Know Your Mediclaim Policy - PowerPoint Presentation

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Know Your Mediclaim Policy “Mediclaim Policy for the students of IIT”

By Safeway TPA Services

POLICY DETAILINSURER : National Insurance Co Ltd

Policy No

:

354100/48/15/8500000719

POLICY START DATE : 13 August

2015

COVERAGE VALID UP TO : 12 August 2016

SUM INSURED : 100000/- (Per Student)

POLICY TYPE : TAILOR MADE

PERIOD

:

13.08.2014 TO 14.08.2014

COVERAGE1) Room, Boarding expenses as provided by the Hospital/Nursing

Home.

Room

rent capping

Room Rent

:

2%

of Sum insured

Maximum –

2000

/- (Per Day)

ICU

:

2%

of Sum insured

Maximum –

2000

/- (Per Day)

2) Surgeon,

Anaesthetist

, Medical Practitioner, Consultants, Specialists Fees.

3)

Anaesthesia

, Blood, Oxygen, Operation Theatre Charges, Surgical appliances any disposable consumables , Medicines & Drugs, Diagnostic Materials and X-Ray, Dialysis, Chemotherapy, Radiotherapy, Cost of pacemaker, Artificial Limbs and cost of Stents and implants

COVERAGEPRE - HOSPITALIZATION :-Relevant Medial Expenses incurred during period up to 30days prior to hospitalization on disease/illness/injury sustained will be admissible

POST – HOSPITALIZAION

:- Relevant Medical Expenses incurred up to 60days after hospitalization will be admissible.

GENERAL POLICY T&C1). Pre-Existing:-

Covered.

2). 30 Days waiting: -

Applicable

.

3). 1, 2 years Exclusions: -

1

Year Exclusions are Applicable

.

4

). Co Payments: -

No

Copayment.

5

). Pre & Post Hospitalization: -

30

/ 60 Days

.

6

). Domiciliary

Hospitalization Charges: -

Not

Covered.

7

). Dental & Spectacles &

Hearing

aids: -

Not

Covered.

8

). Health Check-up: -

Not

Covered.

RESTRICTIONS

Diseases

In-Patient Treatment

Others

Plastic Surgery (Cosmetic)

Laboratory Expenses not consistent with treatment.

Spectacles,Contact Lens,

Hearing Aid

Orthodontics Treatment

Vitamins

Use of intoxicating drugs/ alcohol

Sterility/Venereal Disease/Circumcision

Tonic inconsistent with treatment.

Naturopathy

Intentional Self Injury

Telephone,Fax,Barber,Photocopy

,

Vaccinations,Toiletries

and TV charges

Aids

Special diet and extra diet for patients (unless prescribed by the Doctor)

Congenital Diseases (External)

e.g. An operation to remove a 6

th

finger, Skin Graphting

External Implants

e.g. An operation to remove a 6

th

finger, Skin Graphting

Registration fees

RESTRICTIONS

Diseases

In-Patient Treatment

Others

Convalescence / General Debility.

Supports and Accessories, e.g. Crutches

Admission fees

Service

, Maintenance

and Surcharges

Food & Beverages

Special Nursing, Attendant Pass

Telephone/Fax

Health Drinks:

e.g.

Horlicks

,

Complan

etc

Medical records/ Stationary

Xerox or Certifying charges

Abortion done for voluntary reasons & before 12 weeks

Attendants Charges

Food and Beverage for Relatives

Special Nursing charges

Diagnostic Expenses (only for out-patient)

Extra Bed/ Bed retaining charges

Damage done by the patient (accidentally). Damage charges not covered.

TV/ Laundry

RESTRICTIONS

Diseases

In-Patient Treatment

Others

Convalescence / General Debility.

Supports and Accessories, e.g. Crutches

Admission fees

Service

, Maintenance

and Surcharges

Food & Beverages

Special Nursing, Attendant Pass

Telephone/Fax

Health Drinks:

e.g.

Horlicks

,

Complan

etc

Medical records/ Stationary

Xerox or Certifying charges

Abortion done for voluntary reasons & before 12 weeks

Attendants Charges

Food and Beverage for Relatives

Special Nursing charges

Diagnostic Expenses (only for out-patient)

Extra Bed/ Bed retaining charges

Damage done by the patient (accidentally). Damage charges not covered.

TV/ Laundry

RESTRICTIONS

Injury/disease directly or indirectly caused by or arising from or attributable to War, invasion, Act of Foreign enemy, War like operations (whether war be declared or not)

Cost of spectacles and contact lenses, hearing aids.

Dental treatments except arising out of an accident and requiring hospitalization.

Convalescence, general debility, “Run-down” condition or rest cure, obesity treatment and its complications including morbid obesity, Congenital diseases/defects or Anomalies, treatment relating to all psychiatric and psychosomatic disorders, infertility, sterility, venereal disease, Intentional self-injury and use of intoxicating drugs/alcohol.

All expenses arising out of any condition directly or indirectly caused to or associated with Human T- Cell

Lymphotropic

Virus Type III (HTLB –III) or

Lymphadinopathy

Associated Virus (LAV) or the Mutants Derivative or Variation Deficiency Syndrome or any Syndrome or condition of a similar kind commonly referred to as AIDS.

Charges incurred at Hospital or Nursing Home primarily for diagnosis x-ray or Laboratory examinations or other diagnostic studies not consistent with or incidental to the diagnosis and treatment of positive existence or presence of any ailment, sickness or injury, for which confinement is required at a Hospital/ Nursing Home.

RESTRICTIONS

Expenses on vitamins and tonics unless forming part of treatment for injury or diseases as certified by the attending physician.

Injury or Disease directly or indirectly caused by or contributed to by nuclear weapon/ materials.

Naturopathy Treatment, acupressure, acupuncture, magnetic therapies, experimental and unproven treatments/therapies.

Genetic disorders and stem cell implantation/surgery.

Change of treatment from one system of medicine to another unless recommended by the consultant/hospital under whom the treatment is taken.

Treatment for Age Related Macular Degeneration (ARMD), treatments such Rotational Field Quantum Magnetic Resonance (RFQMR), Enhanced External Counter Pulsation (EECP), etc.

All non medical expenses including convenience items for personal comfort such as charges for telephone, television, ayah, private nursing/barber or beauty services, diet charges, baby food, cosmetics, tissue paper, diapers, sanitary pads, toiletry items and similar incidental expenses.

Any kind of services charges, surcharges, admission fees/registration charges, luxury tax and similar charges levied by the hospital.

CLAIM PROCESS

Eligibility

Covered

Not

Covered

Hospital sends

Intimation to

SAFEWAY

Authorization as

per eligibility

Out of Pocket

payment

TAT : less than 2 hr for routine cases

Emergency : No authorization required

Regularization within 24 Hrs

Member approaches

with Network Hospitals with ID

Cashless treatment

at NWH

HOW TO AVAIL BENEFITS UNDER YOUR POLICY

Member approaches

Any other Hospital

Avails treatment, makes upfront payment

Submits bills to

SAFEWAY

for reimbursement

CASHLESS CLAIMS To avail cashless hospitalization treatment at network hospitals –

Step 1

: SAFEWAY will provide the list of network hospitals offering cashless facility for treatment.

Step 2

: The claimant needs to produce the SAFEWAY Health card at the hospital.

Step 3

: Hospital sends Pre-authorization Request with the treatment details; past history and clinical notes along with estimate of hospitalization expense to SAFEWAY local office.

Step 4

: SAFEWAY issues a letter authorizing treatment to the Hospital the approved amount up to the Sum Insured limits.

Cont………

CASHLESSStep 5: In case the treatment is taken at other non network centers, the Insured is reimbursed the cost of treatment, subject to the provisions of the Policy on the basis of Admit Card/Discharge Card, Diagnostic Reports and Bills/Prescriptions

.

RE-IMBURSEMENT PROCESSStep 1: Please intimate,SAFEWAY TPA Services within 48 hours about the hospitalization. Claim intimation can be done by the following methods.

Inform the Call Centre at

Toll Free No: 1800-102-5671 / 45451300

And intimate the claim to

support@safewaymediclaim.com

Step 2

: At the time of intimation, the customer should provide the following

a. SAFEWAY ID card No

b. Date of Hospitalization

c. Ailment

d. Approximate Date of Discharge

e. Approximate Date of Claim submission.

Step 3

: Download the Claim Form & Medical Certificate Form from our website and fill all columns. The Medical Certificate Form will be filled by the treating doctor.

Step 4

: Submit filled and signed Claim and Medical Certificate Forms to your HR

Deptt

.

Cont……..

RE-IMBURSEMENTStep 5: SAFEWAY will assess the validity of the claim based on the documents submitted, validate the policy, validate the treatment undergone and settle the claim within the claim settlement parameters. In case of claim is not adhering with parameters, the case would be rejected.

Step 6

: SAFEWAY will correspond with you within 7 days of Claim receipt -

Step 7

:

Event of Settlement

: Please sign the Discharge Voucher and send it back to local SAFEWAY office

Event of Shortfall

: Please forward the requested documents for settlement of claim to local SAFEWAY office.

Event of Disallowance

: Please forward the necessary documentation not submitted before to process disallowance and for addendum settlement

RE-IMBURSEMENTDocuments Required for Re-imbursement Claims

Original

detailed discharge summary

Original investigation reports along with bill

Original Hospital Bill-consolidated and with detail breakup of every component of the bill with the patients signature on it.

Incase of surgical packages – detail breakup of the package

Medicine bills with prescriptions.

Claim Form – ( available on

Safeway’s website

www.safewaymediclaim.com

)

MLC Certificate from the hospital in the case of Road traffic accident. Or a certificate from the treating doctor mentioning that the patient was not under the influence of alcohol at the time of Accident.

Payment receipt for the payment done to the hospital.

*

30 Days pre & 60 Days Post hospitalization

Original

investigation reports along with bills & receipts

Consultation receipts.

Medicine bills with

prescriptions

Investigation Reports-Bills with Prescriptions if any

DO’SCarry your ID card (Student ID Card- IIT) at

the time of admission at

network hospitals

Incase of emergency admission kindly contact

Safeway

within 24 hrs of

Hospitalisation

Incase of emergency kindly refer your

Roll No at the time of admission

Take a pre approval from

Safeway

for all the elective cases

Sign on the final bill at the time of discharge from the hospital

For any other assistance call the account manager

PERSONAL ACCIDENT POLICY

PA under Table 1A for S.I Rs 50000/- per student.

PA under Table II for S.I Rs50000/- per student.

Disclaimer : Please

note that all PA(Personal Accident) Claims are being dealt by Insurance Company

Directly, for more details please contact “Student Affair Section

”.

There

is no direct/indirect role

of SAFEWAY

TPA under

this section of coverage.

Your CRMFor any assistance you contact your CRM at below mentioned details

Mr

Rahul

Vij

Mail :

realtech.consultant@gmail.com

Mob :

+

91-92-122-31982

+91-85-888-84533

Desk :

+91 11

47551982

Safeway TPA Services

Pvt

Ltd

Gurpreet Singh

Mob : + 91 999 00 79269

Toll Free : 1800 – 102 -56-71

Phone : +91 45 45 1300

Mail :

support@safewaymediclaim.com