PowerPoint Presentation
Health Insurance
Mediclaim
1Medi Assist Medi Assist is a Third Party Administrator (TPA)
whos primary job is to help employee get benefit of medical
Insurance without hassles.
Health Insurance AssociationYOUHOSPITALMedi AssistTCILNational
Insurance Corporate: TCILHospital: Healthcare providerTPA: Medi
Assist India TPA Pvt LtdInsurer: Insurance company
Health Insurance1. Cover for unforeseen medical expenditure 2.
Reasonable healthcare expenses 3. Cashless hospitalization facility
4. Act as a Prudent Insured at all times
3The premium for this health policy is paid by HP.(FOR
EMPLOYEE,SPOUSE & 2 CHILDREN) Premium for dependent parents to
be borne by the employee
Policy ConditionSl.NoPolicy Conditions1 Maternity benefit
(Caesarian Rs.50000/-, Normal Rs-25000/-)for first & 2 children
only 2 Domiciliary hospitalization is excluded in the policy (
Hospitalization is compulsory )3 Pre-existing illness covered 4 Pre
& Post hospitalization 30days & 60 days 5 New born baby can
be covered after 3 months age 6 Waiting of 30days & 1st year
exclusion exists.7 Family Floater for Rs-10 lacs (For 10claiment
upto Rs-1lacs each) 8 Family size should not be more than 6members
(Self+Spouse+Two children + Dependant parents)9 Room Rent Cap of 1%
and ICU Rent Cap of 2% on SI per day as on 16-07-2010
Health Insurance By Medi AssistCashlessReimbursePre &
PostClaims PaidEnrollHealth InsuranceCards
5Medi Assist Identity Card Medi Assist ID card can be downloaded
from the Medi Assist
websitehttps://www.mediassistindia.com/Login.aspx?LoginTypeID=2
Username:employeeid@tcilPassword: tcil
Click on E- card
Get the printout of Medi Assist E-CardNote : It is very
important to remember that the Medi Assist ID card is NOT a credit
card. It is issued only for identification and information
purposes.
Cashless Hospitalization ProcessCashless hospitalization can be
availed only at Medi Assist network of Hospitals. The essence of
cashless hospitalization is that the insured individual need not
make an upfront payment to the hospital at the time of admission.
https://www.mediassistindia.com/Popup/HospitalSearch.aspx
Select the name of the StateSelect the name of the city TAT: 2-3
Hrs
The network hospitals have a preauthorization request form
available with them. The form has to be jointly filled in by you
and your treating doctor. Please make sure all the details asked in
the form are completely filled. This will ensure speedy processing
of your request.
This form is faxed to the Medi Assist toll free fax number.
Pre Authorization Letter
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In case coverage is available, Medi Assist will issue an
approval to the hospital for a specified amount depending on the
disease, treatment, how much you are insured for, etc. The approval
is called a "Preauthorization". This preauthorization entitles you
to avail cashless facility at the hospital without paying for the
medical expenses.In case, for whatever reason, the preauthorization
request cannot be approved, a letter denying preauthorization will
be sent to the hospital. In this case, you will have to settle the
hospital bill in full by yourself. Please note that denial of a
preauthorization request is in no way to be construed as denial of
treatment or denial of coverage. You can go ahead with the
treatment, settle the hospital bills and submit the claim for a
possible reimbursement. At the time of discharge, please make sure
that you check and sign the original bills and discharge summary.
Please carry home a copy of the signed bill, discharge summary and
all your investigation reports. This is for your reference and will
also be useful during your future healthcare needs.
Reimbursement Process TAT: 20-25 DaysIn case you choose to or
are required to avail of hospitalization facilities at a
non-network hospital, your medical expenses can still be claimed
through Medi Assist. This is called Reimbursement. Reimbursement
claims may be filed in the following circumstancesHospitalization
at a non-network hospitalPost-hospitalization and
pre-hospitalization expensesDenial of preauthorization on
application for cashless facility at a network hospital Claim
intimation - a notice of claim with full particulars of the
hospitalization has to be sent to the Medi Assist within 7 days
from the date of admission. Claim intimation can be registered
through Call Centre or mail to [email protected]
(mention the intimation number and date in the claim form while
submitting the claim documents after registering the intimation in
Medi Assist website https://www.mediassistindia.com/Index.html#
Click on claim IntimationTake the arrow to the Registration
Fill up the detail and submit the intimation & you will get
a Intimation ID
This online ID No. should be reffered to medi Assist for
Clarificationon Intimation.
Claim Reimbursement Form
Claim documents should be submitted within 30 days from the date
of discharge from hospital.Reimbursement claims can be submitted to
Medi Assist through registered post / courier or can be handed over
at any of its Branches. The documents that you need to submit for a
hospitalization reimbursement claim are:Original hospital final
billOriginal numbered receipts for payments made to the
hospitalComplete breakup of the hospital billOriginal discharge
summaryAll original investigation reportsAll original medicine
bills with relevant prescriptionsOriginal signed claim formCopy of
the Medi Assist ID card or current policy copy and previous years'
policy copies (if any)Covering letter stating your complete
address, contact numbers and email ID
The documents that you need to submit for a post-hospitalization
or a pre-hospitalization claim(30 days pre-hospitalization & 60
days post hospitalization benefits) are:
Copy of the discharge summary of the corresponding
hospitalizationAll relevant doctors' prescriptions for
investigations and medicationAll bills for investigations done with
the respective reportsAll bills for medicines supported by relevant
prescriptionsThis is not applicable in case of maternity related
expenses
Based on the processing of the claim, a denial or approval is
executed. In case of approval, a cheque is made out for the
approved amount and sent to you at the address mentioned in your
health insurance policy.In case your claim is denied, the denial
letter is sent to you by courier / post / e-mail quoting the reason
for denial of your claim.
Submit all bills and supporting documents to Medi AssistBills
& docsProcessInfoSubmitChequeYour claim is processed at Medi
AssistIn case any further documents are required, you are asked for
itCheque is prepared and despatched to the Help DeskProcess flow
for Reimbursement
21Documents to be submitted for pre and post-hospitalization
claims are:Copy of the discharge summary of the corresponding
hospitalizationAll relevant doctors prescriptions for
investigations and medicationAll bills for investigations done with
the respective reportsAll bills for medicines supported by relevant
prescriptions
Contact MediAssist Branch Office Delhi: Medi Assist India Pvt
Ltd, H 252, 2nd Floor, Kailash Plaza Building, Sant Nagar East Of
Kailash, New Delhi110065. Phone # 011-30913809 & 30913811 Fax#
01141624844; Toll Free Fax # 18004259559
Mr. Chandan Singh: [email protected] Mr Manish Kumar
: [email protected] Mr Niraj Kumar :
[email protected]. Faisal Khan:
[email protected] Escalations: Lease Plan
22Wish you a healthy and happy future !
Thank you
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