AGREEMENT BETWEEN THE ALANKIT HEALTH CARE LIMITED
INCORPORATED UNDER THE COMPANIES ACT 1956 AT NEW DELHI HAVING
ITS REGISTERED OFFICE 205-208, ANARKALI COMPLEX, JHANDEWALAN
EXTENSION, NEW DELHI -110055
FOR PROVIDING HOSPITALISATION AND/OR OUT PATIENT CARE TO AN
INDIVIDUAL COVERED UNDER THE ALANKIT HEALTHCARE SCHEME.
This Agreement made at
on the_
of
between ALANKIT
HEALTH CARE LIMITED a company duly registered under the Companies Act 1956,
having its Corporate Office at 2E/21, ALANKIT HOUSE,MARKET, JHANDEWALAN
EXTENSION, NEW DELHI - 110055 (hereinafter referred to as Company which
expression shall unless it be repugnant to the context or meaning thereof shall mean and
include its successors and assignees).
AND
Located at___________________________________
_______________________________(here in after referred to as Participating Provider
Hospital, which expression shall unless it be repugnant to the context or meaning thereof shall
mean and include its successors and assignees).
Where the company has formulated a SCHEME (hereinafter referred to as scheme) under which the individuals
who are enrolled under the scheme either individuals or in-groups are provided with hospitalization benefits AND
WHEREAS in pursuance of the providers of an agreement with the company has agreed to extend insurance cover
to the members on the terms and conditions, hereinafter appearing.
It is agreed and between the parties as follows: 1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
That the Company shall provide to each member, of the scheme, with an identification card with recent
photograph of the member, his/her name, age, sex, name of insurer, policy no, validity and card no. The
details of the benefits to which the member is eligible and conditions thereof and the monetary limit of
the insurance cover duly signed by the member and attested by an authorized person of Company which
shall be presented for purpose of assisting hospital in verifying member eligibility. For any verification
or clarification with regard to the status/eligibility of any member of the scheme during the validity
period of the scheme the hospital should correspond with the company.
The Company shall provide thirty days (30 days) advance notice to the Participating Provider Hospital of
any changes in covered services or conditions of coverage applicable thereto.
That the Participating Provider Hospital shall admit the member of the Scheme into the Hospital after
due verification of the member's eligibility by verifying all the details given on the identity card and give
the member appropriate treatment within the monetary limit specified therein, for covered services only.
In case the Participating Provider Hospital finds any tampering, false or incorrect information or any
thing to that effect in the identification card of any member of the scheme, the Participating Provider
Hospital shall immediately inform the company on which the company shall take necessary steps and
instruct the Participating Provider Hospital with regard to the eligibility of the member.
The Participating Provider Hospital shall not admit or treat any member if he/she falls under the general
exclusion specified in the Annexure hereto.
Except in an Emergency, Participating Provider Hospital shall provide Hospital inpatient Services to a
member only after the Participating Provider Hospital has received certification from the company in
advance of admission of each member. Services that have not been so approved or authorized shall be
the sole financial responsibility of the Participating Provider Hospital.
In case of any Emergency, the Participating Provider hospital shall inform the company with in 24 hours
of admission of a valid member by Fax, Telex, and Telegram. In case the admission of a member is
conveyed by Telephone call with in 24 hours the same should be confirmed by a Letter/Fax with in next
24 hours.
The Participating Provider Hospital shall submit/send to the company the original of the discharge
summary along with all original bills, prescriptions, diagnostic/investigation reports, pathological reports
accompanied by the claim from duly signed by insured within 7 days from the date of discharge of the
member from the Participating Provider Hospital. No claim shall be entertained after 30 days from the
date of discharge of the member of the scheme.
The Participating Provider Hospital shall make available to the company such information/additional
information and assistance as may be required by the company in regard to settlement of the claim of the
Participating Provider Hospital.
The Participating Provider Hospital shall be paid the bills amount within a period of 30 days of receipt of
complete bills at the company office.
The participating Provider Hospital shall give 10% discount on total bills to the clients of the company.
While making a claim the Participating Provider Hospital shall drawn the claim as permissible under the
rate card (hospital Tariff) and permitted by the company at the time of agreement.
This agreement shall be in force from the date herein above mentioned and either party can terminate the
agreement with a one month prior written notice to the other party.
For brevity sake it is agreed between the company and Participating Provider Hospital that various terms
as referred to in different clauses of this agreement shall have the same meaning as defined herein after
in Annexure-II.
The Participating Provider Hospital shall ensure that all members of the Scheme are admitted/treated as
the case may be on a priority basis in this context means making available to the members, services like
admission/treatment, beds on an urgent basis. The Alankit Healthcare member will be given due
preference or priority and shall not be held up for want of funds. In case there is no accommodation
available for the members in the Participating Provider Hospital the Provider shall make all attempts
through his good offices to accommodate and admit the member to other Hospital/Nursing Home,
subject to the confirmation from the concerned member. However, the company shall not be responsible
for the settlement of such bills, if the Hospital/Nursing Home is not a provider, recognized by the
company. (The member will have to settle the bills of such non recognized or non accredited
hospital/Nursing Home and forward the bills along with the case memos, pathological reports,
prescriptions, discharge card showing the details of the treatment etc. along with the claim form duly
completed and signed by insurer claim for settlement of claim to the member).
16. The company shall prescribe quality standards to the Participating Provider Hospital. It is mandatory for
the Participating Provider Hospital to adhere to these standards and they are subject to periodic
inspection and review.
17. The Provider will ensure the highest level of service to its members. The Doctors/Authorized
representatives of the company shall be free to visit Participating Provider Hospital to check quality
standards, review and discuss treatment. During such visit and enquiries, the representatives of the
company shall have full access to the member patient's medical records.
18. The Company as well as the Participating Provider Hospital shall have a right to terminate this
agreement at any time without assigning any reason by giving a 30 days prior notice.
19. The Participating Provider Hospital shall not take any deposit of any kind or any amount of money in
lieu of deposit at the time of admission from the members of the company.
20. The Participating Provider Hospital shall treat the members in the hospital only for the required number
of days for treatment and carry out only the required investigations/procedures for the particular ailment
or disease as the case may be for which the member has been admitted/checked as per guidelines to be
followed.
21. The Participating Provider Hospital shall have no objection to the Company using its name, as a
preferred provider, in their advertising and promotional literature.
22. The Company shall not be responsible for any dispute between the member and the Participating
Provider Hospital with regard to any allegation of medical negligence on the part of the Participating
Provider Hospital or the Doctor/Doctors concerned.'
23. The Provider Hospital shall charge the individuals with
a) Telephone Charges, b) Ambulance Charges, c) Registration / Admission or File Charges, d) Extra diet
Charges, so incurred by the member or any of his family members during their stay in the Provider
Hospital.
NB: In case patient declines to pay the difference between the authorized amount & Hospital Amount estimate the
hospital has got the right to refuse admission.
Signed, Witnessed and delivered by the within named
Alankit Healthcare Limited
By the hand of Its authorized official Director
Signed, Witnessed and Delivered by the within named
Participating Provider Hospital
By the hands of
Its authorized official
Witnessed by
1.
2.
For ALANKIT HEALTH CARE LIMITED
ANNEXURE - 1
EXCLUSIONS:
a)
b)
c)
d)
e)
f)
g)
h)
i)
j)
k)
l)
Injury / disease directly or indirectly caused by or arising from or attributable to war invasion, Act of
foreign enemy, war like operations (whether war be declared or not).
Circumcision unless necessary for treatment of a disease, not excluded here under or as may be
necessitated due to an accident, vaccination or inoculation or change of life or cosmetic or aesthetic
treatment of any description, plastic surgery other than as may be necessitated due to an accident or as
part of any illness.
The cost of spectacles, contact lenses and hearing aids. Dental treatment or surgery of any kind unless
requiring hospitalization.
Convalescence, general debility, "Run-down" condition or rest cure, congenital, external disease or
anomalies, sterility, venereal disease, intentional self injury and use of intoxication drugs/alcohol.
All expenses arising out of any condition directly or indirectly caused by or associated within Human TCell Lymphotropic virus type III or Deficiency syndrome or any syndrome or condition of a similar kind
commonly referred to as AIDS.
Charges incurred at Hospital or Nursing Home primarily for diagnosis, X-ray or Laboratory examination
or other diagnostic studies not consistent with or incidental to the diagnosis and treatment of positive
existence or presence of any ailment, sickness or injury, for which confinement is required at
Hospital/Nursing Home under the agreement as defined.
Expenses on vitamins and tonic unless forming part of treatment for injury or disease as certified by the
attending physician.
Injury or Disease directly or indirectly caused by or contributed to by nuclear weapons materials.
Treatment arising from or traceable to pregnancy, childbirth including caesarian section, voluntary
medical termination of pregnancy during the first 12 weeks from the date of conception.
Naturopathy Treatment
The member shall be entitled to the benefits under the Scheme, provided the ailment needs
hospitalization for a period not less than 24 hours except in cases such as Dialysis, Chemotherapy,
Radiotherapy, Laser beam treatment, removal of kidney stone by lithotripsy method.
The Participating Provider Hospital shall follow the entry specifically made in the Authorization letter
regarding the converge of an existing illness.
The provider may also arrange to obtain medicines, injections, disposables, as prescribed by the provider from the
authorized chemist, druggist and include those bills in the final bills, which should accompany the prescriptions.
ANNEXURE II
DEFINITIONS:
Means benefits to which he member are entitled to under the terms &
conditions of the agreement and do not fail in the Exclusion list of
Annexure I.
: Means Benefits/Treatments that are not covered under the Scheme for
EXCLUSIONS
which the company shall not be responsible.
: Means any treatment, which needs admission of the Patient as an inHOSPITALISATION
patient in the hospital.
: Means Investigations and Consultations regarding any medical
OUT PATIENT CARE
complaint not requiring member's admission to a hospital with monetary
limit for which the member is entitled to.
PARTICIPATING PROVIDER : Means a hospital or any other licensed institution under contract with
the company to provide Health Care facilities to members.
HOSPITAL
: Person enrolled with the company individually or By the company
MEMBER
during the validity period of the coverage of the scheme.
: Means those Medically Necessary treatment provided in connection
EMERGENCY SERVICES
with an "Emergency" defined as a sudden or unexpected onset of a
condition requiring medical or surgical care which the Member receives
after the onset of such condition (or as soon thereafter).
: Means medical facilities offered by the company to the best of their
COVERAGE
ability to any valid member within the monetary limit for which the
member is entitled to during the validity period of membership.
The Courts of DELHI alone shall have the jurisdiction to try any suit, matter touching or concerning this
agreement
COVERED SERVICES
: