International Statistical Institute & International Year of Statistics
SIDDAGANGA INSTITUTE OF TECHNOLOGY Year 2012 - 2013
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Transcript of SIDDAGANGA INSTITUTE OF TECHNOLOGY Year 2012 - 2013
SIDDAGANGA INSTITUTE OF TECHNOLOGYYear 2012 - 2013
FOR
POLICY OVERVIEWINSURED 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 19/10/2012 TO 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.
3Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation
Mohali
JaipurDelhi
Lucknow Patna
Jamshedpur
Kolkata
Bhubaneswar
Vishakhapatnam
Guwahati
Hyderabad
Bangalore
ChennaiCoimbatore
Trivandrum
Cochin
Mangalore
Pune
Mumbai
NagpurSurat
AhmedabadBhopal
Indore
Corporate Office•BangaloreRegional Offices•Mumbai•Bangalore•Chennai•Kolkata•New Delhi
Branch Offices - 19
Our Offices
Corporate office
Regional offices
Branch offices
Year
2007
2008
2009
2010
2011
2012
Manpower Strength
400
525
750
830
1010
1350
PAN India Presence
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
POLICY COVERAGE
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
DEFINITION OF HOSPITAL
Day Care Procedures where 24 hours hospitalization is not applicable
POLICY COVERAGE
Anti Rabies Vaccination HysterectomyAppendectomy Inguinal/ventral/Umbilical/ Femoral HerniaCoronary angiography Parenteral chemotherapyCoronary angioplasty Piles/ fistula
D&C of cervix ProstrateDental surgery following accident Lithotripsy (Kidney Stone Removal)
Eye surgery RadiotherapyFracture/dislocation excluding hairline fracture Sinusitis
Gastro Intestinal Tract System Stone in Gall Bladder, Pancreas and Bile Duct
Haemo Dialysis TonsillectomyHydrocele Urinary Tract System
Note: All ailment mentioned above will not be payable for the first two years of operation of the policy.
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 Care 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
IMPORTANT NOTEThe 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 the entitled category as under 2.1,the charges payable under 2.3 and 2.4 shall be limited to the charges applicable to the entitled category.
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
EXPENSES COVEREDExpenses incurred on Ayurvedic / Homeopathic / Unani Treatment are admissible provided the treatment is taken in a registered Government HospitalExpenses incurred on Ayurvedic / Homeopathic / Unani Treatment are admissible provided the treatment is taken in a registered Government HospitalExpenses incurred on Ayurvedic / Homeopathic / Unani Treatment are admissible provided the treatment is taken in a registered Government Hospital
Expenses incurred on Ayurvedic / Homeopathic / Unani Treatment are admissible provided the treatment is taken in a registered Government Hospital
Expenses incurred on Ayurvedic / Homeopathic / Unani Treatment are admissible provided the treatment is taken in a registered Government Hospital
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 NON MEDICAL EXPENSES NOT PAYABLE
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
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
CASHLESS CLAIMS PROCESS
Claims Processing – Pre-Authorization/ Cashless
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Network of Hospitals – Pan-India
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State No. of Hospitals
Number of Packages
Hospitals with Discounts
Andhra Pradesh 582 192 418Assam 30 - 11Bihar 29 2 18Chandigarh 27 14 17Chattisgarh 13 3 7
Dadra & Nagar Haveli 1 - -
Delhi 214 153 158Goa 7 1 4Gujarat 495 60 243Haryana 204 103 160
Himachal Pradesh 13 5 8
Jammu & Kashmir 15 2 5
Jharkand 26 1 9Karnataka 645 188 399Kerala 200 22 91Madhya Pradesh 82 9 40Maharashtra 771 331 402Nagaland 2 - -Orissa 49 11 11Pondicherry 10 - 2Punjab 190 85 122Rajasthan 130 33 103Tamil Nadu 499 243 197Tripura 2 - 2Uttar Pradesh 234 85 166Uttaranchal 23 8 19West Bengal 197 75 92 Grand Total 4690 1626 2704
657 1282
1400
1351
Zones Hospital NetworkWest 1351
Bangalore 657South 1282
North East 1400Total 4690
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.
PROCEDURE FOR REIMBURSEMENT CLAIMS
Claims Processing - Reimbursement Claims
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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)
16Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation
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 EFT Transfer
Bank Account Details to be shared containing the following details in 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
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)
SOME COMMON ERRORS THAT DELAYS SETTLEMENT OF REIMBURSEMENT CLAIMS
CUSTOMER SERVICE CONTACTSName 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 LEVELRajesh [email protected] 9379761657
SECOND LEVELShashikala ( Manager )Email – [email protected] – 9379427268
Medi Assist India TPA Private LimitedBangalore BranchNo 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
ADDRESS FOR CORRESPONDENCE
MediAssist Online!
We are pleased to introduce to you MediAssist Online!
This is a web-based self-service platform provided. With this self-service 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
Click- on the tab login in the home page
Logon to
www.mediassistindia.com
Online Access
Click here- to enter your login details
Online Access
Click the TabCorporateemployee
Please enter your user name and
password
Online Access
Usernameempcode@cegedim
Password
For Beneficiary
DetailsClick this
Tab
For E CardsClick this
Tab
E CardsCan Be
Printed
E CARDS CAN BE
PRINTED
CLAIMS INFORMATION
BY CLICKING
THIS HYPERLINKGET MORE
INFORMATION
CLAIMBREAK
UPDETAILS
YOU CAN GET YOURCLAIM
DEDUCTIONS
CHEQUE DETAILS
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
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 !!!