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IDEAL INSURANCE is one of the largest Insurance Broking house of India providing Risk Management Services to Corporate and Individuals. We provide a Comprehensive Solution to all your Insurance needs. We assure you of our total commitment to our clients’ well being and will ensure the Highest Quality of Service Standards. We are an specialist in Group Health Management and our technical expertise in the subject can help youThe Ideal Advantage:1) Lower your Premiums in the long run2) Manage your claims more effectively3) Design Suitable covers and customize it regularly to meet employee expectations4) Tie up With all Insurance Companies in India ensures we will give you the Best Deal and the Best Insurer5) We will design a Employee Wellness Programme which will ensure better health for your employees resulting into Better Productivity and Lower ClaimsWe assure you of our total commitment to your organizational well being and will always ensure the Best Risk Management Practices. You can drop an email at [email protected] (CEO, Ideal Insurance Brokers Pvt. Ltd.)
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Copyright 2011 by Health and insurance. All rights reserved
Presented By
Rahul Agarwal (CEO)
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Copyright 2011 by Health and insurance. All rights reserved
INSURANCE BROKERS
Insurance brokers are independent intermediaries who represent the client and not the insurance company, unlike an insurance agent who normally represents the company
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AND WHAT DO WE DO FOR YOU…
Identify and evaluate your needs
• Design your Insurance Portfolio
Choose the Right Product• Claims Handling• Legal Representation
Negotiate with the Companies for the most competitive rates
Assist in documentation
Claims Management- After all money matters
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ADVANTAGES OF GROUP HEALTH
Floater cover for Entire Family so higher cover at lower cost Lower Premiums than Individual Plans Easy Claims Settlement Pro Rate Premium if people leave Maternity Benefit Pre Existing Diseases Covered so all disease covered from day
one* Parents can be covered too without any Medical Tests upto age 80 some exclusions are there
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DETAILS OF GROUP HEALTH COVER NORMALLY TAKEN
Floater cover for Self+Spouse+2 Children upto 21 years of Age. Parents can be covered but the proportionate premium to be paid by the
Individuals Coverage
• Basic Hospitalization including 30 Days Pre and 60 Days Post Hospitalization
• Pre-Existing Diseases Covered • Maternity Cover subject to a limit of Rs 25000 for Caesarean and Rs
15000 for normal • Cashless Facility • Accidental Coverage only for the Employee
We need to divide your work group into 3-4 Tiers and give the Coverage Proportionately like Rs 5 lacs for Top Management, Rs 3 for Middle Mgmt., Rs 2 lacs for Lower Management and Clerical Staff and Rs 1 lac for Peon, Drivers, etc.
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ADVANTAGES WITH IDEAL INSURANCE
With Respect to Policy Designing
We help our clients get the best deal from across all Insurance Companies We provide Custom Designed Cover to suit client needs as well as to control claims in
the long term We take complete responsibility of any service/claims/other issues during the policy
period.
With Respect to Claims
Your employee needs to give us intimation during an unfortunate event of a claim and we take over from there managing all documentation, liasioning with the TPA and Insurer for speedy cashless/recovery and other necessary work
We will train all your employees about the procedure of claims so that the claim process becomes hassle free for them
We will provide a 24 hr. Helpline number for any Assistance We will give you One dedicated Service Manager for day-to-day requirements
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Wellness Programme
Benefits of Good Health are many like Better Efficiency, Less Absenteeism, Lesser Attrition, Lesser Claims, lesser Premium outflow, etc
Taking a Health Insurance cannot ensure good Health for your Employees.
At Ideal Insurance, we go that extra mile for our clients by creating a Wellness Programme specially customized for your People which includes
• Naturopathy Sessions with Specialists• Yoga Sessions • Regular Mails and News Letters on Wellness Ideas• Health Check-Ups (Cholesterol, blood pressure and glucose screening
programs)• Healthy Eating, etc
ADVANTAGES WITH IDEAL INSURANCE
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Wellness Programme
Procedure:
Phase I: Conducting the survey in the company to judge the requirements
1. Stress Management2. Smoking Cessation3. Weight Management4. Work-related health issues (in case any)5. Motivation for healthy routine (Good breakfast, Basic Exercise, Climbing Up, etc)
Phase II: Analyze the survey results to design a plan
Phase III: Implement the plan in the organization
ADVANTAGES WITH IDEAL INSURANCE
OUR GROUP HEALTH INSURANCE BUSINESS
We manage Group Health for more
than 20 Corporate clients
Total number of lives served is more
than 20000
We also provide Health Insurance to
more than 10000 individuals
We settle more than 1 claim every day
Our claims settlement ratio is 100%
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ABOUT YOUR POLICY
Insurer:
THIRD PARTY ADMINISTRATOR:
Coverage
Basic Hospitalization Expenses Incl. 30 Days Pre-Hospitalization and 60 Days Post Hospitalization
Cashless Facility (At Network Hospitals of TPA)
Pre-Existing Diseases
First Year Exclusion Waived
Maternity Expenses (9 months waiting period subject to the sub-limits)
25000 for Normal & 35000 for Caesarian Section
Exclusion
AIDS, Domiciliary Hospitalization, Day Care (Less than 24 Hrs)
Cost of Spectacles, Lenses, Cosmetic Surgeries, Pre Natal Defects
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ENROLMENT
You will be given
a HEALTH CARD
Please report any
error immediate
ly to us
This card entitles you
for identificatio
n as a member
Please carry a photo
identification with you
This card does not
entitle you to cashless
without pre authorization
This is NOT a credit card
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GUIDELINES FOR HASSLE-FREE CLAIMS
Approach Network Hospital on recommendation of Physician & Show Cashless Card at the Hospital• If the Disease is not covered
• Information sent is insufficient • Request for Cashless is not sent in time• However, you need to pay the bills which can be reimbursed later
Obtain a Pre-Authorization form and get it filled and signed by the treating doctor and submit to Hospital which will then fax it to the TPA along with other necessary reports• Submit the Pre-Authorization Form available with the Hospital
• Show your Cashless Card, Doctor’s Advice Letter, Probable Date of Admission so that • You will get the Cashless approval even before admission to the Hospital if cashless is approved by the
TPA
After investigation, TPA will fax the approval for Cashless to Hospital
Cashless can be rejected
In case of Planned Hospitalization
In case of Emergency Hospitalization
Go to the Hospital at least 72 Hours before admission and
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CLAIMS REIMBURSEMENT
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If Cashless is not approved or if you visit a Non-Network Hospital
• At the time of Discharge, settle the Hospital Bills in full and collect all the original BILLS, DOCUMENTS, REPORTS and DISCHARGE SUMMARY
• Lodge your claim with the TPA by filling the CLAIM form and attaching Necessary Documents within 7 Days of Discharge
Documents to be Submitted:
• Claims Notification - Within 3 Days of Admission via Letter/Fax/Email• Discharge Summary in Original with all Necessary Details• Detailed Bill –
• Proper Bills with Break-up of all the items/medicines/tests• Doctor’s Bills must be stamped, with Doctor’s Reg. No.
• All Supporting Prescriptions and Reports• Payment Receipt – Must be stamped and signed by Hospital Authorities• Any expenses not pertaining to the Medical Treatment are not covered
DO’S AND DON'TS
Store our Helpline No’s and Also give it to other Family Members
Find out whether the disease is covered in the policy or not
Always carry Cashless Card while going to the Hospital
Maintain All Bills inc. pre and post Hospitalization
Take the bill also from the family/consulting doctor
Never Disclose the amount of coverage to the Hospital
Do not go for very expensive treatment
Enquire about the Approx. cost of Treatment beforehand
Do not panic. Procedures and Rules have to be followed
No Need to call at Weird Hours
Push the Hospital Authorities to send all papers to TPA and
Follow up continuously
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REMINDERS
Your single point of contact with Ideal Insurance is • 98302 00799
Please provide your name, Insurance
Company, ID card no and phone number to
makes it easier for us to service you
Always carry your Health Card, it gives you faster access to
emergency healthcare
Do not wait till the last moment for a planned
treatment; it may become an emergency
any moment – GET THE PRE-
AUTHORIZATION DONE
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Thanks
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