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Engineering Projects (India) Ltd
Engineering Projects (India) Ltd
TPA - Third Party
Administrator. Vipul
MedCorp TPA Pvt Ltd is an
IRDA licensed TPA and is one
of the market leaders in Health
Care delivery Services
Software Development
Vipul Informatics Pvt Ltd is a
VIPUL
GROUP
Vipul Informatics Pvt Ltd is a
niche player in Software
Development and IT SolutionsAutomobile dealerships .
Vipul Motors Pvt Ltd, is One of the
largest dealers of Maruti Suzuki Cars in
India
Vipul MedCare Pvt Ltd :
is into International Operations and Health Management Activities in India and runs MedHealth Cards (OPD &
Discount Card) & H3U ( Largest aggregation of wellness activities in India ),and manages Corporate wellness
Real Estate Development. Vipul
Group Associate Companies are
leading players in real estate
development
Discount Card) & H3U ( Largest aggregation of wellness activities in India ),and manages Corporate wellness
clinics
Vipul Better Care Management Services LLC,
is the largest local TPA in Oman. Is also a leading
player in Gulf Medical Tourism and IT Solutions
RTS Rural Technologies solutions Pvt Ltd is a
leading player in Smart Card based Health Delivery
services and IT based solutions
CashlessMedical Service Facilitation at
over 8000+ Network Hospitals
Pre policy Check up(on behalf of Insurance
Companies)
Network Tie ups
We are an IRDA licensed Third Party Administrator (TPA). Our Processes are ISO 2008:9001
certified.
We are engaged in the following activities:
Claim processing(Reimbursement)
Enrolment(online/offline/selfcare)
Online assistance(Assistance to insured During
Hospitalization)
Network Tie ups(for Insurance Companies)
Servicing of foreign
travel policies
Foreign travel policies &
Health Policies (issued by India Insurers covering
medical treatment or Hospitalization
outside India)
MIS/Reports(online/offline to Insurance co.,
Insured and hospitals)
Claims Audit (of Insurance Companies, where
they do in house settlement)
travel policies(issued by foreign Insurers for
policy holders travelling to India)
Servicing of Non Insurance
Health care schemes(sponsored/approved by Govt /State Govt .)
Mediclaim Policy CoverageMediclaim Policy Coverage• REIMBURSEMENT OF EXPENSES CONNECTED WITH HOSPITALISATION DUE TO ANY
* INJURY
* ILLNESS
* DISEASE
ARISING DURING THE POLICY PERIOD AND TAKEN IN A ARISING DURING THE POLICY PERIOD AND TAKEN IN A
* HOSPITAL (Registered hospital or Minimum facility available in the hospital as per T & C)
* NURSING HOME (Registered Nursing or Minimum facility available in the hospital as per T & C)
Medical Benefit – Standard Coverage
• Room and boarding
Covers expenses related to
• Room and boarding
• Doctors fees
• Intensive Care Unit
• Nursing expenses
• Surgical fees, operating theatre, anesthesia and oxygen and their administration
• Drugs and medicines consumed on the premises
• Hospital miscellaneous services (such as laboratory, x-ray, diagnostic tests)
• Costs of prosthetic devices if implanted during a surgical procedure
• Radiotherapy and chemotherapy• Radiotherapy and chemotherapy
A) The expenses are payable provided they are incurred in India and within the policy period. Expenses will be reimbursed to the
covered member depending on the level of cover that he/she is entitled to.
B) Expenses on Hospitalisation for minimum period of 24 hours are admissible. However this time limit will not apply forspecific treatments i.e. Dialysis, Chemotherapy, Radiotherapy, Lithotripsy (kidney stone removal), Tonsillectomy taken in theHospital/Nursing home and the insured is discharged on the same day of the treatment will be considered to be taken underHospitalisation Benefit.
Pre & Post Hospitalization Expenses
Post-hospitalization Expenses
Pre-hospitalization Expenses
Definition
� If the Insured member is diagnosed with an Illness which results in his / her Hospitalization and for which the Insurer accepts a claim, the Insurer will also reimburse the Insured Member’s Pre-hospitalization Expenses for up to 30 days prior to his / her Hospitalization.
Covered � Yes
Duration � 30 Days
Post-hospitalization Expenses
Definition
� If the Insurer accepts a claim under Hospitalization and immediately following the Insured Member’s discharge, further medical treatment directly related to the same condition for which the Insured Member was Hospitalized is required, the Insurer will reimburse the Insured member’s Post-hospitalization Expenses for up to 60 day period.
Covered � yes
Duration � 60 Days
Medical Benefit – General Exclusions
1. Injury or disease directly or indirectly caused by or arising from or attributable to War or War-like situations
2. Circumcision2. Circumcision
3. Congenital external diseases or defects/anomalies
4. HIV and AIDS
5. Hospitalisation for convalescence, general debility, intentional self-injury, use of intoxicating drugs/ alcohol.
6. Any non-medical expenses like registration fees, admission fees, charges for medical records, cafeteria
7. Charges, telephone charges, vaccination of baby etc
8. Surgery for correction of eye sight, Cost of spectacles, contact lenses, hearing aids
9. Any cosmetic or plastic surgery except for correction of injury
10.Hospitalization for diagnostic tests only not followed by active hospitalized treatment
11.Vitamins and tonics unless used for treatment of injury or disease
12.External and or durable Medical / Non-medical equipment of any kind used for diagnosis and or
13.Treatment including CPAP, CAPD, Infusion pump etc. Ambulatory devices i.e., walker, crutches, Belts,
14.Collars, Caps, Splints, Slings, Braces, Stockings, elastocrepe bandages, external orthopedic pads, sub
15.Cutaneous insulin pump, Diabetic foot wear, Glucometer / Thermometer, alpha / water bed and similar
16.Related items etc., and also any medical equipment, which is subsequently used at home etc.
17.Infertility treatment
18.Voluntary termination of pregnancy during first 12 weeks (MTP)
19. Claims (of high value) submitted without prescriptions/diagnosis
20. Health foods
21. Costs incurred as a part of membership/subscription to a clinic or health centre
22. Naturopathy
23. Cost of appliances, spectacles, contact lenses, hearing aids
24. Non-medical expenses like Hospital surcharge, telephone bills, cafeteria bills
25.ARMD , Genetic Disorders For E.g. Thallesemia
26. Registration Fee, Admission Fee, Surcharges, Telephone Expenses, Attendant's stay, Washing
27.Charges, Private Nurses, Food, Nursery Charges, Misc expenditure and other expenditure which are not 27.Charges, Private Nurses, Food, Nursery Charges, Misc expenditure and other expenditure which are not
28.related to the illness/hospitalization like:
Food Supplements like Bourn vita, Horlicks etc., Toiletries like soaps, shampoos, oils etc., Perfumed
29.antiseptic creams, Cosmetic treatment for eyes/teeth including their accessories, Water Purifiers &
30.Energy Drinks like Glucose C/D and Glycerin.
31.Venereal diseases and genetic diseases
32.Injury or disease caused directly or indirectly by nuclear weapons
33.Naturopathy, ETC.
Reimbursement Process
Employee sends an email to [email protected] within 7 days from the date of admission
mentioning the patient name, patient Vipul card no., hospital name and date of admission
Reimbursement Process
Claim Documents are received within 30 days of discharge at Vipul MedCorp TPA Pvt. Ltd.
Claim is verified by a Doctor within 5 working days after the receipt of the claim documents and if
any deficiency in the documents / medical requirement, doctor raises a query which is sent to the
concerned via mail, else it is sent for the financial settlement.
Query sent to the insured and after the receipt of the query
reply again to be sent for Doctor
Financial settlement of the Claim within 7 working days
after doctors processing
AUDIT Verification
reply again to be sent for Doctor processing
NEFT Issuance within 15 days after
the receipt of claim
after doctors processing
If the query reply is not submitted even after _ reminders (every reminder sent after 15 days) the claim shall be closed and shall opened only after it is condoned by the under writer office
Cashless Process
Employee INTIMATES Vipul MedCorp prior to His/ Her Admission in the hospital and provides Pre-authorization request form through Hospital
Vipul extends cashless if all information provided else raises relevant document / medical query and on receipt of relevant query reply extends cashless subject to T&C of policy within 1-2 hours after the receipt of the requisite papers. Cashless is valid for a period of 10 days.
Cashless is extended in two portions - Initial Approval at the time of discharge which shall be between 70-75 % of the requested amount and balance at the time of discharge
Employee approaches the nearest network hospital and submits the ID card and sends preauth request form within 24 hours of admission in the hospital
At the time of Discharge from the hospital Employee / attendants to the patient signs the Discharge Summary Final Bill and also pays the non payable items and copay if any as per the policy and leaves the all the originals at the hospital. Vipul shall approve the final discharge /Bill within 2 hours after the receipt of the final bill and discharge summary from the hospital.
requested amount and balance at the time of discharge
The hospital may ask for a security deposit at the time of admission that would be adjusted at the time of discharge after deducting for the non-payable items.
In Delhi NCR hospitals, No security deposit is required, Except Sir Ganga Ram Hospital.
Reimbursement Claims – Documents Check-list
1. Documents required (All in original):
2. Claim form filled and signed
3. Discharge Summary
4. Receipts for payments made corresponding to the final bill
5. Hospital Bills with break-up
6. Investigation/Diagnostic reports/Films
7. Any other document related to the hospitalization7. Any other document related to the hospitalization
(Please keep a photocopy off all documents sent)
Documents
Ailment Discharge Final Receipt of Doctors Consultatio
n Investigation Implant
Medico Legal
Certificate
Document Check-list*
Ailment Discharge Summary
Final itemized bill
Receipt of payment
Doctors prescription
n Receipts
Investigation reports
Implant sticker
Certificate (MLC)/FIR
Usual Cases Yes Yes Yes Yes Yes Yes - -
Cataract Yes Yes Yes Yes Yes Yes Yes -
Maternity Yes Yes Yes Yes Yes Yes, if any - -
Implant (fracture, CAG, etc.) Yes Yes Yes Yes Yes Yes Yes -Stent/Rod removal Yes Yes Yes Yes Yes Yes - -Accident (fall, RTA) Yes Yes Yes Yes Yes Yes - Yes
Yes (USG report
D&C (Abortion) Yes Yes Yes Yes Yes
Yes (USG report& Film before
D&C) - -
Fracture Yes Yes Yes Yes Yes
Yes (X-ray report& Film confirming
fracture) - -
Pre-existing Yes Yes Yes
Yes (first consultation
) Yes Yes (initially done) - -
*indicative, specific document requirement is dependent on the case
Online Claim Intimation
visit-www.vipulmedcorp.com
Online Claim Intimation
2nd Page
Check Online Claim
Status
Select ID card dropdown
Insert vipul id n0.n0.
Click search
Online Claim Status Check2nd Page
Relationship Matrix
Name Contact No Email ID
Mr. Rizwan 9311986326 [email protected]
Mr.Abhishake Bahl 9311986332 [email protected]
Mr.Mukesh kapoor 9599598885 [email protected]
Mr Pawan Choube 9311986305 [email protected]
Contact MatrixContacts:
Call Centre 24x7 toll free number: 1800-180-1166 / 1800-180-1177
Phone: 95-124-4699616 to 620
Pilot Number: 95-124-4699600
Toll Free IVR No 1800-102-7477
Fax: 95-124-4308211 --- 95-124-4699611 / 612
Email:
Email:
Website:
www.vipulmedcorp.com
Head Office 515, Udyog Vihar, Phase 5, Gurgaon, Haryana Pin Code: 122 016Phones : 0124-4699600, 4833900, Fax No. : 0124-2438276, 4699611-12, 4308211Email Id : [email protected], Ansal Chamber II, Bhikaji Cama Place, New Delhi, Pin Code: 110 066Contact Person : Mr. Chandan Prasad (9311986381)Phones : 011-46074578-81, Fax No. : 011-41659833Faridabad Plot No- 1A, 19/6, Delhi-Mathura Road, Faridabad
Coordinates
Plot No- 1A, 19/6, Delhi-Mathura Road, FaridabadContact Person : Mr. Mohit Saxena (9311986374)Phones : 0129-2299581, 2280245 Fax No. : 0129-4086657JaipurS-10, Shyam Nagar Ajmer Road, Jaipur Rajasthan Pin Code: 302 019Contact Person : Mr. Rabisankar Sengupta(09314186907)Phones : 0141-4182000 to 4182049, Fax No. : 0141-4182028, Toll Free : 18001806220Mumbai
107 & 109, 1st Floor, Shilpin Centre, G. D. Ambekar Marg, Wadala (W)Mumbai, Pin Code: 400 031, Contact Person : Mr. A.K.Sachdeva (9321235852)Phones : 022-24160031, 022-40764545 (24 Lines), Fax No. : 022-40764555Hyderabad108, 1st Floor, Navkethan complex,Opp to Clock Tower,S D RD, Secunderabad – 500 003 Contact Person: Mr. Sai Prasad Ph : 040 –40021845 Fax – 40024849 Indore
306, 3rd Floor,Shreevardhan Complex, 4,R.N.T. Marg,
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306, 3rd Floor,Shreevardhan Complex, 4,R.N.T. Marg, Indore, Pin Code: 452 001, Contact Person : Mr. Upendra Chouhan (9329733002)Phones : 0731-4285670-75, Fax : 0731-4208920 Bangalore
154, 2nd Floor,Mallige Complex, KHB Colony, 5th Block,Kormangala,Bangalore 560095 Phones : 080-40870888, Tele Fax : 080-41249694
Kolkata19, R.N.Mukherjee Road, Main Building (1 St Floor),Kolkata: 700 001, Contact Person : Mr. Arup Banerjee Mobile : 9378178895Phones : 033-40205700,40205701, Fax No. : 033-40205712
Chennai
New No. 517, Old No. 338, 2nd floor, Anna Salai,Nandanam,(Opp. to G.R.Complex) Chennai, Pin Code: 600 035 Contact Person : Mr. K. RajshekaranMobile No. : 9380037673Phones : 044-49126666, Fax No. : 044-24335716
Coordinates
Phones : 044-49126666, Fax No. : 044-24335716
Chandigarh
S.C.I. No. 98, First Floor,Industrial Area,Phase 2, Chandigarh 160002, Dr Arvind Bakshi (9316889998)Phones : 01722641087,89, 2641304
Amritsar
SCO NO 122-123, FIRST FLOOR, DEEP COMPLEX, COURT ROAD, AMRITSAR- 143001Dr Arvind Bakshi (9316889998)Phones : 0183 5056482
Ludhiana
SCO NO 121, FOURTH FLOOR, CABIN No. 401, Feroze Gandhi Market, Ludhiana 141001Dr Arvind Bakshi (9316889998)Phones : 0161 4633088
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Phones : 0161 4633088
Noida
Plot No. B-125 First Floor,Sector 5, Noida Phones : 0120-4238602, Fax No. : 0120-4238603
Dehradun119 Raj Plaza, 75 Rajpur Road, DehradunContact Person : Mr. Ravi Kumar Phones : 0135-3200004Cochin
Mariam Tower Door No.36/3120-B-3, Kaloor Kadavanthra Road,Kathrikadavu.Cochin-17, Contact Person : Mr. Rajesh R, Mobile : 9744497212Phones : 0484-2102021, 2330079, Fax : 0484-2330080
Vadodara449-450, Phoenix Complex, Near Suraj Plaza,Sayajiganj, Vadodara - 390 005Contact Person : Dr. Ritesh Singh Malik (09328652140) Phones : 0265-6643222, Fax : 0265-2225302Surat602, Meridian Tower, Udhna Darwaja, Pin code: 395 002,
Coordinates
602, Meridian Tower, Udhna Darwaja, Pin code: 395 002,Patna
Kunwar Complex,3rd Floor, Main road Kankarbagh, Patna-800002Conatct Person: Mr. Rajeev Agrawal Phones : 0612-2385894, 0612-2385895
6/8/2017Vipul MedCorp TPA
Pvt Ltd. 21
