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Mediclaim process. Contact Details of HR for Mediclaim Assistance. What is Mediclaim Insurance?.
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What is Mediclaim Insurance? Insurance Company provides Cashless/ reimbursement of hospitalization expenses incurred in India for the treatment of illness/diseases or injuries sustained by the employee and other beneficiaries during the period of insurance
What is a Hospital / Nursing Home Any institution in India established for Indoor care and treatment of sickness and injuries and which has either been registered as a hospital or nursing home with the local authorities and is under the supervision of a registered and qualified medical practitioner OR Should at least have minimum of 15 beds (for class C cities 10) + Operation Theatre etc. and must be run by a Registered Medical Practitioner
Your Policy Details – (1/2) Policy Period 1stApril 2013 To 31st March 2014 Sum Insured As per policy Copy the Sum Insured Family Floater Family Flaoter Policy covers, Self +2 dependents children + Dependent parents* Deduction for parents coverage 1% of the total sum insured for each parent will be deducted from the salary
Your Policy Details - (2/2) Maternity Benefits Maximum upto Rs. 50,000/-or the actual whichever is lower Coverage for Children 2 Living Children covered New Born Baby Coverage/ Limit Baby covered from day one Room Rent and Nursing Charges Room Rent not exceeding 1% of the Sum Insured per day or the actual amount whichever is less ICU & Nursing Charges ICU expenses not exceeding 2% of suminsured per day
Important Point to be Noted – Intimations towards admission should be given within 24 hours of Hospitalization / injury Claim Submission within15 days from discharge Pre Natal- Post Natal Expenses not covered unless admitted in Hospital/ Nursing home and treatment is taken there. No Caps on Claims
Coverage Details All Pre existing diseases are covered from day one. Pre Hospitalization charges payable for the period of 30 days prior to Hospitalization. Post Hospitalization charges payable for a period of 60 days from the date of discharge. All Surcharges, service charges, admission fees, registration charges levied by the hospital are NOT payable. Domiciliary treatment and hospitalization limit (Part of Sum Insured) not covered.
What is Covered in the policy ? MEDICAL expenditure such as : Room & Boarding Expenses. Nursing Expenses. Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees. Anaesthesia, Blood, Oxygen, OT charges, Surgical expenses. Medicines & Pharmacy Expenses. Diagnostic materials and X-ray Expenses. Dialysis, Chemotherapy, Radiotherapy Expenses. Cost of pacemaker, Artificial Implants & similar expenses.
What is NOT covered in the policy? (1/2) All Non Medical Expenditure. Food purchased from Hotels / Hospital Canteen Naturopathy Treatment. Cost of vitamins/tonics unless forming part of treatment for the covered disease. Cosmetic Surgery, Spectacles, contact lens, hearing aids. Treatment for Infertility Beauty Treatment of any description. Plastic surgery (other than necessitated due to accident).
What is NOT Covered in the policy?(2/2) • Treatment of AIDS, HIV, VD (STD). • Accident treatment under the influence of Alcohol or intoxicating drugs. • Congenital External Disease, defects or anomalies. • Out patient treatment. • Dental treatment • Disease or accident due to adventure sports. • Intentional self Injury. • The exhaustive list of not payable items are attached
General Terms & Conditions Hospitalization Period • Minimum Hospitalization should be for the period of 24 Hours • Every Individual has to give a claim intimation giving the details of patient name / phs id no./ ailment / date of admission / hospital name/ contact nos. etc • Reimbursement/ Cashless Intimation should be mailed to • Mr. NiteshPadwal on nitesh.padwal@rpgls.com with a copy to • intimation@ttkhealthcareservices.com • Day Care Procedures that do not require 24 hours hospitalization : • Dialysis, • Chemotherapy, • Radiotherapy • Cataract • Eye surgery • Lithotripsy (kidney stone removal) • D & C • Tonsillectomy
Format for Claim Intimation From : xyz@gmail.com • To : nitesh.padwal@rpgls.com • CC: intimation@ttkhealthcareservices.com Subject: Claim Intimation Please note the hospitalization intimation as per the details given below: TTK ID : ___________________ Employee Name : __________________ Employee Code: ______________________ Patient Name : ________________________ Name of the Hospital: ____________________ Date of Hospitalization: __________________
Identity Cards TTK will issue Identity Card to each employee and their dependants. No physical cards will be issued to any employee. Employee can take the printout of the e-card which is available on TTK website. IMPORTANT: The card is issued only for identification purpose & should not be construed as an Authorization to the hospitals to proceed with the treatment.
Cashless Facility • To avail the cashless facility from the TTK network hospital, policyholder/employee/person accompanying the patient need to provide TTK card details to hospital, hospital in turn will send the details to TTK Mumbai • Following details to be provided to hospital on admission/ before admission • TTK ID Card Number of patient (not mandatory, employee number will do) Mobile Number, Corporate Name, valid ID proof of patient • Hospital will fill the following details and send it to TTK Mumbai (mumpreauth@ttkhealthcareservices.com) • - Nature of illness/ disease/ injury. • - The remarks of the recommending physician or the treating physician’s name, address & contact no
Cashless Facility • - The hospital where the policyholder intends to take treatment • - The estimated cost etc. • The preauthorization request should be sent atleast48 hours before admission. • TIPS TO MAKE CASHLESS HASLE FREE • Give Mobile number on the Pre authorization form • Valid photo ID proof of patient at the time of admission • Prior investigation reports, based on which hospitalization recommended
Pre-authorization Form Part I- Has to be filled by the employee/ the person accompanying the patient Part II- Has to be filled by the hospital authorities
Authorization Upon receipt of cashless request from hospital to TTK Mumbai, our team of Dr’s, review the details and decide on admissibility (shortfall, Approval, Denial) 1: shortfall: Any further document required to process claim further, to be submitted by hospital 2: Approval: If all documents are in line to take decision, then initial approval given to hospital (this is initial, and not final approval), upon receipt of final bill and discharge summary, final decision will be taken 3: Denial: Based on policy T & C if the said ailment is not covered, the denial letter with reason will be intimated to fax Authorization is given by our medical team subject to policy terms & conditions such as extension of coverage for the ailment, balance sum insured etc. Authorization is rarely denied unless the policy disallows it specifically or sum insured balance is unavailable.
Claim Settlement – Cashless Please ensure that the bills are signed either by the Claimant / employee at the time of discharge Please note : Cashless Hospitalization facility is available only at Network Hospitals listed by TTK
Reimbursement Process (1/4) Please fill up the claim form of United Insurance Company Limited and attach the following documents in original for reimbursement claims: Original bills, receipts and discharge certificate / card from the hospital. Medical history of the patient recorded by the Hospital. Original Cash-memo from the hospital (s) / chemist (s) supported by proper prescription. Original receipt, pathological and other test reports from a pathologist / radiologist including film etc supported by the note from attending medical practitioner / surgeon demanding such tests. Attending Consultants / Anesthetists / Specialist certificates regarding diagnosis and bill / receipts etc. Surgeon’s original certificate stating diagnosis and nature of operation performed along with bills / receipts etc. Any other information required by TPA / Insurance Company.
Reimbursement Process (2/4) All the original bills / reports along with the filled up claim form has to be sent to respective HR Partners for processing
Reimbursement Process (4/4) Important Note: • The claim has to be sent within 7 days from the date of discharge • After initial scrutiny of the claim, the TTK may ask for additional documents, if required in the form of “Deficiency Letter” • On receipt of Deficiency Letter, the employee can send the necessary documents to respective HR Partner within 7 days of date of receipt of letter. In case of non-submission of additional documents asked by TTK, the claim may be rejected. • Please attach the deficiency letter also while sending the deficiency documents.
WHAT TO DO IN AN EMERGENCY ? In an accidental case or in medical emergency you are advised to approach nearest Network / Non Network Hospital with your ID Card. If the admittance is in network hospital you or your relatives or the hospital will send the preauthorization note to TTK (Helpdesk is open 24 hrs a day). TTK will verify the coverage and if covered issue the authority letter to network hospital. If you are in non network hospital you may pay the expenses and claim reimbursement based on the coverage.
Access to http://ttkhealthcareservices.com View to E card Check claim status Updated Hospital Network List
Steps to login to TTK Website Go to, http://ttkhealthcareservices.com Click yes if system prompts any security information alert.
Please turn off Pop-up blocker in tools bar Go to, “Please select login” Select : Employee login”
Please enter the below details: Group ID : R0403 Policy No : 121200/48/13/41/00000130 System would ask for change password once you login to the site. User ID : Employee number Password : Employee number
Click here for Policy number Please type your Group Code Please type your password Please type your Employee Number
Click here for claim status and select the name in respect of whom claim is made
