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 onlySum Insure – Rs. 2 Lac family Floater10 % co pay for each and every claim.
4 Add on CoversPre-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....ContdMaternity 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 SICataract - Up to 10% of SI per eye.Day care treatments – Covered up to SI
6 ExclusionsInjury 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 necessitatedby 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, congenitalexternal disease or defects, venereal disease etc. kindly see the link. Please go to the section mentioned exclusions.
7 Exclusions…ContdAny 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 authoritiesUnder supervision of a registered and qualified medical authoritiesMinimum of 15 inpatient beds(incase of smaller cities and towns the bed count is a minimum of 10)Fully equipped operation theatreFully qualified nursing staff available 24/7Fully 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)MIBLINSURANCE 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.EnhanceEmployees’ Morale
12 Claims ManagementThird 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 canfirst get admitted andthen get approvalEmployeeI cardTied hospitalTPAPre-approvalClaim-settled byTPA directly
14 PRE-AUTHORIZATION PROCESS FOR CASHLESS Employer / MIBL / HospitalSends intimation toTPAEmployee approachesTPA / MIBL / Hospital with Mediclaim CardEligibilityOut of PocketpaymentNotCoveredCoveredCashless treatmentat NWHAuthorization asper eligibility
15 Protocol for Availing Treatment in Non Network Hospital (Reimbursement Claim)Member avails treatment at any hospital and makes upfront paymentMember submits bills toMIBL / TPA Help deskMIBL / TPA representative verifies the documents submittedIn case of incomplete documents recovery of documents for scrutinyMIBL 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 billsHospital Discharge Card / Discharge Summary.Cash Memos of the chemists supported by Doctors prescription.Pathological & Medical Investigation reports.Bills and receipts for above tests etcClaim 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 contactPrathibha, Corporate Relations/2nd Level of contactMr. S. Venkatakrishnan, Corp Service Manager
18 Contact Details - MIBL Mr. Rebanta Sanyal Level 1 Mr. Rohit Mehrotra – Business Head – Commercial Level 4Mobile NoMr. K. Sai Prasad - Area Manager –Commercial Level 3Mobile NoMr. Swapnandu Das – Territory Manager Commercial Level 2Mobile NoMr. Rebanta Sanyal Level 1Mobile No