Scribd Logo
Upload

Welcome to Scribd!

  • Acko General Mou

    Uploaded by

    Babu Suman
    16 views4 pages
    hi

    Original Title

    ACKO GENERAL MOU

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    hi

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    16 views4 pages

    Acko General Mou

    Uploaded by

    Babu Suman
    hi

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    of 4
    Name ofthe NetworkProvider> SUNRSSE MULTI SPECS ALITY HUspT7 ol. adéress 2¢]A00-), Sou Vesareget rornd7 d -s1e00) ‘Sir[Madam, : subject: Addendum to the Agreement entered between Family Heath Plan nsurance12 Imited_an one eae, 1. Family Heath Plan Insurance TPA Limited hereinafter referred tos TPA) and the é i chs ii hereinafter referred to as the Network Prowder) entered into an Agreement dated Jel 4ay("Agreement’) fr providing he services to the eae eet werious insurance. companies underihe Tsurance policies sued by such Insurance companies and being serviced by TPA. a areas al tnsurane Limited (hereinafter referred to as THE INSURER) has tied up wth the TPA ie 0 ‘nereement dated 16° November 2019 for servicing Its members covered under various sues policies eres to be issued by THE INSURER from time to time hereinafter referred toas “Members ) 3, shetpates herein agree that the Network Provider shall provide the cash les facies tothe Members Which shall be services by the TPA. a. rei Stuns tor entifestion of Members/Poleyhlders of THE INSURER who would be senced under The nereerent shall be laid down and intimated to the Network Provider through eral or liter from time to time by THE INSURER or the TPA. .. ii charge fr the cashless services rendered by the Network Provider to THE INSURER hal 5 paid as Tae tne rate provided under the Agreement between the TPA ad the Network Provider ore ‘Agreement between THE INSURER and the Network Provider, whichever is lower. cee Tagurance Regulatory and Development Authority of tna (Heath insurance) Regblons, 2016 ye ator referred to a5 the Regulations), itis required to havea tipartte arrangement when services ‘are provided through TPA. 4. The Addendum captures the terms and conditions ofthe Agreement and other conaions that would be srcoble on the parties wih respect to Network Provider providing the castess services to the Members. 8, Definitions ) sAgreement” shall mean this agreement and all, Schedles supplements, appendices, “Aetdages and modications thereof madein accordance with she terms of Ws agreement. {iy "Benefit shall mean the extent or degree of service the Insured Persons are entitled to receive based on their contract with the Insurer. {uy "Health Services" shall mean the health care sen/ees covered under the Policy, subject to tratation/ exclusion under the terms and conditions stipulated therein fh) "Heath Regulations” shall mean and Includes, but nt limited the extent applicable, Insurance Regulatory and Development Authority of India (Health Insurance) egultions, 2016; Insurance Rexulatory and Development Authority of India (Third Party Admirers Health Services) etuatons, 2016; RDA! Guldsines on Standaration in Healy Wsurnee ‘and any other Ree noticaions/guidelines 2s may be prescribed by IRDA! on health products and amended from time to time. {)__*Hesptalization" shall mean admission in Hospital 0" 8 minimum period of 24 consecutive ‘in- atent Car’ hours except for specified procedures/ treatments, where ‘such admission could be Fora period of less than 24 consecutive hours. fay Insrensured Person(s)” shall ean customers of the Insurer who are entitled for Benefit lundera valid health Insurance policy of the Insurer, 10. nu. 2 13, ua 15, (vii) "Policy/Policies* shall mean the health insurance policy/policies of the Insurer provided to the Insured Persons and to be serviced by the TPA. (vii) "IRDA" shall mean the Insurance Regulatory and Development Authority of India established under the Insurance Regulatory and Development Authority Of India Act 1999, Effective Date (i) The Parties hereby agree that the Effective date of the Agreement shall be the date on which the Agreement is executed. General Provisions regarding the Provider tye the oie shall Register the Hostal Rept ROHN Regio Hosp Network of Trourafee) maintained by Insurance Information Bureau (V8). tw On the ncurer shal have the authority o repute or eect a clam, Uris sl have a dedicated officer) inthe administration department assigned fr Insured Persons and the officer(s) shall be informed and aware of varlous types of benefits offered by the inser, tw) _TaPetes agree to comply whh all the stattory and regulatory requirements 2s may be applicable from time to tine. (years sal comply with equremens of Insurer ke standardized bing, ICO-10/ PCS coding dnd other requirements that IRDA\ directs the Insurer / TPA / Network Providers or as may be required by the Insurer from time to time, (vi) Provider will separately list package charges as mentioned in proposal cum offer documents 35 ‘Annexure 1 and 2 which form an integral part of this agreement. Such package charges must be Inclusive of stay, medicines, consumables, surgical fees, operation theatre etc. No additional payment would be entertained unless the medical team of Insurer/TPA agrees with treaung eonsultant for any deviation. It is agreed further that the Provider shall be governed by the forms, directions, ceilings and stipulations of the IRDAI issued from time to time. cane of Aire Breet a ht he Poly aed by esrer nd the PA bg ened ee ea fe or oes to conte rv seca es ecard he TA ort serent wh the TPA es bent een ee er aes ome te ame eeambent Rn aE ee cada cone provide umeuped eves Representations and Warranties ty tnsurer reserves eight to Inspect the premises ofthe Provider at any time without making Sy thor intimation. Provider shall provide access to Insufer to visit the premises and conduct inspection as and when Insurer desires. Reauthorizatlor {) Where there isa change in the line of treatment afresh authorization shall be obtained fom the Insurer /TPA immediately ths Is called a Reauthorization. Process Note For De-Empanelment Of Providers fh the TPA / Insurer shal fllow the de empanelment process as described in Schedule 6 of HOA Creulay Reference No IRDA/TPA/REG/CIR/059/03/2016 dated 28-03-2016 as amended by IRDAI from time to time, reauthorization procedure Emergency Admissions: 16, Umitat co) 117, Confidentiality! “0 1 with treating doctor til contusion of eligibility of ing, sight saving, emergency ‘medical iting fr authorization. ProWder ‘or as er their norms -the insurer / TPA may continue to ds overage is arrived at. However, any I

    You might also like