Sla - Prudent

“SERVICE LEVEL AGREEMENT.” By Prudent Insurance Brokers Pvt. Ltd.

[20-Nov-2009]

PRUDENT INSURANCE BROKERS PVT. LTD. 217 Prabhadevi Estate, V. S. Marg, Mumbai 400 025 Tel: 91-22-66242800 FAX: 91-22-24314850

49 A/5, “Smruti”, Gulmohar Path,Pune 411 004 Tel: 020-64011830 020-64011831

www.PrudentBrokers.com | E-mail: [email protected]

CONTENTS: NO.

PARTICULARS

1.00

OBJECTIVE

1.01

PARTIES

1.02

POLICY TERMS & FEATURES

2.00

SCOPE OF AGREEMENT

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Objective of the Service Level Agreement (SLA) This Service Level Agreement (SLA) underlines the Service Levels, which will be performed by “Prudent Insurance Brokers Pvt.Ltd.”, the Insurance Broker for the specified Insurance Policy availed by the Client. Further Clients Name & Prudent Insurance Brokers Pvt.Ltd. as (PIBL) Members to this Agreement Clients Name

& Prudent Insurance Brokers Pvt.Ltd. 49 A/5, “Smruti” Gulmohar Path Off Law College Road Pune – 411004 Tel:020-6401 1830/31 Fax: 020-2546 3338

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Agreement Background This agreement is effective from 01/07/2009, the date of issue of the Customized Mediclaim Policy by “Insurance Co. Ltd.”, the Insurance Company for the client. The Policy issued has “TPA Pvt. Ltd.” as the Third Party Administrator (TPA), whose consent has been obtained by PIBL to facilitate completion of the obligations of PIBL under this Agreement. The various service parameters associated with Employee Benefit Policies, such as issuance of Cashless Cards, Settlement of Claims, Member Addition-Deletion, Query handling and other similar issues are being addressed by this SLA with specified Turn Around Timelines to be pursued (TAT) and Mechanism laid out for each of such activities. The beneficiaries of the Employee Benefit Policies shall be the employees of the Client from time to time. Scope of the Agreement Presented below are the Critical Modules, which will cover relevant issues under the scope of this Agreement – 1. 2. 3. 4. 5. 6. 7.

Policy Management Cards Management Employee Induction Help Desk Claim management Policy administration Monthly Information System (MIS)

The features of the policy shall be as follows: As per the Policy Scope of the SLA Policy Management i)

ii)

The policy will be issued in the name of the Company within 7 working days of the submission of the existing Member information. For the interim period a “Held Cover Letter” (i.e. a covering letter) will be issued to confirm commencement of coverage under the policy.

Due Diligence - Policy once issued will be ratified by PIBL to confirm adherence to the “SCOPE of COVERAGE” as negotiated for final consideration. 4 Confidential Documents/20-Nov-09

Cashless Cards Timeline for cashless card issuance – The cashless cards will be issued within 7 working days from date of receipt of complete information in respect of the existing members as well as new joinees to be covered under the policy. The cards will then be distributed at the Help Desk to be set up by PIBL at the premises of the Client as per the schedule and directions given by the Client in that regard. The Cashless card shall cover the names of the dependent parents, spouse and two children of every employee of the Client. The Card shall be valid for a period of one year from the date of inception of the policy. On the expiry of such period PIBL shall inform the Client about expiry or possible renewal of the policy. In case of renewal of the Policy by the Client, the period of validity shall extend further for one year from the date of inception of the new policy. The Cashless Card shall not be transferable to any person. In case the employment of the employee ceases by any reason whatsoever, the Client shall inform PIBL to update the database of the employees of the Client. The Cashless Card shall enable the employee of the Client to avail various medical treatments at identified Hospitals without any payment (by cash/ cheques or otherwise) to the Hospital for the same (whether at the time of admission to the Hospital, availing such treatment or even after discharge from the Hospital). PIBL shall ensure that the final Bills raised by the Hospital for payment are approved and accepted for payment within four hours from the time of communication of the final Bill amount by the Hospital to the TPA. PIBL shall however, initiate steps to avoid possible communication gaps/ lapses for this purpose. Employee Induction i)

Employee Presentation – At the policy inception presentations to the employees of the Company at the Company’s premises shall be made to inform them about the policy, its features, its scope / coverage and also the various claim related processes along with the dos and don’ts the employees need to follow and give a copy of the same to the Company for sharing it to the employees for their ready reference. Dates for such presentations can be mutually decided.

ii)

For new joinees such presentations will be made during the induction Process.

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Help Desk i.

Help Desk – PIBL will set up helpdesk at Company’s premises on ( As per Client convenience).This Help Desk will facilitate claim/ query - handling and resolution/ settlement process.

ii.

Query Resolution – PIBL will pursue to resolve all queries within 3 working days after the date of receiving the queries. The queries shall be noted by the concerned representative of PIBL attending the Help-desk.

Claim Management i)

Non-Cashless Claim Settlement – For Non Cashless Claims the timeline is 15 working days from the time complete documents are submitted by the Client to PIBL. Completeness of documentation is subject to submission by the employee of all deficiencies raised by the Insurance Company regarding the claim. PIBL shall be responsible for such claims getting settled within the mutually agreed time frame. For the purpose of this agreement, Non-cashless claim means a claim in respect of the medical treatment availed from a Hospital not covered in the list of recognized Hospitals issued by TPA to the Client from time to time. Any amount for settlement of such claim shall be paid in the name of Company.

ii)

Troubleshooting for Cashless Claim Settlement – The claims in Network Hospitals are to be settled cashless by the TPA. The member intending to use the cashless facility will be required to follow the cashless authorization process prescribed by the concerned hospital.

iii)

Cashless claim settlement is authorized and guaranteed to be available in all the hospitals as per list enclosed. The timeline framed for the same is 6 Hours from the receipt of document by TPA.

If any hospital withdraws the cashless facility after signing this agreement, PIBL shall give the changes in the list of Hospitals (for cashless facility) to the Client, PIBL will assist cashless authorization the event the member doesn’t received the same in spite of following cashless authorization process. Policy Administration i) Addition/Deletion of members – Data for addition-deletion of employee is expected preferably once in the month i.e. 1st week of every month. For addition/ changes in dependent members the employee shall be provided by filling in the data at the time of 6 Confidential Documents/20-Nov-09

induction and from time to time and the same shall be collected by PIBL and forwarded to the Insurance Company immediately. ii)

Policy Endorsements – The Insurance Company will issue the endorsements with the details of individual employees shall be sent by PIBL to the Company within 7 days of receipt of such data by PIBL.

iii)

Cash Deposit Balance– The float available with the insurance company for the particular policy will be monitored by PIBL on monthly basis. A threshold level will be determined and on approaching the threshold limit a trigger will be sent to the client requesting for replenishment of the float. PIBL shall provide the details of the transactions within 3 days from end of every month.

iv)

Premium Accounting Statement – Before 5th day of every month the monthly Account statement of the previous month will be sent to the concerned officials of the Company. This statement will elaborate the Endorsements passed in the policy and the resultant consumption and Refund of premium and therefore the Float Status. The premium amount shall be paid by the Company in the name of the Insurance company through PIBL. Such payment to PIBL shall be deemed to be the compliance of the obligations of the Company under the Policy.

v)

Data Management – To ensure correctness of database in terms of coverage of all eligible members and deletion of all members who have left the Company PIBL undertakes to map the complete database available with it and the Insurer against the master database of the Company. This activity shall be done once every quarter.

Monthly Information System i)

Monthly MIS Reports – On 10th day of every month, PIBL will generate An MIS elaborating –

Monthly Claim Tracker – A Monthly Claim tracker that will give details of all Cashless and Non Cashless claims filed during the month with updates on status of pending claims and details of passed Claims will be sent to the concerned person of the Company within 5 days from the end of every month. Break up of claims made by Employee and dependents shall be included in the same along with Claim Ratio. 7 Confidential Documents/20-Nov-09

ii)

Policy Review Meeting – Monthly MIS Report will be presented to the client covering all aspect of the policy.

The concerned Manager (names mentioned below) of PIBL will monitor adherence to the set Turn Around Time (TAT) as per this SLA. If any deviation is noticed by the HR on the set TAT the same may be escalate as per the attach escalation matrix. INSURANCE CO LTD

THIRD PARTY ADMINISTRATOR (TPA)

Prudent Insurance Brokers Private Limited Primary contact – Ajay Dhage – 097300-75792 (Contact for Addition & Deletions) [email protected] Vijay Marne – 097300-33064 (Contact for Claims) [email protected] Loveleen Samuel – 097300-75797 (Practice Leader – Employee Benefit Services) [email protected] Escalation- Piyush Choudhary – 097300-75796 (AVP – Pune) [email protected] PERSISTENT SYSTEMS LTD Primary contact – Backup – Escalation –

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Signatures: PRUDENT INSURANCE BROKERS PVT. LTD.

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