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Www.mediassistindia.com GMC Policy Presentation VA Tech WABAG Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 1.

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Presentation on theme: "Www.mediassistindia.com GMC Policy Presentation VA Tech WABAG Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 1."— Presentation transcript:

1 GMC Policy Presentation VA Tech WABAG Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 1

2 Salient features of the Policy are given in this presentation. For Complete Information Please Refer the Policy Documents. Disclaimer 2 Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation

3 The insurance provides cashless/ reimbursement of hospitalization expenses incurred in India for the treatment of illness/diseases or injuries sustained by the insured person during the period of insurance. What is Mediclaim Insurance ? 3Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation

4 Policy Conditions Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 4 Sum Insured : The Amount up to which a claim for medical hospitalization can be made. Coverage is individually (Rs / Rs / Rs ) Current Policy period :16/06/2013 to 15/06/2014 Major exclusions applicable for standard policies are waived in this policy. Hence the policy has wider cover as follows: All pre existing diseases are covered from day one First 30 days waiting period not applicable. 1 year, 2 years & 4 years exclusions for specific ailments/treatments not applicable Family definition: Self, Spouse, 2 dependent children and 2 dependent parents New born baby covered from day one Internal Congenital disease covered under life threatening circumstance

5 Any institution in India established for Indoor care and treatment of sickness and injuries and which either: has been registered as a hospital or nursing home with the local authorities and is under the supervision of a registered and qualified medical practitioner OR Should comply with minimum criteria as under: üAt least 15 in-patient beds (for class C cities 10) üFully Equipped operation Theatre of its own wherever surgical Operations are carried out. üFully Qualified Nursing staff under its employment round the clock The term Hospital/Nursing home shall not include an establishment,which is a place of rest, a place for the aged, a place for drug addicts or for alcoholics, a hotel or a similar place Hospital / Nursing Home Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 5

6 The below given medical Expenses are payable If any insured person suffers an illness or accident during the policy period which requires the hospitalization as an inpatient Room Rent, Boarding Expenses & Nursing: 1% of S.I + Rs.2000 * Intensive care Unit:2% of S.I + Rs.4000 * A Medical practitioner, Anesthesia, Blood, Oxygen, Operation theatre charges, surgical appliances Medicines, drugs and consumables Diagnostics procedures The cost of prosthetic and other devices or equipment if implanted internally during a surgical procedures Disease wise Capping: Cataract Rs Per eye and No Capping for other diseases Hospitalization: Admission into hospital for medically necessary treatment as an inpatient for continuous period of at least 24 hours * Proportionate clause applicable if room rent exceeds eligibility limit What are the expenses Reimbursable? 6 Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation

7 Maternity Benefit Maternity expenses are covered for 2 children. The insured person who are already having two or more living children will not be eligible for this benefit Normal Delivery Expenses Capped To : Rs Cesarean (C-section) Delivery Expenses Capped To:Rs months waiting period waived Pre-natal and post-natal expenses are not covered unless admitted in Hospital/Nursing Home and treatment is taken there New Born Baby covered from day one Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 7

8 Pre-Hospitalization: The Medical Expenses incurred due to an Illness in the 30 days immediately before the Insured Person was Hospitalized, provided that: Such Medical Expenses were in fact incurred for the same condition for which the Insured Person’s subsequent Hospitalization was required Post-Hospitalization: The Medical Expenses incurred in the 60 days immediately after the Insured Person was discharged post Hospitalization provided that: Such costs are incurred in respect of the same condition for which the Insured Person’s earlier Hospitalization was required Pre and Post Hospitalization Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 8

9 Treatment undertaken in a hospital/Nursing Home on the recommendation of medical Practitioner for the following diseases, Illness or injury which requires hospitalization for less than 24 hours: Dialysis Chemotherapy Radiotherapy Eye Surgery Lithotripsy (Kidney stone removal) Tonsillectomy Dilatation & Curettage Hydrocele Surgery Hernia Repair Surgery Sinusitis Coronary Angiography Day care procedure Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 9

10 LASIK surgery for correction of eyesight, Contact lens, Spectacles, Hearing aids including Cochlear implants Dental treatment unless arising due to accident Medical termination of pregnancy / abortion within 12 weeks Sterilization procedures, treatment of infertility/sub-fertility/ Assisted conception procedures Plastic and cosmetic surgery, vaccination, inoculation, circumcision External “congenital” disease, anomalies, defects Intentional self injury / suicide attempt, psychiatric and psychosomatic disorders Direct / indirect effects of use of alcohol / intoxicating drugs AIDS and related syndromes “Technical admission” –Admission for diagnostic/evaluation without active line of treatment Expenses on vitamins or general tonics Naturopathy treatment Policy Exclusion

11 Pre and post expenses related to maternity claim Unproven procedure/ treatment, experimental or alternative medicine/treatment including acupuncture, acupressure, magneto- therapy, RFQMR, etc. Genetic disorders/stem cell implantation/surgery External equipments like CPAP, CAPD, infusion Pump etc., ambulatory devices like walker/ crutches/ belts/ collars/caps/ splints/ slings/ braces/ stockings/ diabetic foot-wear/ glucometer/ thermometer & similar related items & any medical equipment which could be used at home subsequently Treatment for obesity or condition arising therefrom (including morbid obesity) and any other weight control program/ services/ supplies. Massages/ Steambath/ Surodhara & alike Ayurvedic treatment. Any kind of service charges/surcharges, admission fees/registration charges etc. levied by the hospital. Policy Exclusion

12 Actionable By Employee: § Login to india.com § Click on “Login” link in the website § Click on “Corporate Employee” § Login through below given credentials § Update Your Mobile Number & ID under “Employee Contact Details” § Check Data under “Beneficiary Details” § Change Password by Clicking “Forgot Password” in Login Page § Always click “Log out” after accessing your account Employee login: § Username : wabag § Password : vatechwabag Snapshots are given in following slides for easy reference. E - Login Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 12

13 Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 13 E – Login Cont…

14 Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 14 E – Login Cont…

15 Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 15 E – Login Cont…

16 Cashless Facility Emergency Admission Planned Admission (48 hrs in advance) Insurance Help Desk at the Hospital Hospital Admission Insurance Help Desk Pre-Authorization Process

17 Please submit the following documents in original along with completed claim form within 15 days from the date of discharge Discharge Summary Final Hospital Bill (with detailed break-up) & Receipts Medicine Bills along with Doctor’s Prescriptions Investigations & Test Reports with Doctor’s prescriptions. If original is required for future treatment, please submit photocopies duly attested by the treating doctor with his signature & seal In case of non-availability of prescriptions, kindly ask your Physician to countersign on the reverse of pharmacy bills Process of Reimbursement Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 17

18 Please send all the documents to Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 18

19 Escalation Matrix Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 19

20 Wish You & Your Family A Healthy & Happy Future !!! -Team & Medi Assist Thank you… Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 20


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