the date of admission and 60 days after the date of discharge, related to the main hospitalisation will be paid. Stand-alone OPD charges are not covered in these highly cost effective plans.
  • Taxation benefit - In case the premiums are being recovered from the employee’s salary, you will need to mention that on Form 16. In which case, individually the employees can take advantage of tax benefit under section 80D
  • List of Network Hospitals where Cashless is available - Do read this article 
  • Same Day Surgeries - Day Care Treatment - Yes, they are covered. Typically the policy says that all such treatments which took 24 hours or more but due to technology advancements can now be done in  less than 24 hours, they will also be covered. These are also called day care treatments
  • Special Service Benefits - Eyes, Dental Care, Skin - Anything which arises out of any illness, injury or disease that requires hospitalisation for 24 hours will be covered. Normal checkups for  eyes, dental etc will not be covered on stand alone basis 
  • No Claim Bonus. -This feature. is typical of retail health insurance plans. Since this is a group plan, NCB is not available 
  • Claim Process and Dispute Resolution -  Our experience suggests that claim disputes often arise due to pre existing disease and its interpretation, whether the hospitalisation was required for 24 hours or not etc. There are standard processes involved here and most plans cover pre existing, so we feel  such  disputes  may be minimal if any.  While PlanCover.com will provide all support for claims, in the. event there is still  an unresolved matter  for  you, we will also  guide  you  for  a formal claim dispute mechanisms  -  whether it be via ombudsman, consumer courts or the grievance cell of the insurer and IRDAI


Portability of Group Health Insurance to Retail Health Insurance Plans
For various reasons people exit group plans. The most common reason is leaving the organisation which is enrolled into these plans. If such an event was to happen, the employee ( and covered members in the family ) have an option of seeking portability. Portability of health insurance allows for an individual to take coverage under a new plan and get credit for the time he or she has spent earlier under a different policy. These credit go towards waiving off the waiting periods that are there in a retail policy. Under this plan any member leaving the group can avail portability benefits. This will however, be following the policies laid down by the insurer for portability cases and aligned to the IRDAI guidelines on portability.
Our team will be more than happy to have this be organised for you. Just raise a ticket on this platform. 

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