Medical

VMware provides a comprehensive Health Insurance through National Insurance Co. Ltd. The Third-Party Administrator is Family Health Plan TPA Ltd. (FHPL)

Policy Period: 4th August 2020 to 3rd August 2021

Eligibility

All regular full-time employees and their qualified dependents are eligible. Dependents include spouse, two (2) dependent (below the age of 21) children, two (2) parents and co-habitation partner.

Note: The cohabitation partner can be of same or different sex. The employee must be in a committed relationship with the cohabitation partner and meet all the requirements set out in the Declaration of Committed Relationship Form​ [VMware network access required].

Benefits

  • Pre-Existing diseases covered from day one
  • Waiver on 30 days waiting period
  • Waiver on 1st year exclusion
  • Hospitalization expenses
  • Pre- and post-hospitalization expenses
  • Congenital ailments (Internal and External)
  • Day care procedures
  • Maternity
  • Emergency ambulance charges
  • Vision power correction- Provided the power is equal to or higher than +6.0 D

Hospitalization/Inpatient

Hospitalization/Inpatient expense reimbursement is limited to INR 500,000 per family per year (Base cover). The period for which an insured person is admitted in the hospital as inpatient and stays there for the sole purpose of receiving the necessary and reasonable treatment for the disease/ailment contracted/injuries sustained during the period of policy. (A). The minimum period of stay shall be 24 hours other than cases mentioned below (B). All expenses shall be reimbursed provided they are incurred in India. (C) All expenses to be incurred within the policy period.

Co-Payment under the Base Cover

A Co-payment of 20% on parental claims and 10% on employee, spouse and children is applicable on the approved hospital bill. Example: For INR 10,000 as claimed amount for hospitalization of a parent, Insurance company will pay INR 8000, and employee must pay INR 2000 in such a scenario.

Note: Co-pay is not applicable on the Top-Up cover chosen by the employee. ​

Day Care

As a standard rule, expenses of Hospitalization for minimum period of 24 hours are admissible. However, this time limit is not applied to specific treatments i.e. Dialysis, Chemotherapy, Radiotherapy, Cataract, Lithotripsy (Kidney Stone removal), D & C (Dilation & Curettage), Tonsillectomy, otherwise require hospitalization taken in the Hospital/Nursing Home and the Insured is discharged on the same day.

Cataract Cover

Cataract Surgeries are covered up to conventional method procedures only and lens associated with the surgery up to multi-focal lens. Trifocal lens and laser treatment towards cataract are not covered under the policy.

Hospitalization Expenses

If the Insured is diagnosed with an Illness or suffers Accidental Bodily Injury which necessitates his Hospitalization for a minimum of 24 hours with an active line of treatment, the Insurer will reimburse the Insured Person’s consequent Hospitalization Expenses for:

  • Room Rent (inclusive of nursing charges) – Restricted to Single Standard A/C room, no restriction on ICU
  • Doctor’s fees (Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists fees)
  • Intensive Care Unit
  • Nursing expenses
  • Surgical fees, operating theater, anesthesia, blood and oxygen
  • Physiotherapy
  • Drugs and medicines consumed on the premises
  • Hospital miscellaneous services (such as laboratory, x-ray, diagnostic tests)
  • Costs of prosthetic devices if implanted during a surgical procedure (Copy of Original tax invoice of the hospital vendor mandatory)
  • Organ transplantation including the treatment costs of the donor but, excluding the costs of the organ.
  • Instrument charges payable up to INR 25,000/-

Pre-Hospitalization Expenses

If the Insured Person is diagnosed with an Illness which results in his Hospitalization and for which the Insurer accepts a claim under a) above, the Insurer will reimburse the Insured Person’s Pre-Hospitalization Expenses for up to 60 days prior to his Hospitalization.

Post-Hospitalization Expenses

If the Insurer accepts a claim under the above and, immediately following the Insured Person’s discharge, s/he requires further medical treatment directly related to the same condition for which the Insured Person was Hospitalized, the Insurer will reimburse the Insured Person’s Post-Hospitalization Expenses for up to 90 days following his discharge.

Local Emergency Ambulance Services

The Insurer will also pay for Emergency ambulance road transportation by a licensed ambulance service to the nearest Hospital where Emergency Health Services can be rendered. Coverage is only provided in the event of an Emergency. These expenses are payable up to INR 3,000 per person per occurrence.

Maternity Health Cover

Treatment taken in Hospital arising from or traceable to Pregnancy, Childbirth including normal delivery/caesarian section.

Special Conditions Applicable to Maternity Health Cover Extension:

  • These benefits are admissible only if the expenses are incurred in Hospital as in-patients in India.
  • Claim in respect of delivery for only first two children and/or operations associated therewith will be considered in respect of any one Insured person covered under the Policy or any renewal thereof. Insured Persons with two or more children will not be eligible for this benefit.
  • Expenses incurred in connection with voluntary termination of pregnancy (except where carried out under medical advice) during first 12 weeks from the date of conception are not covered.
  • Any hospitalization with an active line of treatment that occurs during the pre and post-natal period will be covered only up to the maternity limit.

Maternity limit: Up to INR 65,000 per pregnancy /policy year (Applicable only towards the first two living children).

The above includes up to INR 2,500 per pregnancy /policy year towards Pre-natal and Postnatal expenses.

Part Maternity claims, where the Sum Insured towards the maternity benefit is exhausted under some other policy, are payable up to the maternity limit.

Income Protection Plan – Insures you against loss of earnings if you become ill and are unable to work.

Entitlement:  Coverage of INR 25,000 per week upto 3 months in case of long-term illness leading to loss of pay. Income Protection plan is qualified when there is disability arising due to any of the following health conditions

  1. Neurological disorders – myasthenia gravis, multiple sclerosis, parkinson’s, epilepsy, paralytic stroke and alzheimer’s
  2. Certain infection – like meningitis or any forms of encephalitis.
  3. Rheumatoid arthritis, osteoarthritis
  4. Coma
  5. Cancer, Kidney Failure etc

It is necessary that hospitalization is required for the above conditions and the employee is unable to return to work leading to loss of pay. You must exhaust your annual/sick/causal Leave entitlement to be eligible for income protection plan. You should inform your manager and HR with a written notice stating the expected period of leave and return to work as soon as reasonably possible, so that proper arrangements can be made prior to your leave period.

Note: Income protection plan eligibility is subject to insurance company’s approval.

General Exclusions

  • Injury or disease directly or indirectly caused by or arising from or attributable to War or War-like situations or directly or indirectly caused by nuclear weapons.
  • Circumcision unless necessitated due to an accident or necessary for treatment of a disease not excluded here under or as may be necessitated due to any accident), vaccination, inoculation or change of life or cosmetic or aesthetic treatment of any description, plastic surgery other than as may be necessitated due to an accident or part of an illness.
  • Any non-medical expenses like registration fees, admission fees, charges for medical records, cafeteria charges, telephone charges, cost of spectacles, contact lenses, hearing aids, non-medical pharmacy items, dressing charges, taxes, etc.
  • Convalescence, general debility, “run down” condition or rest cure, sterility, intentional self-injury / suicide, all psychiatric and psychosomatic disorders and disease / accident due to and or use, misuse or abuse of drugs / alcohol or use of intoxicating substances or such abuse or additions etc.
  • Domiciliary Hospitalization Benefit.
  • HIV and AIDS & Venereal diseases.
  • Infertility treatment.
  • Naturopathy, unproven procedure or treatment, experimental or alternative medicine and related treatment including acupressure, acupuncture, magnetic and such other therapies etc.
  • Vitamins and tonics unless used for treatment of injury or disease.
  • Voluntary termination of pregnancy during first 12 weeks (MTP).
  • Ayurvedic treatment unless taken at registered Government hospital/ Government medical colleges.
  • Expenses incurred at Hospital or nursing home primarily for evaluation/ diagnostic purposes which is not followed by active treatment for the ailment during the hospitalized period.
  • Expenses incurred for investigation or treatment irrelevant to the diseases diagnosed during the hospitalization or primary reasons for admission.
  • Genetic disorders and stem cell implantation/Surgery.
  • External and or durable medical/non-medical equipment of any kind used for diagnosis and or treatment including CPAP, CAPD, Infusion pump etc., Ambulatory devices i.e. walker, crutches, belts, collars, caps, splints, slings, braces, stockings etc. of any kind, diabetic foot wear, glucometer/thermometer and similar related items and also any medical equipment which is subsequently used at home etc.
  • Doctor’s home visit charges, attendant /nursing charges during pre and post hospitalization period.
  • Treatment which is continued before hospitalization and continued even after discharge for an ailment/disease/injury different from the one for which the hospitalization was necessary.
  • Outpatient diagnostic, medical or surgical procedures or treatments, non-prescribed drugs and medical supplies, hormone replacement therapy, sex change or treatment which results from or is in any way related to sex change.
  • Any dental treatment or surgery which is corrective, cosmetic or of aesthetic procedure, filling of cavity, Root canal including wear and tear etc. unless arising from disease or injury and which requires hospitalization for treatment.
  • Expenses incurred during hospitalization or during the pre-post period that are not medically justified.
  • All expenses arising out of any condition directly or indirectly cause by, or associated with Human T-Lymphotropic Virus Type III (HTLD-III) or Lymohadinopathy Associated Virus(LAV) or the mutants derivatives or Variations Deficiency Syndrome or any syndrome or condition of similar kind commonly referred to as AIDS , HIV and its complications including sexually transmitted diseases.
  • Any treatment arising out of the Insured’s participation in hazardous activity including but not limited to scuba diving, motor racing, parachuting, hand gliding. Rock or mountain climbing etc.
  • Treatment of obesity or ailment arising there from (including morbid obesity) and any other weight control program, services or supplies etc.
  • If the Insured opts for a higher Hospitalization Class than the terms of the authorization obtained, then the amount payable (all medically payable charges) by or on behalf of the Insurer shall be reduced in direct proportion and shall be borne by the Policyholder or Primary Insured.

Note: For an exhaustive list of exclusions write to National Insurance.

Voluntary Top-Up Cover

A top up health insurance is an extra safety net that provides additional health insurance over and above any existing insurance coverage available. The benefits of the policy are the same as existing policy. The top up available to employees is an additional INR 200,000 or INR 300,000 or INR 500,000 or INR 1,000,000 over and above the existing INR 500,000 base cover, however, the premium for top up needs to be borne by the employees.

How it works: The Company’s cover is for max of INR 500,000, in case you or your declared dependents need to undergo a treatment which costs over INR 500,000 then the top up can be utilized as an additional cover. All other terms and conditions of the policy remain unchanged.

Top-Up Premium Amount: Please click on the link below for Top-Up premium amount which has been negotiated for VMware employees.

Review the Policies and Procedures to view the Top-Up premium.

Note:

  • Policy conditions remains as per the main policy. However, co-payment is not applicable on Top-up
  • In case employee decides to leave VMware before policy expiry date (3rd Aug 2020), premium paid towards Top-up will not be refunded and the benefit would not be continued.
  • For new hires, premium will be calculated on pro-rata basis and deduction will happen in the subsequent month payroll.
  • For existing employees, the amount towards annual premium will be deducted from your salary – One-time deduction
  • Tax exemption under 80D on top-up policy premium (**Subject to change in Income Tax Law

Enrollment of Dependents

If you wish to enroll dependents in the Healthcare Plan, you must do so within 30 days of your date of joining. Coverage is effective on your date of hire. If you choose not to enroll dependents within 30 days of your date of hire, you will not be permitted to do so till the next annual enrollment window is open. If you experience a qualifying life changing event, you may enroll the new dependent within 30 days of the change (see section below on making changes), or during the annual Open Enrollment period, with automatic approval, effective August 3rd every year. Cohabitation partners need to fill Partner evidence form and complete the enrollment on MyLife [VMware network access requiredportal upon qualifying the eligibility period.

Contributions

VMware pays 100% of the premium costs (Base Cover only) for you and your eligible dependents.

When Coverage Begins

Coverage for you will begin on the first day of your employment with VMware and coverage for your dependents commence upon your declaring them on MyLife [VMware network access required].

When Coverage Ends

Coverage for you and your dependents under the VMware Healthcare plan will end on the last day of your employment with VMware.

Claims Process:

  • Pre-Authorization Form is required to be filled and submitted at hospital insurance desk for availing cashless hospitalization. The form needs to be sent 3 days in advance for all planned hospitalizations.
  • Reimbursement​ Claim Form is to be submitted as per the Claim Submission Checklist. The claim needs to be submitted within 30 days from date of discharge.
  • Pre and post-hospitalization expenses up to 60 days before and 90 days after can be reimbursed as per the Claim Submission Checklist​. The claims need to be submitted within 15 days, upon completion of 90 days from date of discharge.

 

Contact Us

HR Source
ASK HR [VMware network access required]
Phone: (+91) 8067642555
Internal Phone: ext. 29200


Insurance Help Desk
Email: insurancehelpdesk@vmware.com

Resources

Claim Submission Checklist

Declaration of Committed Relationship Form [VMware network access required]

MyLife [VMware network access required]

Pre-Authorization Form

Reimbursement Claim Form