FOR SIDDAGANGA INSTITUTE OF TECHNOLOGY Year 2012 - 2013 POLICY OVERVIEW INSURED SIDDAGANGA INSTITUTE OF TECHNOLOGY INSURER THE NATIONAL INSURANCE COMPANY LTD POLICY NUMBER 604203/48/12/8500000613 604203/48/12/8500000609 604203/46/12/8500000058 THIRD PARTY ADMINISTOR MEDI ASSIST INDIA TPA PVT LTD PERIOD OF INSURANCE FROM TO 19/10/2012 18/10/2013 Please Note: Policy features detailed in the following slides are only important highlights which are subject otherwise to the Terms, Conditions and Limitations of the Policy. Please refer to the Policy Schedule/Wordings issued by the Insurer for more details of the same. PAN India Presence Corporate Office • Bangalore Regional Offices Mohali Delhi Jaipur Lucknow Ahmedabad Jamshedpur Bhopal Indore Nagpur Bhubaneswar Surat Guwahati Patna Kolkata Mumbai Pune Vishakhapatnam Hyderabad Our Offices Mangalore Cochin Trivandrum Bangalore Chennai Coimbatore • • • • • Corporate office Regional offices Branch offices Mumbai Bangalore Chennai Kolkata New Delhi Branch Offices - 19 Year Manpower Strength 2007 400 2008 525 2009 750 2010 830 2011 1010 2012 1350 Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 3 POLICY COVERAGE The Mediclaim Policy Reimburses Hospitalisation Expenses incurred due to:Disease Illness or any bodily injury sustained through Accident Treatment done in a Hospital /Nursing Home / Day Care Centre on the advice of a qualified Physician / Medical Specialist / Surgeon As an Inpatient in the Hospital (fulfilling the definition of Hospital) For a minimum of duration of 24 hours DEFINITION OF HOSPITAL An institution established in India for indoor care & treatment of sickness and injuries Registered as Hospital or Nursing Home with local authorities Under supervision of registered & qualified medical practitioner Has minimum of 10 inpatient beds (In towns having less than 10 Lakhs population OR 15 inpatient beds if located in other towns Has fully equipped operation theatre of its own Has fully qualified Nursing Staff and Doctors and Maintains Daily Record for each Patient The Term Hospital or Nursing Home shall not include an establishment which is a place of rest, a place for the aged, a place for drug-addicts or place for alcoholics a hotel or a similar place POLICY COVERAGE Day Care Procedures where 24 hours hospitalization is not applicable Anti Rabies Vaccination Hysterectomy Appendectomy Inguinal/ventral/Umbilical/ Femoral Hernia Coronary angiography Coronary angioplasty Parenteral chemotherapy D&C of cervix Dental surgery following accident Prostrate Lithotripsy (Kidney Stone Removal) Eye surgery Fracture/dislocation excluding hairline fracture Radiotherapy Sinusitis Gastro Intestinal Tract System Stone in Gall Bladder, Pancreas and Bile Duct Haemo Dialysis Hydrocele Tonsillectomy Urinary Tract System Piles/ fistula Note: All ailment mentioned above will not be payable for the first two years of operation of the policy. admissible provided the treatment is taken in a registered Government EXPENSES COVERED 2.1 Room, Boarding and Nursing Expenses as provided by the Hospital / nursing home not exceeding 1% of Sum Insured Per Day for Normal Room or actual amount whichever is less. 2.2 Intensive CareHospital Unit (ICU) Expenses not exceeding 2% of sum Insred Per Day or actual amount whichever is less 2.3 Surgeon, Anaesthetist, Medical Practitioner, Consultants’ Specialist fees. 2.4 Anesthesia, Blood, Oxygen, Operation Theatre Charges, surgical appliances, Medicines & Drugs, Dialysis, Chemotherapy, Radiotherapy, cost of Artificial limbs, Cost of Prosthetic devices implanted during surgical procedure like Pacemaker and relevant laboratory/Diagnostic tests, X-ray and other medical expenses related to the treatment. 2.5 Pre-Hospitalization medical charges up to 30 days period immediately before insured’s admission to hospital for that treatment of illness or injury 2.6 Post-Hospitalization medical charges up to 60 days period immediately after insured’s admission to hospital for that treatment of illness or injury Expenses incurred on Ayurvedic / Homeopathic / Unani Treatment are admissible provided the treatment is taken in a registered Government IMPORTANT NOTE The amounts payable under 2.3 and 2.4 shall be at the rate applicable to the entitled room category. In case Insured opts for a room with rent higher than theExpenses entitled category as under 2.1,the charges payable under 2.3 and 2.4 shall be limited to the charges applicable incurred on Ayurvedic / Homeopathic / Unani Treatment are admissible provided the treatment is taken in a registered Government to the entitled category. Hospital No payment shall be made under 2.3 other than part of the hospitalization bill. Expenses incurred on Ayurvedic / Homeopathic / Unani Treatment are admissible provided the treatment is taken in a registered Government Hospital FEW NON MEDICAL EXPENSES NOT PAYABLE Following are few Non Medical Expenses which are not reimbursable under the Policy: Telephone charges Attendant's charges Home Visit/Nursing charges - at residence after discharge Assistant fee/Follow up charges in advance Sundry/Medico Legal Charges/Diabetic chart charges Thermometer Charges Container for Specimen/Disposable Bag charges Admission Kit External Surgical Aids: Lumbo-sacral/Collar belt /Knee cap/Knee brace/ walker/hot water bag/baby kit/urine pot / traction kit/ folding commode etc Inhaler/ Nebulizer /Glucometer or any other equipments Diet charges Special/protein diet/health drinks unless prescribed by the doctor Documentation/Folder/Stationery/In Patient chart charges Expenses on vitamins and tonics unless forming part of treatment Naturopathy Treatment, Acupressure, Acupuncture, Experimental and unproven treatment/therapies. (ABOVE LIST IS NOT EXHAUSTIVE. TO SEE THE COMPLETE LIST OF NON MEDICAL EXPENSES PLEASE VISIT OUT WEBSITE WWW.MEDIASSISTINDIA.COM) FEW MAJOR EXCLUSIONS Circumcision, Cosmetic or Aesthetic Treatment, Plastic Surgery unless required to treat any injury or illness Vaccinations and Inoculations, Vitamins and Tonics unrelated to treatment Cost of braces, equipment or external prosthetic devices, non-durable implants, eye glasses, cost of spectacles and contact lenses, hearing aids including cochlear implants and durable medical equipment All types of Dental treatments except arising out an accident Obesity treatment and its complications, congenital external disease/defects or anomalies, Treatment related to all psychiatric and psychosomatic disorders, Infertility, sterility, use of intoxicating drugs/alcohol, use of tobacco leading to cancer Intentional self inflicted injury, attempted suicide and arising out of non adherence to any medical advice Participation in hazardous sports of any kind, or any criminal act STD, AIDS and other related conditions Diagnostic, X-Ray or Lab expenses not consistent with or incidental to the diagnosis of positive existence of ailment Voluntary Termination of Pregnancy Naturopathy treatment, Experimental/Unproven treatment Service Charges and All Non Medical Expenses Domiciliary Hospitalization, Treatment taken outside India Note : Please refer to policy condition for full list of exclusions CASHLESS CLAIMS PROCESS This service enables the customer to avail treatment at the Network Hospital without being required to pay for the treatment. All expenses incurred will be paid to the Hospital after deducting non medical expenses subject to maximum limit of sum insured Please produce your Medi Assist ID Card to the Network Hospital where you wish to avail treatment. Additionally you will be required to provide a valid Photo ID proof such as Voter ID, PAN Card, Driving License etc to the hospital Kindly fill in the Medi Assist Card Number, Name of the Patient, Age & Contact Number in the Cashless Request Form The treating doctor/ hospital will fill in the remaining part of the Request Form & Fax it to Medi Assist for approval. Pre Authorisation approval for Cashless will be sent through Fax / Email to the Hospital Please Check & Sign the hospital bill before Discharge Avoid informing the hospital your total coverage details to prevent inflated billing Claims Processing – Pre-Authorization/ Cashless Medi Assist India TPA Pvt. Ltd | Private & Confidential 11 Network of Hospitals – Pan-India No. of Hospitals Number of Packages Hospitals with Discounts 582 30 29 27 13 192 2 14 3 418 11 18 17 7 1 - - Delhi Goa Gujarat Haryana 214 7 495 204 153 1 60 103 158 4 243 160 Himachal Pradesh 13 5 8 Jammu & Kashmir 15 2 5 Jharkand Karnataka Kerala Madhya Pradesh Maharashtra Nagaland Orissa Pondicherry Punjab Rajasthan Tamil Nadu Tripura Uttar Pradesh Uttaranchal West Bengal Grand Total 26 645 200 82 771 2 49 10 190 130 499 2 234 23 197 4690 1 188 22 9 331 11 85 33 243 85 8 75 1626 9 399 91 40 402 11 2 122 103 197 2 166 19 92 2704 State Andhra Pradesh Assam Bihar Chandigarh Chattisgarh Dadra & Nagar Haveli 1400 1351 657 1282 Zones Hospital Network West 1351 Bangalore 657 South 1282 North East Total 1400 4690 Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 12 PROCEDURE FOR REIMBURSEMENT CLAIMS Please submit the following documents in original Discharge Summary. (Original ) . Final Hospital Bill (with detailed break-up) &Cash paid Receipts (Original) Medicine Bills along with Doctor Prescriptions. Investigations & Test Reports. (Original) Duly Filled Claim Form with Signature. (can be downloaded from website: www.mediassistindia.com Bank Account Details of the Employee to be provided containing following details Name of Account Holder (Employee) as per Bank Records Bank Account Number Bank Name and Address IFSC Code Copy of cancelled cheque with all the above details Note: In case of non-availability of prescriptions, kindly ask your Physician to countersign on the reverse of pharmacy bills. Claims Processing - Reimbursement Claims Medi Assist India TPA Pvt. Ltd | Private & Confidential 14 PROCESS TO DOWNLOAD ID CARDS FROM MEDI ASSIST WEBSITE HR can access Medi Assist Website by following the steps below:- Log in to Medi Assist website www.mediassistindia.com Select Corporate Login from the Log in Title Log in Name shall be Employee Number followed by short name of Corporate Password will be shared separately by a welcome mail Employee can view the names of enrolled. Medi Assist India TPA Pvt. Ltd Turn Around Time (TAT) Process Turn Around Time (TAT) PRE-AUTHORIZATION Approvals processed within 1 Hour to 3 Hours maximum Planned hospitalization can be availed 2 days prior to admission REIMBURSEMENT CLAIMS Settlement: 15 working days by Electronic Fund Transfer (EFT) (after receipt of complete claim documents) Mandatory Requirements for Bank Account Details to be shared containing the following details in EFT Transfer addition to all claims documents • Full Name of Account Holder (Employee) as per Bank Records • Name and Address of Bank • IFSC Code • Copy of Cancelled cheque containing all above details Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation 16 SOME COMMON ERRORS THAT DELAYS SETTLEMENT OF REIMBURSEMENT CLAIMS Submitting document without claim form Quoting wrong claim amount on claim form Enclosing certificate from doctor instead of detailed discharge summary Not attaching original cash paid receipts and submitting details on prescription / hospital letter head instead of proper numbered receipt Incomplete documents: non submission of Lab reports, breakup for bills and medicine prescriptions Not providing Bank Account Details for effecting settlement of claims through EFT mode Providing Bank Account Details of a beneficiary instead of Employee Bank Account Claim Documents submitted after 30 days of Discharge for Main Hospitalization and beyond 7 days for Post Hospitalization Expenses. (Waiver of this condition is considered by Insurer in extreme cases of hardship where it is proved to the satisfaction of the Company that under the circumstances in which the insured was placed it was not possible for him or any other person to give such notice or file claim within the prescribed time-limit) CUSTOMER SERVICE CONTACTS Name Bhavya A L Email [email protected] Mobile 9342529734(Temp) Corporate Response 080–32942863 (9-30 am to 6 pm) Call Centre Toll Free Number 1800 425 9449 Accessible from any location in India. Multi lingual support available in English, Kannada, Hindi) ESCALATION MATRIX FIRST LEVEL Rajesh s [email protected] Mobile- 9379761657 SECOND LEVEL Shashikala ( Manager ) Email – [email protected] Mobile – 9379427268 ADDRESS FOR CORRESPONDENCE Medi Assist India TPA Private Limited Bangalore Branch No 45/A, “Green Arch", B Block, II Floor 1st Main Road, J P Nagar Phase III, Sarakki Industrial Layout, Bangalore 560078 Website: www.mediassistindia.com MediAssist Online! We are pleased to introduce to you MediAssist Online! This is a web-based self-service platform provided. With this selfservice application, you will be able to download soft copies of the Medi Assist cards for you and also check the reimbursement claim status. Steps to be followed for: Coporate HR Login Features: Beneficiary details Claims details E-card Change password option Logon to www.mediassistindia.com Click- on the tab login in the home page Online Access Online Access Click here- to enter your login details Click the Tab Corporate employee Username [email protected] Online Access Password Please enter your user name and password For Beneficiary Details Click this Tab For E Cards Click this Tab E Cards Can Be Printed E CARDS CAN BE PRINTED CLAIMS INFORMATION BY CLICKING THIS HYPERLINK GET MORE INFORMATION CLAIM BREAK UP DETAILS YOU CAN GET YOUR CLAIM DEDUCTIO CHEQ DET Online Issues If you have forgotten your password, or have problems logging into the system, please contact MediAssist directly by emailing quoting employee code and corporate name contact Ms. Bhavya A L [email protected] The same will be ratified within 3 working days from the receipt of the mail. Wish you a healthy life and happy future ! Thank you !!!