OPD & Other Benefits Coverages

1) OPD, Dental, Optical and health Checkup applicable for employees only on reimbursement basis. 3
months waiting period applicable for New Joiners. Original Prescription from Registered Medical
Practitioner along with Dr’s Registration number will be needed.
2) Consultation, Investigation and Routine checkup prescribed by doctor is covered
3) OPD bills: Member can submit the bills up to 90 days from the date of bills, else on quarterly basis, unable
to allow till end the of policy period due to constraints from Audit & Compliance
4) Annual Health Check-up – Reimbursement of annual health check-up is covered under OPD limit with
registered pathology/hospital.
5) All the dental procedures to be covered as a part of OPD sum insured excluding cosmetic procedures.
(Root canal and Crawn is covered not Cap)
6) No claim shall be admitted after 15 days of policy expiry date.
7) Bills & Prescriptions should be in the name of Insured Member
8) Cost of medicine shall be reimbursed only for the period prescribed and provided the same falls within
the policy period
9) Original Payment Receipt- with Receipt No & Tax No.
10) Under Vision, Prescriptive Lenses and Glasses are covered. These should be supported by Doctors’
prescription and not from an optician, frames are not covered.
11) Specific requirement on doctor’s qualification for OPD - A person who holds a valid registration from the
medical council of any state or Medical Council of India Or Council for Indian medicine set by the
Government of India or state Government.
12) Over the counter medicines are covered along with doctor’s prescription.
For OPD claims the Reimbursement claim form needs to be filled in by the employees. Claims will be
processed based on documents supported by original medical bills.
13) Pre and Post Natal will be covered from the date of conceive of child
14) RMO charges are not covered
15) Any devices inserted in body are covered under hospitalization
16) Infertility treatment not covered
17) 30 and 60 days pre and post hospitalisation covered on reimbursement basis only, irrespective of pre and
post hospitalisation done in different hospital. The pre and post hospitalisation claim will be processed
only once the main hospitalisation claims gets approved.
18) Day care procedures are covered as per standard IRDA lists
19) Alzheimer’s, Parkinson, Dementia are not covered in the policy
 TPA and Insurer SLA & Escalation Matrix

1. Cashless TAT: 2-4 hours. Approval for claims exceeding 1 lakh is required from insurer.
Reimbursement: 5 days for clean claims. If any deficiency, then the same is raised within 5 days.
Reminders are sent every 15 days and calling is also done after 1st reminder.

Escalation Matrix – TPA – All India sites (except Delhi & Gurgaon)

Name Mail Id Contact No

General Queries Customer Care info@fhpl.net 18001024033

Claims Related Ankita Gawade ankita.gawade@fhpl.net -

Account Manager Anil kumar Singh anilkumar.singh@fhpl.net 7777 049 411

Escalation Level Ajay Mehra ajay.mehra@fhpl.net 9223 329 008

For Delhi & Gurgaon: Point of Contact – Saurabh Bahl

saurabh.bahl@fhpl.net – 9212 256 978/9899 242 133

Escalation Matrix – Willis Towers Watson India Insurance Brokers

Name Mail Id Contact No

Kirthi Kotian Kirthi.kotian@willistowerswatson.com 9867 386 370

Mridula Nadkarni Mridula.Nadkarni@willistowerswatson.com 9987 942 749

Escalation Matrix – Liberty

Nameal Mail Id Contact No

Chetan Jaiswal Chetan.Jaiswal@libertyinsurance.in 8879 521 282

Kiran Savane kiran.savane@libertyinsurance.in 7506 507 643

Gaurav Kelkar Gaurav.Kelkar@libertyinsurance.in 8451 052 992

 Claim Checklist and Claim Form

Attached below are the checklist and Claim Form. Claim Form needs to be filled for OPD
reimbursement cases as well.

Checklist.pdf Liberty General.pdf