ITTI Pvt. Ltd., MEDICLAIM INSURANCE

ITTI Pvt. Ltd., MEDICLAIM INSURANCE

• 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 02-11-2013 and end date 01-11-2014

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.

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.

Add on Covers

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. 1000 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

Add On Covers....Contd

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. www.mediassist.com. Please go to the section mentioned exclusions.

Exclusions

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

Exclusions…Contd

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

INSURED (Members)

TPA’s

MIBL as the nodal agency…

MIBL

INSURANCE CO.

“As an Intermediary our

mission is to ensure best

possible services to our

ultimate customers by blending

technology with experience and

expertise”

Value Added Services

-Collection of claims forms

-Verification of documentation / Checklist

-Follow-up for deficient documents

-Handing over payment of settled claims.

- Handling all policy related queries

- Assist in Admissions / Discharge in Network hospitals*

- Assist in case of Emergency

-Conduct Employee Orientation on Policy related issues

Enhance

Employees’ Morale

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 In emergency one can first get admitted and first get admitted and

then get approvalthen get approval

Employee

EmployeeI cardI card

TPA

TP

A

Tied

hos

pita

l

Tied

hos

pita

l

Pre-approval

Pre-approval

Cla

im-s

ettle

d by

Cla

im-s

ettle

d by

TP

A d

irect

ly

TPA

dire

ctly

Claims Management

Member Reimbursement Claim

(MRC)

Complete Documents

Incomplete Documents

Network Hospital Claim

At MIBL/TPA – Document verification

Settlement / Rejection / Disallowance

Claims Management

At TPA Claims Processing / Medical scrutiny

Receipt of missing document

Eligibility

Covered

Not

Covered

Employer / MIBL / Hospital Sends intimation to

TPA

Authorization as per eligibility

Out of Pocket payment

Employee approaches TPA / MIBL / Hospital with Mediclaim Card

Cashless treatment at NWH

PRE-AUTHORIZATION PROCESS FOR CASHLESS

MIBL sends papers to TPA who process the claim and provides

the cheque

MIBL sends papers to TPA who process the claim and provides

the cheque

MIBL / TPA representative verifies the documents

submitted

MIBL / TPA representative verifies the documents

submitted

In case of incomplete documents recovery of documents for scrutiny

In case of incomplete documents recovery of documents for scrutiny

Member avails treatment at any hospital and makes upfront payment Member submits bills toMIBL / TPA Help desk

Protocol for Availing Treatment in Non Network Hospital

(Reimbursement Claim)

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 www.mediassist.com

Escalation Matrix: M/s. Mediassist India TPA Pvt. Ltd.,

• 1st point of contact• Nagesha, Corporate Relations• 9342533651 / 080 26590504/05/06 • [email protected]• 2nd Level of contact• Mr. S. Venkatakrishnan, Corp Service Manager• 9686195495• [email protected]

Contact Details - MIBL

Mr. Rohit Mehrotra – Business Head – Commercial Level 4 Mobile No - 9967714700 [email protected]

Mr. K. Sai Prasad - Area Manager –Commercial Level 3 Mobile No - 9900977229 [email protected]

Mr. Swapnandu Das – Territory Manager Commercial Level 2 Mobile No- 09886894199 [email protected]

Mr. Rebanta Sanyal Level 1Mobile No- [email protected]

Thank you for your attention!!