Employee Insurance Benefits

Group Mediclaim Policy

Bharat Petroleum Corporation Ltd
Policy Period : 24th Jan 2020 to 23rd Jan 2021
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POLICY DETAILS DESCRIPTION

Policy Holder Bharat Petroleum Corporation Ltd

Policy Number 920000/34/19/04/00000254

Policy Start & End Date 24th Jan 2020 to 23th Jan 2021

Name of Insurance company The New India Assurance Company Limited

Third Party Administrator (TPA) MD India Health Insurance TPA Pvt. Ltd.
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POLICY DETAILS DESCRIPTION

Sum Insured Uniform - INR 1,00,000
Family Floater Employee + Spouse + 2 Dependent Children
Pre Existing Disease Benefit Pre-existing diseases covered
30 Day Waiting Period Waived Off
1/2/4 years Waiting Period For Waived Off
Specific Diseases
Maternity Rs. 15,000/- For Normal &
Rs. 20,000/- For Caesarean Section
New Born Baby Covered from Day 1 Under Family Floater
Sum Insured

Pre & Post Hospitalization Expenses
Room Rent
Up to 30 Days pre and 60 days post
hospitalisation
1% of SI for Normal & 2% of SI for ICU. All
other charges are in accordance with room
rent restrictions.
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POLICY DETAILS DESCRIPTION

Day Care Treatments
Ambulance Charges
Cashless Facility
Capping on Disease (Ailments wise)
Claim Intimation
Claim documents submission
Covered
1% of Sum insured and or maximum to
Rs.2500 whichever is less
Yes
Not Applicable
Intimation of claim to be given within 7
days from date of admission
Claim documents to be submitted within
30 days from the date of discharge.
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 Room and boarding

 Doctors fees
 Intensive Care Unit
 Nursing expenses
 Surgical fees, operating theatre, anesthesia and
oxygen and their administration
 Physical therapy
 Drugs and medicines consumed on the premises
 Hospital miscellaneous services (such as laboratory,
x-ray, diagnostic tests)
 Dressing, ordinary splints and plaster casts
Radiotherapy and chemotherapy
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CASHLESS HOSPITALISATION

Member get admitted in TPA verifies applicability of

Member / Hospital applies
the hospital by showing his the claim to be registered
for pre-authorization to the
ID Card. Treatment starts. TPA within 24 hrs and issues pre-
authorization

Yes
Hospital sends complete Member gets treated and Pre-
discharged after paying all authoriza
set of claims documents tion given
for processing to the TPA non entitled benefits like
by the
refreshments, etc. TPA

No

Claims Processing by TPA Release of payments to Claim Denied.

& Insurer the hospital
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REIMBURSEMENT HOSPITALISATION

Employee intimates the

claim within 48 hours of
Admission in the hospital &
submits all the documents to
TPA within 30 days from the
discharge from the hospital
TPA will check the documents.
If required then ask for the
additional/missing documents.

TPA will check for the Submits the shortfall

eligibility and documents to Insurance
admissibility of the claim Helpdesk within 7 working
as per policy terms days from the receipt of
intimation

Is Claim
payable ?
Yes No

TPA will process the claim and On rejection of the claim,

raise claim for payment to Insurer will review claim and
Insurance company provide outward
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Policy Terms
Process
REIMBURSEMENT PROCEDURE
Reimbursement Claim
Documents Should be submitted
within 30 Days from date of
Discharge
Forms &
Claim Process
Formats
1 Claim Form And Check List
Main Hospital bills in original (with bill no; signed
2 and stamped by the hospital) with all charges
itemized and the original receipts
3 Discharge Card /summary (original)
Original Investigation reports, Bills and Receipts
4 for Medicines along with Doctors prescription in
Original
Attending doctors’ bills and receipts and
5 certificate regarding diagnosis Follow-up advice
or letter for line of treatment after discharge from
hospital, from Doctor.
Break up with details of Pharmacy items,
6 Materials, Investigations even though it is there in
the main bill
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Cashless claim Checklist for

form reimbursement claim
Forms and
claim
Submission

Claim Submission
MDIndia Health Insurance TPA Pvt. Ltd.
Reimbursement
claim form
Mezzanine Floor, Ballard House,
Adi Marzban Path, Ballard Estate,
bearing CTS Number 1185,
Fort, Mumbai – 400 001.

General Definition
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MD India TPA Online Portal Details

Login to https://mdindiaonline.com/mdihome.aspx

Click on “My Account” tab on the top

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MD India TPA Online Portal Details

Then select “Corporate Employee Login”

User Id: Employee Code

Password: DD/MM/YYYY
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MD India TPA Online Portal Details

View of Portal
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MD India Mobile App HAWK

• Link for play store: https://play.google.com/store/apps/details?id=com.mdid.hawk&hl=en_IN

• Link for IOS : https://itunes.apple.com/in/app/mdindia-hawk/id1045111022?mt=8

Introduction
The HAWK mobile application is developed by MDIndia Healthcare Services (TPA)
Pvt. Ltd. The HAWK mobile application offers quicker and better service to the
policy holders and corporate.
Mobile application is compatible with Android and IOS version.
Can be downloaded from Google play store

Corporate Employee Login

Tap the Corporate Employee login on the MDI HAWK Home Page.
Select the MDID or Employee ID Radio button.
Enter User Name, Password and click the Login button.

User Name will be MDID number or employee code & password will be Date of birth,
for e.g. If employee id is 51 & DOB is 01/01/1990 then password to be entered is
01/01/1990 (backslash should be included too)

When a user enters MDID or employee code, the system generates and sends an
OTP to registered mobile number and E-mail ID of the user.
The purpose of OTP is to ensure that only properly authenticated users are
authorized access to application and data
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MD India Mobile App HAWK

The Corporate Employee screen contains Drawer Menu

insurance related information like, Insurance
Company Name, Policy Number, Policy
Holder Name, MDID, Agent Code, Risk Start
Date, Risk End Date, Policy Holder Address
and Email Address.

• Dependent details can be viewed

• E-cards can be downloaded
• Claim status/ details can be
viewed
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MD India Mobile App HAWK

Draw Menu
The Drawer contains following menus:
✤ Home
✤ Policy Intimation
✤ E-Card
✤ Claims
✤ Claim Status
✤ Network Hospital
✤ Forms
✤ FAQs
✤ Branches
✤ Health Tips
✤ Wellness Calculator
✤ Contact Us
✤ Logout
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Contact Details

From TPA :
MDIndia Health Insurance TPA
Pvt. Ltd.

1st Level
Mr. Kartik Joshi
Contact- 7420074497
Email id:-
mumbaicorp3@mdindia.com

2nd Level
Mr. Nilesh Golvankar
Contact- 7420074495
Email id:-
ngolvankar@mdindia.com