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ServicePresentation:PTPureTestingSoftwarePvtLtd

Mediclaim Policy Form

Bharti AXA General Insurance Co Ltd

Index
PolicyDetails CoreServices
Cards Cashless Reimbursement

Advantages MediAssistContactdetails

Medi Assist India TPA Pvt. Ltd

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

Shouldatleasthaveminimumof15beds(forclassC cities10)+OperationTheatreetc.andmustberun byaRegisteredMedicalPractitioner.


Medi Assist India TPA Pvt. Ltd 3

PolicyDetails
Sum Insured Family Floater

Rs2LacsFloater/Family

Definition of Family

TheProposer+Spouse+DeptChildren

Room Rent

2%ofSumInsured/day. 3%ofSumInsured/day. NineMonthWaitingperiodWaived Normal&Caesarean50000/ BabycoverFromDay1asapartofFamilyfloater


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ICCU & ICU

Maternity Limit

PolicyDetails,Pre&PostHospitalisation
PreExistingDiseaseCovered, First30Days,1stYrsExclusionwaived PreHospitalizationchargespayablefortheperiodof30dayspriortoHospitalization. PostHospitalizationchargespayableforaperiodof60daysfromthedateofdischarge.

HospitalizationPeriod
MinimumHospitalizationshouldbefortheperiodof24Hoursfortheclaimtobe eligibleforpayment Someproceduresthatdonotrequire24hourshospitalizationalsogetpaidunder DayCareProcedures.Howeverthesameisrequiredtobeavailedonlyinnetwork hospitals.

Medi Assist India TPA Pvt. Ltd

WhatwillyourpolicyPay?
MEDICALexpendituresuchas: Room&BoardingExpenses. NursingExpenses. Surgeon,Anaesthetist,MedicalPractitioner,Consultants, SpecialistsFees. Anaesthesia,Blood,Oxygen,OTcharges,Surgicalexpenses. Medicines&PharmacyExpenses. DiagnosticmaterialsandXrayExpenses. Dialysis,Chemotherapy,RadiotherapyExpenses. Costofpacemaker,ArtificialImplants&similarexpenses.
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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).

Medi Assist India TPA Pvt. Ltd

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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Role of Medi Assist

IdentityCards
MediAssistwillissueIdentityCardtoeachProposerandtheirdependants. PhysicalPhotoLessCards/E cardcanbedownloadedfromourwebsite

IMPORTANT: Thecardisissuedonlyforidentificationpurpose& shouldnotbeconstruedasanAuthorizationtothe hospitalstoproceedwiththetreatment.

Medi Assist India TPA Pvt. Ltd

Role of Medi Assist

ClaimsSettlement Cashless
1. CashlessHospitalizationfacilityisavailableonlyatNetworkHospitalslistedbyMediAssist. 2. Approach the network Hospital at least 24 hours in advance in case of planned

hospitalization (forNetworkvisitwww.mediassistindia.comforthelatestlist orreferbookletprovidedalong


withcards).

3.RequesthospitaltosendCASHLESSform.Formshouldbedullyfilled&Signedbyinsured

&Hospital.

4.IncaseofEMERGENCYPleaseasktheHospitaltomention EMERGENCY inboldletters 5.InformatHelpLinenumbersforspeedyprocess. Imp:PleaseensurethatthebillsaresignedeitherbytheProposer/ Claimantatthetimeofdischarge PN:MediAssistconsideringthepolicyconditionswillauthorizeordenythecashlessrequest

within23Hoursofreceipt

RequestformforCashlessHospitalizationareavailableat: NetworkHospitals MediAssistOffice www.mediassistindia.com


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Role of Medi Assist

CashlessHospitalizationaCompletePaperlessprocess
FAX / Mail MediAssistFAXSERVER (24/7/365)

Employees/ Dependentwith MAIDCard

NetworkHospital

Process

PolicyVerification & ClaimProcessing Intimationto Hospital/Insured FAX/SMS/EMAIL


Medi Assist India TPA Pvt. Ltd

AuthorizeNetwork HospitalforCashless
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Role of Medi Assist

ClaimSettlement Reimbursement

ThedocumentsinoriginaltobesubmittedtoMediAssist@addressmentionedin cardwithinstipulatedtimeasmentionedinpolicyschedule NOTICEOFCLAIM:Immediatenoticeofclaimwithparticularsshouldbegivento OICL/MediAssistwithin24(TwentyFour)hoursofadmissionorbefore discharge. IntimationnumberwillbecommunicatedbySMS/Online.


Documents Required (Claim documents should be submitted within 15 Days from DOD): ClaimFormdullyfilled&signed. OriginalDischargeSummary. OriginalFinalHospitalBill(withdetailedbreakup)alongwithCashpaymentReceipt. OriginalMedicineBillsalongwithDoctorPrescriptions AllOriginalInvestigations&TestReportsalongwithfilmsifany. Incaseofnonavailabilityofprescriptions,askyourphysiciantocountersign onthe reverseofpharmacybills. Alldocumentsmustbedulyattestedbytheinsuredperson
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ReimbursementClaimsProcessFlow
MAtodo Documentscrutiny &liabilitycheck Insured
ClaimsProcessIn caseofQuerytobe informedbyMAto Throughpost/ courier/mail MAProcessclaims: andSettle/denyinform Clientsoftformat onstatusofclaim
Process

Submissionof Reimbursement claimtoMA

Reminderletter:After7daysgap ClosureNotice:After15daysgap Ifnotheard,claimtobeclosed

MAtosend cheque

Medi Assist India TPA Pvt. Ltd

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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

WearenegotiatingtheOPDdiscountwiththesefollowinghospitals: ColumbiaAsiaHospital,ParasHospital,Medanta TheMedicity,AlchemistHospital


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ClaimInvestigation(FraudControl)
Dedicatedfulltimeteamofdoctorsassignedtocarryoutclaiminvestigations NeedbasedInvestigation Suspiciousclaimshandedovertoinvestigators(keyinternalflags) RoutineInvestigation Approximately10%ofallclaims reimbursementandcashlessare auditedandinvestigated. ColdCallingHospitaland/orBeneficiary MediAssistexecutivecallspatient/attendanttocrosscheckdetails furnishedinthepreauthorisationclaimform

Medi Assist India TPA Pvt. Ltd

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HelpLinenumbers
Toll Free No Land Line
Fax Nos.

: 18004259449 : 080 26584810-11 : 18004259559 : 080 26584812-13

Toll Free FAX No FAX No

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

LEVEL2 Mr.ManishKumarSingh Mr.ChandanSinghChandel

9310580716 9313894418

crm_delhi@mediassistindia.com crm_delhi@mediassistindia.com

Spoc BackendSupport Spoc BackendSupport

LEVEL3 Mr.NIRAJK.SINGH

9311797425

nirajks@mediassistindia.com

3rd ESCALATION

DR.FAISALKHAN

faisalk@mediassistindia.com

FINALESCALATION

Medi Assist India TPA Pvt. Ltd

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Wish you a healthy and happy future !

Thank You
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