Sla - Prudent

“SERVICE LEVEL AGREEMENT AGREEME NT.” .” 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

2 Confidential Documents/20-Nov-09

Objective of the Service Level Agreement (SLA) This Ser This Servic vice e Lev Level el Agr Agreem eement ent (SL (SLA) A) unde underli rlines nes the Ser Servic vice e Lev Levels els,, whi which ch will 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


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), whos wh ose e co conse nsent nt ha hass be been en ob obta taine ined d by PI PIBL BL to fa faci cili lita tate te co comp mple letio tion n 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 handli ng and other similar 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. activi ties. The benefi beneficiarie ciariess of the Emplo Employee yee 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. Policy Management 2. Cards Management 3. Employee Induction 4. Help Desk 5. Claim management 6. Policy administration 7. Monthly Information System (MIS) The features of the policy shall be as follows: As per the Policy

Scope of the SLA Policy Management i)

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 “Hel “H eld d Co Cove verr Le Lett tter er” (i (i.e .e.. a co cove veri ring ng le lett tter er)) wi will ll be is issu sued ed to co conf nfir irm m 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 ii)

Cashless Cards Timeline Timeli ne fo forr cas cashle hless ss car card d iss issuan uance ce – Th The e ca cash shle less ss ca cards rds wi will ll be is issue sued d wi withi thin n 7 working worki ng days from date of receipt of comp complete lete information information in respec respectt of the existi existing ng 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 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 treat tre atme ments nts at id ident entif ifie ied d Ho Hospi spita tals ls wi witho thout ut an any y pa paym ymen entt (b (by y ca cash sh/ / ch cheq eque uess 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 Comp Co mpan any’ y’ss pr prem emis ises es sh shal alll be ma made de to inf infor orm m th them em ab abou outt th the e po poli licy cy,, 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.


Help Desk i.

Help Desk – PIBL will set up helpdesk at Company’s premises on ( As per Client conve co nvenie nience nce). ).Thi Thiss He Help lp De Desk sk wi will ll fa faci cili lita tate te cl clai aim/ m/ que query ry - ha handl ndling ing an and d resolution/ settlement process.

ii.

Query Resolution – PIBL will pursue to resolve all queries within 3 working days after aft er the date of receivin receiving g the queries. queries. The queries queries shall shall be noted 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 sub mitted 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 recog rec ogni nize zed d Ho Hosp spita itals ls is issue sued d by TP TPA A to the Cl Clie ient nt fr from om ti time me to ti time me.. An Any y amount for settlement of such claim shall be paid in the name of Company.

ii)) ii

Trouble Trou blesh shoo ootin ting g for Cashl Cashles esss Claim Claim Settle Settleme ment nt – Th The e claim claimss in Ne Netw twor ork k Hospitals are to be settled cashless by the TPA. The member intending to use the cas cashle hless ss fac facili ility ty wil willl be requ require ired d to fo follo llow w the cas cashle hless ss aut author horiza izatio tion n process prescribed by the concerned hospital.

iii)

Cashless claim settle Cashless settlement ment is author authorized ized and guara guaranteed nteed to be availa available ble in in all 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/Del Addit ion/Deletion etion of member memberss – Data Dat a for add additio ition-d n-dele eletio tion n of emp employ loyee ee is expe expecte cted d pref prefera erably bly onc once e in the st mont mo nth h i. i.e. e. 1 wee week k of ever every y mo month. nth. For add additio ition/ n/ cha change ngess in dep depende endent nt 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 In The Insu sura ranc nce e Co Comp mpan any y wi will ll is issue sue the end endor orse seme ment ntss wi with th the de deta tail ilss 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 ap appr proa oach chin ing g th the e th thre resh shol old d li limi mitt a tr trig igge gerr wi will ll be se sent nt to th the e cl clie ient nt requesting request ing for replenishment of the float. PIBL shall provide the detai details ls 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 wi ll el elab abor orat ate e the En Endo dorse rseme ments nts pa pass ssed ed in th the e po poli licy cy and the re resul sulta tant nt consum con sumptio ption n and Ref Refund und of pre premium mium and ther therefo efore re the Flo Float at Sta Status. tus. The premium amount shall be paid by the Company in the name of the Insurance comp co mpan any y thr throu ough gh PI PIBL BL.. Su Such ch pa paym ymen entt to PI PIBL BL sha shall ll be dee deeme med d 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 claimss made by Employee claim Employee and dependen dependents ts shall be include included d 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 –


Signatures:

PRUDENT INSURANCE BROKERS PVT. LTD.


Sla - Prudent

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