I understand and agree to the following:

Release of Liability and Informed Consent
I understand that the Outpatient Program is only being facilitated by Intel . Services under this Program is provided by third party vendors and Intel is not liable for the services availed including but not limited to quality of care, infrastructure and equipment.

I hereby release Intel and any other juridical person(s) including Medi Assist Healthcare Services Private Limited associated with this Outpatient Program, their affiliates, directors, officers, employees, agents, representatives, subcontractors, successors and assigns, from any liability arising from or in any way connected with my participation in this program and related services.

I could be asked for clarification or additional supporting documentation before the reimbursement claim is approved. Intel reserves the right to reject claims if the supporting documentation is found inadequate, inaccurate or otherwise against the stated policy of the Outpatient Program.

Employees are liable to ensure all claim details and supporting documentation submitted (including payment receipts, doctor’s receipts and other documents) for the purpose of reimbursement is true and correct. In case of any misuse of the guideline including misrepresentation of facts, Intel reserves the right to take disciplinary action including and up to termination in accordance with Intel’s Code of Conduct policy.

As a part of the claims verification and audit process, Medi Assist, acting on behalf of Bajaj Allianz General Insurance reserves the right to contact and / or visit the service provider to verify the authenticity of the claims.

Intel reserves the right to amend or withdraw altogether the services being offered under the Outpatient Program at any point in time without prior notice.

Personal Data and Confidentiality

I, confirm that my participation in the Outpatient Program is voluntary and hereby give consent to the use of sensitive personal data of my family (i.e.) Child or Children, Spouse and Parents or Parents-in-law information. I understand the sensitive personal data or information may be accessed from the MediBuddy Portal of Medi Assist Healthcare Services Private Limited to ascertain employee eligibility for the reimbursement program and to track program usage. I understand that Intel has reviewed MediBuddy Portal of Medi Assist Healthcare services Limited & Medi Assist Insurance TPA Private Limited and not reviewed the Medi Assist mobile app and Intel does not encourage the use of the Medi Assist mobile app and employees may use it at their own risk. The importance of safeguarding sensitive personal data or information is recognised and all persons viz. natural or juridical involved in this Outpatient Program are obligated and shall take reasonable steps to protect such sensitive personal data or information from unauthorised access or use. Employees are responsible to enroll dependents adhering to the policy guidelines. In case of any misrepresentation of facts, Intel reserves the right to take disciplinary action including and up to termination in accordance with Intel’s Code of Conduct.

I understand and agree to the following:

Release of Liability and Informed Consent
I understand that the Outpatient Program is only being facilitated by Intel . Services under this Program is provided by third party vendors and Intel is not liable for the services availed including but not limited to quality of care, infrastructure and equipment.

I hereby release Intel and any other juridical person(s) including Medi Assist Healthcare Services Private Limited associated with this Outpatient Program, their affiliates, directors, officers, employees, agents, representatives, subcontractors, successors and assigns, from any liability arising from or in any way connected with my participation in this program and related services.

I could be asked for clarification or additional supporting documentation before the reimbursement claim is approved. Intel reserves the right to reject claims if the supporting documentation is found inadequate, inaccurate or otherwise against the stated policy of the Outpatient Program.

Employees are liable to ensure all claim details and supporting documentation submitted (including payment receipts, doctor’s receipts and other documents) for the purpose of reimbursement is true and correct. In case of any misuse of the guideline including misrepresentation of facts, Intel reserves the right to take disciplinary action including and up to termination in accordance with Intel’s Code of Conduct policy.

As a part of the claims verification and audit process, Medi Assist, acting on behalf of Bajaj Allianz General Insurance reserves the right to contact and / or visit the service provider to verify the authenticity of the claims.

Intel reserves the right to amend or withdraw altogether the services being offered under the Outpatient Program at any point in time without prior notice.

Personal Data and Confidentiality

I, confirm that my participation in the Outpatient Program is voluntary and hereby give my consent to the use of sensitive personal data of my family (i.e.) Child or Children, Spouse and Parents or Parents-in-law information. I understand the sensitive personal data or information may be accessed from the MediBuddy Portal of Medi Assist Healthcare Services Private Limited to ascertain employee eligibility for the reimbursement program and to track program usage. The importance of safeguarding sensitive personal data or information is recognised and all persons viz. natural or juridical involved in this Outpatient Program are obligated and shall take reasonable steps to protect such sensitive personal data or information from unauthorised access or use. Employees are responsible to enroll dependents adhering to the policy guidelines. In case of any misrepresentation of facts, Intel reserves the right to take disciplinary action including and up to termination in accordance with Intel’s Code of Conduct.

I understand and agree to the following:

Release of Liability and Informed Consent
I understand that the Supplementary COVID insurance plan Program is only being facilitated by Intel . Services under this Program is provided by third party vendors and Intel is not liable for the services availed including but not limited to quality of care, infrastructure and equipment.

I hereby release Intel and any other juridical person(s) including Medi Assist Healthcare Services Private Limited associated with this Supplementary COVID insurance plan Program, their affiliates, directors, officers, employees, agents, representatives, subcontractors, successors and assigns, from any liability arising from or in any way connected with my participation in this program and related services.

I could be asked for clarification or additional supporting documentation before the reimbursement claim is approved. Intel reserves the right to reject claims if the supporting documentation is found inadequate, inaccurate or otherwise against the stated policy of the Supplementary COVID insurance plan Program.

Employees are liable to ensure all claim details and supporting documentation submitted (including payment receipts, doctor’s receipts and other documents) for the purpose of reimbursement is true and correct. In case of any misuse of the guideline including misrepresentation of facts, Intel reserves the right to take disciplinary action including and up to termination in accordance with Intel’s Code of Conduct policy.

As a part of the claims verification and audit process, Medi Assist, acting on behalf of Bajaj Allianz General Insurance reserves the right to contact and / or visit the service provider to verify the authenticity of the claims.

Intel reserves the right to amend or withdraw altogether the services being offered under the Supplementary COVID insurance plan Program at any point in time without prior notice.

Personal Data and Confidentiality

I, confirm that my participation in the Supplementary COVID insurance plan Program is voluntary and hereby give consent to the use of sensitive personal data of my family (i.e.) Child or Children, Spouse and Parents or Parents-in-law information. I understand the sensitive personal data or information may be accessed from the MediBuddy Portal of Medi Assist Healthcare Services Private Limited to ascertain employee eligibility for the reimbursement program and to track program usage. I understand that Intel has reviewed MediBuddy Portal of Medi Assist Healthcare services Limited & Medi Assist Insurance TPA Private Limited and not reviewed the Medi Assist mobile app and Intel does not encourage the use of the Medi Assist mobile app and employees may use it at their own risk. The importance of safeguarding sensitive personal data or information is recognised and all persons viz. natural or juridical involved in this Outpatient Program are obligated and shall take reasonable steps to protect such sensitive personal data or information from unauthorised access or use. Employees are responsible to enroll dependents adhering to the policy guidelines. In case of any misrepresentation of facts, Intel reserves the right to take disciplinary action including and up to termination in accordance with Intel’s Code of Conduct.

I understand and agree to the following:

Release of Liability and Informed Consent
I understand that the Supplementary COVID insurance plan Program is only being facilitated by Intel . Services under this Program is provided by third party vendors and Intel is not liable for the services availed including but not limited to quality of care, infrastructure and equipment.

I hereby release Intel and any other juridical person(s) including Medi Assist Healthcare Services Private Limited associated with this Supplementary COVID insurance plan Program, their affiliates, directors, officers, employees, agents, representatives, subcontractors, successors and assigns, from any liability arising from or in any way connected with my participation in this program and related services.

I could be asked for clarification or additional supporting documentation before the reimbursement claim is approved. Intel reserves the right to reject claims if the supporting documentation is found inadequate, inaccurate or otherwise against the stated policy of the Supplementary COVID insurance plan Program.

Employees are liable to ensure all claim details and supporting documentation submitted (including payment receipts, doctor’s receipts and other documents) for the purpose of reimbursement is true and correct. In case of any misuse of the guideline including misrepresentation of facts, Intel reserves the right to take disciplinary action including and up to termination in accordance with Intel’s Code of Conduct policy.

As a part of the claims verification and audit process, Medi Assist, acting on behalf of Bajaj Allianz General Insurance reserves the right to contact and / or visit the service provider to verify the authenticity of the claims.

Intel reserves the right to amend or withdraw altogether the services being offered under the Supplementary COVID insurance plan Program at any point in time without prior notice.

Personal Data and Confidentiality

I, confirm that my participation in the Supplementary COVID insurance plan Program is voluntary and hereby give consent to the use of sensitive personal data of my family (i.e.) Child or Children, Spouse and Parents or Parents-in-law information. I understand the sensitive personal data or information may be accessed from the MediBuddy Portal of Medi Assist Healthcare Services Private Limited to ascertain employee eligibility for the reimbursement program and to track program usage. I understand that Intel has reviewed MediBuddy Portal of Medi Assist Healthcare services Limited & Medi Assist Insurance TPA Private Limited and not reviewed the Medi Assist mobile app and Intel does not encourage the use of the Medi Assist mobile app and employees may use it at their own risk. The importance of safeguarding sensitive personal data or information is recognised and all persons viz. natural or juridical involved in this Outpatient Program are obligated and shall take reasonable steps to protect such sensitive personal data or information from unauthorised access or use. Employees are responsible to enroll dependents adhering to the policy guidelines. In case of any misrepresentation of facts, Intel reserves the right to take disciplinary action including and up to termination in accordance with Intel’s Code of Conduct.

I understand and agree to the following:

I understand that the Flu Vaccination Program is only being facilitated by Intel . Services under this Program is provided by third party vendors and Intel is not liable for the services availed including but not limited to quality of care, infrastructure and equipment.

I hereby release Intel and any other juridical person(s) including Medi Assist Healthcare Services Private Limited associated with this Flu Vaccination Program, their affiliates, directors, officers, employees, agents, representatives, subcontractors, successors and assigns, from any liability arising from or in any way connected with my participation in this program and related services.

Flu vaccination should not be taken if:

1. You have any fever, flu symptoms, allergic disorder or any health problems on the day of vaccination.
2. You are allergic to any vaccines, chicken, eggs or egg products
3. You are a pregnant or breast feeding - seek permission from your doctor to take the flu vaccination.
4. It is mandatory for you to sign and submit the consent form to the medical staff at the time of taking the vaccination.
5. FluQuadri® is an inactivated quadrivalent influenza vaccine indicated for the prevention of influenza disease caused by influenza type A and B viruses contained in the vaccine and not for COVID-19.
6. Currently this service is available only in 8 cities across India (Bengaluru, Hyderabad, Mumbai, Delhi, Noida, Gurgaon, Pune, and Chennai). If your requirement is outside these 8 cities, do write a request to Medi Assist and they will try to assist you. Please note this is will take time and depends on the center in your requested city accepting the empanelment and hence the Medi Assist decision will be final here

Personal Data and Confidentiality

I, confirm that my participation in the Flu Vaccination Program is voluntary and hereby give consent to the use of sensitive personal data of my family (i.e.) Child or Children, Spouse and Parents or Parents-in-law information. I understand the sensitive personal data or information may be accessed from the MediBuddy Portal of Medi Assist Healthcare Services Private Limited to ascertain employee eligibility for the program and to track program usage. I understand that Intel has reviewed MediBuddy Portal of Medi Assist Healthcare services Limited & Medi Assist Insurance TPA Private Limited and not reviewed the Medi Assist mobile app and Intel does not encourage the use of the Medi Assist mobile app and employees may use it at their own risk. The importance of safeguarding sensitive personal data or information is recognised and all persons viz. natural or juridical involved in this Flu Vaccination Program are obligated and shall take reasonable steps to protect such sensitive personal data or information from unauthorised access or use. Employees are responsible to enroll dependents adhering to the policy guidelines. In case of any misrepresentation of facts, Intel reserves the right to take disciplinary action including and up to termination in accordance with Intel’s Code of Conduct. Intel/Medi Assist/Sanofi or its employees, agents, representatives shall not be responsible for any direct, indirect or consequential damage resulting during or after the vaccination.