Smart Health – Top Up Cover
 INTRODUCTION
 BENEFITS
 POLICY BENEFIT DETAILS
 COMPARISON BETWEEN INDIVIDUAL POLICY & TOP UP COVER CUSTOMISED
FOR AT&T
 ILLUSTRATION
 SUM INSURED AND PREMIUMS APPLICABLE
 NOMINATION AND PAYMENT
 FAQ
Introduces Top Up Cover for employees and family members:
 Top-up health insurance is in addition to the base Group Medical Insurance coverage
provided to all the employees. The top-up policy comes into force only when the
hospitalization expenses exceed the threshold limit which is INR 4 lakhs for AT&T
employees.
 This is an option extended to employees to opt for Top Up Cover. This Top Up cover
provides extended financial protection to the Insured and his/her family against
Hospitalization Expenses.
 This Scheme shall provide financial support for any hospitalization that exceeds the sum
insured limit provided by AT&T i.e INR 4,00,000/- to all AT&T employees. In case Sum
Insured exceeds the current limit of INR 4,00,000/- the employee can avail the balance
amount through this option of “Top up Cover” depending on the amount of top up opted
for.
Benefits:
 This is a customized health top up plan designed exclusively for AT&T employees only
and at customized and negotiated standard premium across all age groups pricing.
 Terms and conditions in line with the corporate policy covering Pre-Existing, Maternity,
Child cover etc.
 Provides financial support in case of any critical illness where the company provided sum
insured is also exhausted.
Policy Benefit Details
Standard Hospitalization
•Yes
TPA Services
•Paramount TPA
Pre existing diseases
•Yes
Maternity benefits
•Yes up to INR 50,000 in case of normal as
well as in case of C-Section (included
within total Sum Insured)
Room Rent Capping
•Single Standard AC Room
9 month waiting period
•No
Baby Day 1 Cover
•Yes
*This Policy can only be used when base Sum Insured of AT&T is exhausted.
Comparison between Individual Policy available in the market &
Smart Health Top Up Policy customized for AT&T
Smart Health Top Up Policy Individual Policy
 Pre-Existing Ailments Covered
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 30 Days Waiting Period Waiver
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1st
Year Exclusion Waived off
No Co-Payment in Claims
Room Rent capped to Single Standard
AC Room per Day
Maternity Coverage
Baby Day1 Coverage
No Age Limit for the Entry
No Disease wise Capping
Premium for 3 Lacs Sum Insured is
approx 14K
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Pre-Existing Ailments not Covered
30 Days Waiting Period Applicable
1st Year Exclusion Applicable
20% Co-Payment in Claims
Room Rent capped 1% of Sum Insured
per Day
Maternity Coverage not Available
Baby Day1 Coverage not Available
45 is the Maximum Age Limit for the
Entry
20% of Sum Insured Disease wise
Capping for Cataract, Hernia, Piles,
D&C, Hysterectomy, etc.
Premium for 3 Lacs Sum insured is
approx 20K
Illustration
 Mr. X is 35 years old, has an existing health cover of INR 4 Lakh from his employer.
 He opts for the Top Up Health plan with Sum Insured of INR 2 Lakhs
 His premium will be INR 11300/- plus Taxes.
 He undergoes hospitalization and the expenses incurred are INR 5 Lakhs
 He can claim under his employer’s medical policy INR 4 Lakh
 And the remainder INR 1 Lakh will be paid for by the Top Up Cover he opted for.
(conditions applied based on the type of room rent chosen for hospitalization.)
Sum Insured & Premium Options:
 The product is available on:
 Family Floater Basis ( Self, spouse, two dependent children up to the age of 23 years &
Parent are covered)
 The additional coverage that can be opted over and above the company medical coverage is
from INR 1 lac to INR 10 lacs. The Premium will vary according to the Top Up Sum Insured
chosen:
*
Sum Insured & Premium Options Cont..:
Sum
Insured (INR)
1 Lakh
2 Lakhs
3 Lakhs
4 Lakhs
5 Lakhs
Premium (Excludes
Service Tax) (INR)
Premium payable
includes service
charge @12.36%(INR)
10150
11300
14000
14750
15500
11405
12697
15730
16573
17416
Sum Insured (INR)
6 Lakhs
7 Lakhs
8 Lakhs
16500
17100
18000
18600
19500
18539
19214
20225
20899
21910
Premium (Excludes
Service Tax) (INR)
Premium payable
includes service
charge @12.36%(INR)
9 Lakhs 10 Lakhs
* Above mentioned Premium are on annual basis and is applicable for all Age Band in AT&T.
How to enter into the policy:
 Please click the link provided and choose the option of sum assured you would want to
opt for. (Link is www.paramounttpa.com/att_enroll)
 Please make a note of the premium that you will have to pay against the sum assured you
select.
 The Insurer will consolidate the nominations received and send the information to AT&T
and the sum assured chosen.
 AT&T pays the amount directly to United India and the premium gets deducted from
employee’s next payroll cycle.
FAQ’s:
1. Can I enter into the policy mid year?
No, you can enter the scheme only at the time of inception and it shall be later opened only for
new joiners.
2. Suppose I exhaust my sum insured of group policy and top up cover, can I increase my
top up cover sum insured by paying extra premium mid year?
No, you cannot increase the sum insured midyear.
3. What happens to the policy at the time of leaving:
You have two choices.
A) You can either quit from the policy and the refund shall be paid by United to you on prorata basis provided you have not claimed within this year.
B) You can convert this into your individual base policy by adjusting the refund amount. Please
connect with Emedlife team to know more details on the premium.
FAQ’s:
4. Will I get discount on Premium at next renewal if don’t claim ?
All discounts are subject to total Group Claim Ratio.
5. Can I enter into the policy mid year?
No, you can enter the scheme only at the time of inception and it shall be later opened only
for new joiners.
6. Suppose I exhaust my sum insured of group policy and top up cover, can I increase my
top up cover sum insured by paying extra premium mid year?
No, you cannot increase the sum insured midyear
7. Who do I contact in case of any clarifications or Claims?
Emedlife Team
FAQ’s:
8. Will I get Tax Benefit?
Yes, United India will issue Tax Certificate to all employees who will take this policy.
9. Who will be TPA and where should I find Network Hospital List?
Paramount TPA remains the same and updated list can be found on
www.paramounttpa.com
10. Maternity claims will be paid in Top Up Policy or not, if an Employee exhaust his
limit of 50K in AT&T Policy?
Yes, the balance payment will be done by the top up cover upto a limit 50k.If Maternity
expenses goes beyond 50K, Employee needs to submit original payment receipt.
Emedlife SPOC will take care rest of the process.
11. Can I add/ change more dependents?
No, the dependents covered will be the same as per base policy provided by AT&T.
Thank you !
Please contact in case of further clarifications to
Mr. Vijay Kumar
+91 9810269429
[email protected]
Mrs. Ruchi Nandi
+919811419257
[email protected]