Escolar Documentos
Profissional Documentos
Cultura Documentos
Index
PolicyDetails CoreServices
Cards Cashless Reimbursement
Advantages MediAssistContactdetails
Policy coverages
DefinitionHospital/NursingHome
Any institution in India established for Indoor care andtreatmentofsicknessandinjuriesandwhichhas eitherbeenregisteredasahospitalornursinghome with the local authorities and is under the supervision of a registered and qualified medical practitioner
OR
PolicyDetails
Sum Insured Family Floater
Rs2LacsFloater/Family
Definition of Family
TheProposer+Spouse+DeptChildren
Room Rent
Maternity Limit
PolicyDetails,Pre&PostHospitalisation
PreExistingDiseaseCovered, First30Days,1stYrsExclusionwaived PreHospitalizationchargespayablefortheperiodof30dayspriortoHospitalization. PostHospitalizationchargespayableforaperiodof60daysfromthedateofdischarge.
HospitalizationPeriod
MinimumHospitalizationshouldbefortheperiodof24Hoursfortheclaimtobe eligibleforpayment Someproceduresthatdonotrequire24hourshospitalizationalsogetpaidunder DayCareProcedures.Howeverthesameisrequiredtobeavailedonlyinnetwork hospitals.
WhatwillyourpolicyPay?
MEDICALexpendituresuchas: Room&BoardingExpenses. NursingExpenses. Surgeon,Anaesthetist,MedicalPractitioner,Consultants, SpecialistsFees. Anaesthesia,Blood,Oxygen,OTcharges,Surgicalexpenses. Medicines&PharmacyExpenses. DiagnosticmaterialsandXrayExpenses. Dialysis,Chemotherapy,RadiotherapyExpenses. Costofpacemaker,ArtificialImplants&similarexpenses.
Medi Assist India TPA Pvt. Ltd 6
WhatwillyourpolicyNOTPay?
AllNonMedicalExpenditure,FoodpurchasedfromHotels/orbroughtfromhome. Surgery for correction of eye sight cost of spectacles, contact lenses, hearing aids, Cosmetic Surgery, etc. NaturopathyTreatment. Costofvitamins/tonicsunlessformingpart oftreatmentforthecovered disease. TreatmentforInfertility BeautyTreatmentofanydescription. Plasticsurgery(otherthannecessitatedduetoaccident). Circumcisionunlessrequiredfortreatmentofanillness. Geneticdisordersandstemcellimplantation/surgery Injury/diseasedirectlycausedbyWar,Invasion,actofforeignenemy,warlike operations. Admissiontothehospitalonlyforthetests/investigations(withouttreatment).
WhatwillyourpolicyNOTPay?
TreatmentofAIDS,HIV,VD(STD). AccidenttreatmentundertheinfluenceofAlcoholorintoxicating drugs. CongenitalDisease,defectsoranomalies. Outpatienttreatment. InjuryordiseasescontributedbyNuclearweapons/materials. Diseaseoraccidentduetoadventuresports. IntentionalselfInjury. FamilyplanningOperations(VasectomyorTubectomy)etc. Dentaltreatmentunlessarisingduetoaccident Medi Assist India TPA Pvt. Ltd
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IdentityCards
MediAssistwillissueIdentityCardtoeachProposerandtheirdependants. PhysicalPhotoLessCards/E cardcanbedownloadedfromourwebsite
ClaimsSettlement Cashless
1. CashlessHospitalizationfacilityisavailableonlyatNetworkHospitalslistedbyMediAssist. 2. Approach the network Hospital at least 24 hours in advance in case of planned
3.RequesthospitaltosendCASHLESSform.Formshouldbedullyfilled&Signedbyinsured
&Hospital.
within23Hoursofreceipt
CashlessHospitalizationaCompletePaperlessprocess
FAX / Mail MediAssistFAXSERVER (24/7/365)
NetworkHospital
Process
AuthorizeNetwork HospitalforCashless
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ClaimSettlement Reimbursement
ReimbursementClaimsProcessFlow
MAtodo Documentscrutiny &liabilitycheck Insured
ClaimsProcessIn caseofQuerytobe informedbyMAto Throughpost/ courier/mail MAProcessclaims: andSettle/denyinform Clientsoftformat onstatusofclaim
Process
MAtosend cheque
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CHECKLIST:
ForHospitalization/DaycareReimbursementclaim.
A) OriginalDetailedDischargeSummaryofHospital/NursingHome. B) OriginalDetailedFinalBillofHospital/NursingHome. C) DetailedBreakUpofFinalBill. D)ReceiptofPaymentofFinalbill(Advance&BalanceAmount). E) AllDoctorPrescriptionsforMedicines&LabInvestigations. F) AllLabInvestigationReports. G) AllMedicines/Pharmacy/MedicalStoreBills.
InCaseofRoadTrafficAccident&Fracture.
A) NonAlcoholInfluenceCertificatetotheTreatingDoctor. B) MedicoLegalCertificate(MLCCopy)/CopyofFIR
ForPre/PostHospitalizationReimbursementClaim.
A) ReceiptofPayments. B) AllDoctorPrescriptionsforMedicines&LabInvestigations. C) AllLabInvestigationReports. D) AllMedicines/Pharmacy/MedicalStoreBills.
ForMajorInvestigationReimbursementclaim.
A) ReceiptofPayments. B) AllDoctorPrescriptionsforinvestigations. C) AllInvestigationReports.
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MediAssistAdvantages
AleadingproviderofTPAserviceswithPanIndiaDeliveryCapabilities Experienceofservicinglargecorporateaccounts Completepackageofserviceofferingsfromillnesstowellness Focusedapproachtocorporatehealthportfolio Toprotectbothyoursavingsandhealth ClaimsprocessingtoClaimsManagement Qualitysystemsinplacetocontrolflowofinsurers fundsforclaims Presenceofauditmechanismstominimizeerroneousclaimssettlement Onlinecashlesspreauthorizationfacilitywithsomemajorhospitals Useofdashboardstomonitorserviceperformanceacrossthecountry
TwoHealthCampsduringthepolicyperiod withthepriorconsultancywithHR
ClaimInvestigation(FraudControl)
Dedicatedfulltimeteamofdoctorsassignedtocarryoutclaiminvestigations NeedbasedInvestigation Suspiciousclaimshandedovertoinvestigators(keyinternalflags) RoutineInvestigation Approximately10%ofallclaims reimbursementandcashlessare auditedandinvestigated. ColdCallingHospitaland/orBeneficiary MediAssistexecutivecallspatient/attendanttocrosscheckdetails furnishedinthepreauthorisationclaimform
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HelpLinenumbers
Toll Free No Land Line
Fax Nos.
Delhi Customer Care Nos. Land Line @ Delhi : 011 30913809, 30913811 Fax Server @ Delhi : 011 41624844 Cashless Mail Id : padelhi@mediassistindia.com
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HelpLinenos./EscalationMatrix:
Pleasecontactthebelowmentionedexecutivesforanyqueries. Alsopleasesendalltheoriginaldocumentstothebelowmentionedexecutivesrespectively attheaddressgiven(Pleaseensurethenamesareasmentionedbelow):
ESCALATIONMATRIXFORSERVICINGOF GROUPMEDICLAIMINSURANCEPOLICIES LEVEL MOB.NO EMAILID NATUREOFSERVICES
LEVEL1 Mr.Nikhilkumar
9312371722
crm_delhi@mediassistindia.com
Spoc BackendSupport
9310580716 9313894418
crm_delhi@mediassistindia.com crm_delhi@mediassistindia.com
LEVEL3 Mr.NIRAJK.SINGH
9311797425
nirajks@mediassistindia.com
3rd ESCALATION
DR.FAISALKHAN
faisalk@mediassistindia.com
FINALESCALATION
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Thank You
Medi Assist India TPA Pvt. Ltd 19