1. ITTI Pvt. Ltd.,
MEDICLAIM INSURANCE

2. Insurance Co Name – United India Insurance Co Ltd
Insurance Co Name – United India Insurance Co Ltd., Mission Rd Branch, Bangalore.
Broker Name – Mahindra insurance Brokers, Bangalore.
TPA – Mediassist India TPA Pvt Ltd., Bangalore.
Cover Start Date and end date

3. Salient Features Of Mediclaim Policy
Mediclaim Policy covers in-patient hospitalization expenses provided the hospital stay is for minimum period of 24 hrs.
However this time limit is not applied to specific treatments like Dialysis, Chemotherapy, Radiotherapy, Eye Surgery, etc. where the insured is discharged on the same day.
Employee + Spouse + 2 kids + 2 Dependent Parents only
Sum Insure – Rs. 2 Lac family Floater
10 % co pay for each and every claim.

4. Add on Covers
Pre-existing disease cover is an extension wherein the policy covers any disease or ailment existing prior to the inception of the policy.
30-days exclusion waiver is an extension wherein any medical expenses incurred during the first 30 days of inception of the policy is covered.
1st year exclusion waiver is an extension wherein few diseases not covered under normal circumstances during first year of the inception of the policy will be covered.
Pre & Post Hosptalization - The policy will cover all medical expenses incurred for 30 days prior to hospitalization as well as expenses incurred for 60 days post hospitalization.

5. Add On Covers....Contd
Maternity Cover under which maternity expenses for employee and spouse are covered up to a specified limits for both Normal – Rs.
25,000 & Cesarian Delivery – Rs. 35,000.
Waiver of 9 month waiting period for Maternity coverage.
New Born Baby Cover under which new born baby is covered from birth i.e. day 1 with in the SI.
Ambulance Charges up to Rs in case of emergency.
Room rent and other charges – Normal 1% SI and ICU 2% of SI
Cataract - Up to 10% of SI per eye.
Day care treatments – Covered up to SI

6. Exclusions
Injury or diseases caused by invasion, war, act of foreign enemies, etc.
Circumcision unless necessary for treatment of a disease covered.
Cosmetic treatment or plastic surgeries other than those necessitated
by an accident or any illness.
Cost of spectacles, contact lens or hearing aids.
Dental treatment or surgery unless requiring hospitalization in case of an accident.
Convalescence, general debility, run down condition, congenital
external disease or defects, venereal disease etc. kindly see the link. Please go to the section mentioned exclusions.

7. Exclusions…Contd
Any medical treatment undergone because of intentional self injury or consumption of intoxicating drugs or alcohol.
AIDS or any of its variant.
Expenses on vitamins and tonics unless forming part of treatment for injury or disease as certified by the attending physician.
Hospitalisation solely for the purpose of testing not covered.
Injury or disease directly or indirectly caused by or contributed to or by any nuclear weapon or materials.
Naturopathy Treatment

8. DEFINITIONS OF HOSPITALS
An institution established India for indoor care and treatment of sickness.
Registered with local authorities
Under supervision of a registered and qualified medical authorities
Minimum of 15 inpatient beds(incase of smaller cities and towns the bed count is a minimum of 10)
Fully equipped operation theatre
Fully qualified nursing staff available 24/7
Fully qualified doctors available 24/7

10. MIBL as the nodal agency…
“As an Intermediary our mission is to ensure best possible services to our ultimate customers by blending technology with experience and expertise”
INSURED (Members)
MIBL
INSURANCE CO.
TPA’s

11. - Handling all policy related queries
Value Added Services
- Handling all policy related queries
- Assist in Admissions / Discharge in Network hospitals*
- Assist in case of Emergency
-Conduct Employee Orientation on Policy related issues
-Collection of claims forms
-Verification of documentation / Checklist
-Follow-up for deficient documents
-Handing over payment of settled claims.
Enhance
Employees’ Morale

12. Claims Management
Third Party Administrators, the Company that administers the plan on behalf of Insurance Company, will handle the claims.
If Non-TPA approved hospital is used the employee will first pay the bill and forward the documents to MIBL to facilitate faster claims settlement.
In emergency one can
first get admitted and
then get approval
Employee
I card
Tied hospital
TPA
Pre-approval
Claim-settled by
TPA directly

13. Claims Management Settlement / Rejection / Disallowance
Member Reimbursement Claim (MRC)
Network Hospital Claim
At MIBL/TPA – Document verification
Incomplete Documents
Complete Documents
At TPA Claims
Processing / Medical scrutiny
Receipt of missing document
Settlement / Rejection / Disallowance

14. PRE-AUTHORIZATION PROCESS FOR CASHLESS
Employer / MIBL / Hospital
Sends intimation to
TPA
Employee approaches
TPA / MIBL / Hospital with Mediclaim Card
Eligibility
Out of Pocket
payment
Not
Covered
Covered
Cashless treatment
at NWH
Authorization as
per eligibility

15. Protocol for Availing Treatment in Non Network Hospital
(Reimbursement Claim)
Member avails treatment at any hospital and makes upfront payment
Member submits bills to
MIBL / TPA Help desk
MIBL / TPA representative verifies the documents submitted
In case of incomplete documents recovery of documents for scrutiny
MIBL sends papers to TPA who process the claim and provides the cheque

16. Standard Claim documents
Duly filled Claim form.
Detail Hospital final Bills with break ups.
Payment Receipts for above bills
Hospital Discharge Card / Discharge Summary.
Cash Memos of the chemists supported by Doctors prescription.
Pathological & Medical Investigation reports.
Bills and receipts for above tests etc
Claim Bill / Statement of total expenses incurred.
All the originals should be submitted, keep a copy of the same.
Additional documents as may be required case to case basis.
For any kind of further information please also log onto

17. Escalation Matrix: M/s. Mediassist India TPA Pvt. Ltd.,
1st point of contact
Prathibha, Corporate Relations /
2nd Level of contact
Mr. S. Venkatakrishnan, Corp Service Manager

18. Contact Details - MIBL Mr. Rebanta Sanyal Level 1
Mr. Rohit Mehrotra – Business Head – Commercial Level 4
Mobile No
Mr. K. Sai Prasad - Area Manager –Commercial Level 3
Mobile No
Mr. Swapnandu Das – Territory Manager Commercial Level 2
Mobile No
Mr. Rebanta Sanyal Level 1
Mobile No

19. Thank you for your attention!!