OPD & EAP Program Benefit Guide

TSYS Card Tech Services India LLP

&
Global Payments Asia Pacific India Pvt. Ltd.

Policy Period: 1st May’24 to 30th Apr’25

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Table of contents
❖ OPD & EAP Benefit Program
▪ Coverage Details
▪ Benefits with Sub-limits
Table ofnotcontents
▪ What is covered under this program
▪ App Usage Details:
▪ App Registration Process
▪ Steps to book Online and Offline Consultations
▪ Steps to book Prescribed Diagnostics/Lab tests
▪ Steps to book Prescribed Pharmacy
▪ Steps to book Annual Health check up
▪ Reimbursement Process
▪ FAQs
▪ Do’s and Don’ts
▪ Contact Matrix

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OPD & EAP Benefit Program
Policy Period: 1st May’24 to 30th Apr’25

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OPD & EAP Benefit Program
Coverage details

Particulars Details

Vendor Name Visit Health

Policy Period 1st May’24 to 30th April’25

Plan Type Family floater

Beneficiaries Dependents declared in GMC will be considered

Wallet Limit INR 10,000/- per family

Risk Advisor Willis Towers Watson Insurance Brokers India Pvt Ltd

• Family Floater: means employees and their dependents together are eligible for the entire wallet amount. Any one member or all of
them can use the annual limit. There is no individual sub limit applicable for dependents however few benefits have the sub-limits.

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 OPD & EAP Benefit Program
OPD Coverage Parameters

S. No. Benefit Type of Claim Sub-limits

Unlimited on Visit
1 Teleconsultations (General Physician, Specialist, Super Specialist) Cashless
App
Unlimited on Visit
2 EAP Program (Grief counselling and Psychologist consultations) Cashless
App
Cashless +
3 In-clinic Doctor Consultation (General Physician, Specialist, Super Specialist) ₹10,000
Reimbursement
Cashless +
4 Prescribed Diagnostics (Pathology & Radiology) ₹10,000
Reimbursement
5 Prescribed Pharmacy Cashless Only ₹5,000
Cashless +
6 Vaccination (WHO Approved) ₹2,000
Reimbursement
Cashless +
7 Dental (except preventive & cosmetic) ₹5,000
Reimbursement
Vision (Vision check up done by optometrist / optician & Prescribed glasses),
8 Reimbursement ₹5,000
Cost of frames not covered
9 Annual Health Checkup (Pre-defined Package) Cashless Only ₹5,000

Note:
● Teleconsultations are unlimited, and the cost of online consultation will not be deducted from the OPD Sum Insured
● Wallet is Family Floater
● Above stated benefits are available within overall limit of INR 10,000 per family. Unlimited benefits will be over and above of the limits.

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 OPD & EAP Benefit Program
Policy Inclusions for Dental and Vision

W h a t Dental Treatments Are Covered Under The Policy?

Any consultation/ procedure/ medication prescribed by dentist will be deducted from the dental wallet only.
● List of Dental procedures are mentioned below:
● Dental Examination
● Medication
● Scaling and Polishing
● X ray/ OPG
● Filling / Restoration
● Prophylaxis
● Root Canal Treatment
● Extractions OPD Coverage Parameters
● Oral Surgery
● Re cementation / Crowning
● Implant
● Orthodontic treatment (non- cosmetic)

W h a t Vision Treatments Are Covered Under The Policy?

Vision Procedure including prescription glasses and lenses and excluding cosmetic procedures, sunglasses and frames.

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 OPD & EAP Benefit Program
What is not covered under this Program

W h a t Is Not Covered Under The Policy?

● AY U S H (Ayurveda, Yoga, Naturopathy, Unani, Siddha and Homeopathy) treatment/ procedures

● Maternity and pre-post natal
● Birth control, sterility a n d infertility
● Non-Medical Expenses such as O P D charges, registration charges, administration, sanitization
charges, Injection charges, etc
● Counselling Sessions like psychotherapy, rehabilitation, etc
OPD Coverage Parameters
● O T C (over-the-counter) products, food supplements, vitamins, tonics (unless prescribed and as per the
diagnosis)
● Other medical expenses like blood b a n k charges, i m m uniza tion charges, etc
● Therapies like naturopathy, acupressure, magnetic therapy, physiotherapy, and other alternative treatments.

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App Registration Process

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OPD & EAP Benefit Program
Registration process

Download the Visit App on your Mobile

Planned Hospitalization
Hospitalization

Network Hospital –
Cashless Facility
Emergency Hospitalization

Non network Hospital -

Reimbursement

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OPD & EAP Benefit Program
Registration process

Register on the Visit App Planned Hospitalization

Hospitalization

Network Hospital –
Cashless Facility
Emergency Hospitalization

Non network Hospital -

Reimbursement

S t e p 1: S t e p 3:
S t e p 2: Verify your number by
Tap on S i g n u p with your
Get Started entering the O T P
mobile number
received

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OPD & EAP Benefit Program
Registration process

Register on the Visit App Planned Hospitalization

Hospitalization

Network Hospital –
Cashless Facility

Non network Hospital -

Reimbursement

S t e p 4: S t e p 5:
Enter your o f f i c i a l e m a i l Enter your V e r i f i c a t i o n C o d e r e c e i v e d o n y o u r o f f i c i a l
a d d r e s s and tap on Sen d m e e m a i l i d and tap on Verify.
th e cod e It will take you to home page and login will be successful.

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Steps to book Online Consultations

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Online Consultation
How to book online consultation

Planned Hospitalization
Hospitalization

Network Hospital –
Cashless Facility
Emergency Hospitalization

Non network Hospital -

Reimbursement

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Online Consultation
How to book online consultation

Planned Hospitalization
Hospitalization

Network Hospital –
Cashless Facility
Emergency Hospitalization

Non network Hospital -

Reimbursement
S t e p 4: S t e p 5:
S t e p 6:
Select the Sp ecializat i on Select the D o c t o r you
Select the P a t i e n t details
you want to consult want to consult and tap
(only covered members
on C o n s u l t N o w
under GMC policy will be
reflect here)
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In Person Doctor Consultation
How to book online consultation

Planned Hospitalization
Hospitalization

Network Hospital –
Cashless Facility
Emergency Hospitalization

Non network Hospital - S t e p 7: S t e p 9:

Reimbursement Select appointment S t e p 8: Your consultation is
for N o w or S c h e d u l e Choose C a l l P r e f e r en ce confirmed and a c h a t
for later and tap on Confirm w i n d o w will open

Conffirmation TAT: <5 M in s a n d D o c t o r C a l l b a c k TAT: 3 0 - 4 5 Mins

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Steps to book In-clinic Consultations

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In Person Doctor Consultation
How to book offline consultation

Planned Hospitalization
Hospitalization

Network Hospital –
Cashless Facility
Emergency Hospitalization

Non network Hospital -

Reimbursement

Sl o t Availability: 6 H o u r s o n w a r d s , Conffirmation TAT: 6 H o u r s , P a y m e n t Conffirmation: 2 H o u r s prior a p p o i n t m e n t

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In Person Doctor Consultation
How to book offline consultation

Planned Hospitalization
Hospitalization

Network Hospital –
Cashless Facility
Emergency Hospitalization

Non network Hospital -

Reimbursement

Note: Sl
T hoet Availability: 6H
Visit A p p will a uotuor -sdoe nt ewcat rydos u, rConffirmation
l o c a t i o n s if pTAT:
ermi6s sH
i oonusr sa,r Pe aeynm
a eb n
l etdConffirmation:
. Y o u c a n a l s o 2mHaonuuras l lprior
y e n taepr paolo
i nct amteionnt

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In Person Doctor Consultation
How to book Dental Appointment

Planned Hospitalization
Hospitalization

Network Hospital –
Cashless Facility
Emergency Hospitalization

Non network Hospital -

Reimbursement
S t e p 1: S t e p 2: S t e p 3: S t e p 4:
Tap on the C a r e tab > Browse and Select from Review and Confirm
Select your Pr efer r ed
Cashless Dental list of Available Dentists Booking
D a t e & T i m e Slot

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In Person Doctor Consultation
How to book Dental Appointment

Planned Hospitalization
Hospitalization

Network Hospital –
Cashless Facility
Emergency Hospitalization

Non network Hospital -

Reimbursement

Note: F o r V is io n t r e a t m e n t s y o u n e e d to ra is e a r e i m b u r s e m n e t re q u e s t

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Steps to book Prescribed/Lab Tests/Diagnostics

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Lab Tests/Diagnostics
How to book lab tests/diagnostics?

Planned Hospitalization
Hospitalization

Network Hospital –
Cashless Facility
Emergency Hospitalization

Non network Hospital -

Reimbursement

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Lab Tests/Diagnostics
How to book lab tests/diagnostics?

Planned Hospitalization
Hospitalization

Network Hospital –
Cashless Facility
Emergency Hospitalization

Non network Hospital -

Reimbursement

Step 5: Step 7: Step 8:

Review your tests and Step 6:
Choose the Lab Partner Choose/add Address for
Tap on Book Tests Choose Patient
and tap on Conffirm pathology tests - home
collection

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Lab Tests/Diagnostics
How to book lab tests/diagnostics?

Planned Hospitalization
Hospitalization

Network Hospital –
Cashless Facility
Emergency Hospitalization

Non network Hospital -

Reimbursement

R x d i g i t i z a t i o n TAT: U p to 6 0 Mins, C o n fi r m a t i o n TAT: 6 H o u rs , R e p o r t d e liv e ry TAT: Av g . < 4 8 h o u r s b u t c a n b e h i g h e r for s p e c i a l i s e d tests)

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Steps to book Prescribed Pharmacy

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Booking Prescribed Pharmacy
How to book prescribed pharmacy

Planned Hospitalization
Hospitalization

Network Hospital –
Cashless Facility
Emergency Hospitalization

Non network Hospital -

Reimbursement

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Booking Prescribed Pharmacy
How to book prescribed pharmacy

Planned Hospitalization

Network Hospital –
Cashless Facility
Emergency Hospitalization

Non network Hospital -

Reimbursement

Note: T h e Visit A p p will a u t o - d e t e c t y o u r l o c a t i o n s if p e r m i s s i o n s a r e e n a b l e d . Y o u c a n a l s o m a n u a l l y e n t e r a lo c a t io n

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Booking Prescribed Pharmacy
How to book prescribed pharmacy

Planned Hospitalization

Network Hospital –
Cashless Facility
Emergency Hospitalization

P r e s c r i p t i o n d ig it iz a t io n TAT: U p to 6 0 M in s a n d D e liv e ry TAT: 6-72 h o u r s

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Steps to Book Annual Health Check Up

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Booking Annual Health check up
How to book Annual Health check up

Planned Hospitalization
Hospitalization

Network Hospital –
Cashless Facility
Emergency Hospitalization

Non network Hospital -

Reimbursement

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Booking Annual Health check up
How to book Annual Health check up

Planned Hospitalization
Hospitalization

Network Hospital –
Cashless Facility
Emergency Hospitalization

Non network Hospital -

Reimbursement

R x d i g i t i z a t i o n TAT: U p to 6 0 Mins, C o n fi r m a t i o n TAT: 6 H o u rs , R e p o r t d e liv e ry TAT: Av g . < 4 8 h o u r s b u t c a n b e h i g h e r for s p e c i a l i s e d tests)

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Booking Annual Health check up
How to check the status of your booking

Planned Hospitalization
Hospitalization

Network Hospital –
Cashless Facility
Emergency Hospitalization

Non network Hospital -

Reimbursement S t e p 2: S t e p 4:
S t e p 1:
Tap on L a b T e s t s in the S t e p 3: Check your order status in
Tap on the C a r e tab
Care Tab Choose your O r d e r the S t a t u s Timeline

R x d i g i t i z a t i o n TAT: U p to 6 0 Mins, C o n fi r m a t i o n TAT: 6 H o u rs , R e p o r t d e liv e ry TAT: Av g . < 4 8 h o u r s b u t c a n b e h i g h e r for s p e c i a l i s e d tests)

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Steps to request reimbursement claim

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OPD & EAP Benefit Program
Reimbursement Claims

Planned Hospitalization

Network Hospital –
Cashless Facility
Emergency Hospitalization

Non network Hospital -

Reimbursement
S t e p 1:
Tap on the C a r e tab S t e p 2: S t e p 3: S t e p 4:
Tap on A d d O P D Choose the claim Select the D a t e and tap
Reimbursements category C l a i m N o w o n Confirm
Request

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OPD & EAP Benefit Program
Reimbursement Claims

Planned Hospitalization

Network Hospital –
Cashless Facility
Emergency Hospitalization

Non network Hospital -

Reimbursement S t e p 5: S t e p 6: S t e p 7:
Choose P a t i e n t N a m e Fill claim details, upload Reimbursement request
required documents and raised
tap on S u b m i t

C l a i m p r o c e s s i n g TAT: U p to 3 w o rf iin g d a y s a n d S e t t l e m e n t TAT: U p to 7 w o rf iin g d a y s

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OPD & EAP Benefit Program
Reimbursement Claims

Planned Hospitalization

Network Hospital –
Cashless Facility
Emergency Hospitalization

Non network Hospital -

Reimbursement
S t e p 10: S t e p 11:
S t e p 8: S t e p 9: Check your
Tap on the C a r e tab Tap on My C l a i m s Select your C l a i m
Claim Status

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OPD & EAP Benefit Program
Frequently Asked Questions

W h a t is Unlimited Tele-consultation?
Yes, online doctor consultation on Visit App is available for all employees and their family members under the policy.

Is Health c h e c k u p covered in m y policy?

Yes, Annual health check up covered on cashless mode only.

W h a t is c a shless a n d r ei mburse me nt in this plan?

All bookings that are made via the Visit Health Mobile App will be cashless. Whereas for the bookings not done via the Visit App
reimbursement can be done.

C a n I claim r ei mbur sement for m e di c ines I have pur c ha s e d from a p h a r m a c y shop?

No, there is no reimbursement option for offline medicines. All medicine orders must be placed via Visit App to be covered under OPD
Policy.

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OPD & EAP Benefit Program
Frequently Asked Questions

W h a t is O P D S u m Insured limit a n d s ub- limit?

Your O P D S u m Insured limit is 10,000 which is your overall wallet limit that include all parameters..
S u b - limit is the limit on individual parameter (as mentioned on page 1)

H o w c a n I file a r e i m burse me nt on Visit App?

• Open the Visit App
• Go to ‘Care’ Tab
• Tap ‘Add OPD Reimbursements Request’
• Enter your bank details (one time process only)
• Choose the claim category
• Select the Date and tap on Confirm
• Choose Patient Name
• Fillbears
Member claimout
details,
pocket upload requiredexpenses
non medical documents
or and tap on Submit
entire hospital bill if not Covered under policy
W hconditions
a t is the&deadline
any other Non-admissible items.
for claim submission?
The reimbursement claim should be requested within 30 da ys from the date of invoice/appointment.
Example:
If your appointment date is 14th May, 2024 then the last date for claim submission would be 13th June, 2024

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OPD & EAP Benefit Program
Do’s and Don’ts

W h a t Are The Guidelines To File Claims?

● Every claim should be supported by a valid doctor’s prescription.
● For follow-up consultations, upload front and back page of the doctor’s prescription.
● File separate claims for different categories such as consultations, pharmacy, etc.
● If a single invoice includes billing of different categories, upload the same invoice for respective categories

W h a t Is Considered To B e A Valid Prescription?

● The date on the prescription and the appointment date should be the same.
● The patient’s name should be the same on the prescription and the reimbursement request.
● The prescription should include the valid stamp/signature, the qualification of the doctor and the registration
number of the doctor.
● The prescription should be on a valid letterhead of the clinic/hospital.
● The prescription should be from an allopathic doctor or qualified western medical doctor
Member bears out pocket non medical expenses or
(homoeopathy/ayurveda is not covered
entire hospital bill if not Covered under under
policy the policy).
● The prescription
conditions & any should contain that diagnosis
other Non-admissible items. or chief complaint.

W h a t Is Considered To B e A Valid Invoice?

●At the
Thetime of discharge
patient’s member
name should be signs the Final
the same on thebillinvoice and the prescription
● andTheleaves back
invoice all theinclude
should documents.
a validMember takes
name/stamp/signature of the merchant
photocopies of all documents.
● The invoice should include a date and invoice number (cash memos will not be accepted)

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OPD & EAP Benefit Program
Do’s and Don'ts

For Reference, Are There Any Examples Of Valid & Invalid Prescriptions?
Here Are Real Examples Of Valid & Invalid Prescriptions

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OPD & EAP Benefit Program
Contact Matrix

Level Name Mobile Number Timings Email ID

SPOC 1 Support Team 011-43146687 Monday to Saturday, 8am to 8pm tsys@getvisitapp.com

Escalation Level 1 Mr. Alekh Dixit NA alekh.dixit@getvisitapp.com

Escalation Level 2 Ms. Sapna Bhatt +91-9136089608 Monday to Friday, 9am to 7pm tsys@willistowerswatson.com

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OPD & EAP Benefit Program
TATs
TAT for specific queries
Mail Response from Support team Miscellaneous Queries Within 24 working Hours
Confirmation TAT <5 mins
Online Consultation
Doctor callback TAT 30-45 mins
Slot availability 6 Hours onwards
Offline Consultation Confirmation TAT 6 Hours
Payment Confirmation 2 Hours prior appointment
Prescription Digitization Up to 60 mins
Prescribed/Lab Tests/Diagnostics Confirmation TAT 6 Hours
Report Delivery TAT Average <48Hours (can be higher for specialized tests)
Prescription Digitization Up to 60 mins
Prescribed Pharmacy
Delivery TAT 6-72 Hours
Prescription Digitization Up to 60 mins
Annual Health check up Confirmation TAT 6 Hours
Report Delivery TAT Average <48Hours (can be higher for specialized tests)
Claim processing TAT 3 working days
Reimbursement Claims
Settlement TAT 7 working days

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Thank You

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