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Presentation on Health Benefits Plan 2010-11
TOTAL OUTSOURCE INDIA PVT LTDGMC POLICY no. 604200/46/10/8500000031
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Index Service Providers & Roles
Policy Highlights
Standard Exclusions
Basic Health Plan Services
Modality
Important Contact Numbers
Health Insurance is for common good, use it judiciously 2
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The Services Providers & Roles
Medimanage Insurance Broking PL. Health Plan Consultant, Value Added Services Provider & Overall
Services Integrator
Mediassist India Pvt. Ltd. Third Party Administrator who would settle all your Hospitalization Claims,
Thru Cashless route or Reimbursement route
The National Insurance Company Ltd Insurer & the underwriter of Risk
Health Insurance is for common good, use it judiciously 3
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Policy Highlights Payments under Standard Mediclaim Policy of The National Insurance
company limited for any hospitalization in India
Family Floater Cover
Sum Insured of Rs. 1,50,000/- per family
Coverage for Employee + Spouse + 2 Children + 2 Dependent
Parents (1+5)
Female employees can either add parent or parent-in-laws
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Policy Highlights Special Benefits
Pre-Existing Diseases Cover from Day One
Maternity Benefit Cover from Day One with the limit of up to Rs. 25,000/-
for normal & Rs. 50,000/- for Caesarian section
New Born Child Cover from Day One (Provided there is intimation of babysbirth within 7 days after birth) Waiver of First Year Exclusions
Waiver of 30 Days Waiting Period
Waiver of Pre-health check up
Cover for Hospitalization due to Terrorism Effect
Health Insurance is for common good, use it judiciously 5
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Policy Highlights Specific Limits Room, Boarding & Nursing Expenses limited to 1% of Sum Insured per
Day or Rs. 2500/- whichever is lower
ICU Unit Expenses limited to 2% of Sum Insured per day or Rs.
5,000/- which ever is lower
Health Insurance is for common good, use it judiciously 6
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Policy Highlights You can avail benefits
If you are already in employment before 15th April 2010, then
immediately
If you have joined recently, then after your enrollment process is
completed as per intimation from HR.
The Insurance cover ends on Standard Termination of the Policy i.e. 14th April 2011 at 12:00
midnight
Separation from Total OutSource India Pvt Ltd
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Policy Highlights The insurance cover Pays for.
Only Inpatient Expenses i.e. only when you are hospitalized &
Treated for disease (minumum 24 hrs hospitalization)
Pre-Hospitalization Expenses for 30 days prior to date of Admission
in hospital & related to same illness
Post-Hospitalization Expenses for 60 days after the date of
Discharge from hospital & related to same illness
But does Not Pay for. Out Patient Expenses i.e. Diagnostics, investigations, consultations
etc. which do not result into hospitalization
Non Medical Expenses like Telephone Charges, Food Bill of
attendants, Registration Charges, Toiletries, Service Charges etc.
Health Insurance is for common good, use it judiciously 8
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Standard Exclusions HIV and AIDS
Intentional Self-Injury, Use of intoxicating drugs/alcohol
Venereal Diseases, Naturopathy
All psychiatric & psychosomatic disorders
Injury or Disease caused directly or indirectly by nuclear weapons /war
Expenses on Vitamins/Tonics unless forming part of treatment
Cost of Spectacles or Contact Lenses, Correction of eye sight, Hearing Aid etc.
Health Insurance is for common good, use it judiciously 9
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Standard Exclusions Any cosmetic or plastic surgery except for correction of injury
Any hospitalization for Diagnostic tests only
Infertility treatment
Any hospitalization less than 24 hours except for specific treatments like Dialysis,
Chemotherapy, Radiotherapy, Cataract Surgery, Lithotripsy, Tonsillectomy etc.
Any Non Medical Expenses like Registration Fees, Admission Fees, Charges for
Medical Records, Cafeteria Charges, Telephone Charges, Service Charges etc.
Any dental treatment or surgery which is corrective, filling of cavity, root canal
etc.
Health Insurance is for common good, use it judiciously 10
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Standard ExclusionsExpenses incurred for investigation or treatment or irrelevant to the diagnosed
during hospitalization
Genetical disorders & stem cell implantation / surgery
Change of treatment from one stream to the other (for example switching over
from allopathy to homeopathy etc) recommended by consultant
Treatment of Obesity & any other weight control program
Any treatment required arising from insureds participation in any hazardous activity
Any stay in the hospital for any domestic reason or no active regular treatment is
given
Massages, Steam bathing, Shirodhara & alike treatment under Ayurveda
Health Insurance is for common good, use it judiciously 11
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Standard Exclusions Doctors home visit charges, Attendant/Nursing Charges during pre &
post Hospitalization
Treatment which is continued before & after hospitalization for an
ailment / disease / injury different from one for which hospitalization
was necessary.
Voluntary Termination of Pregnancy
Outpatient Diagnostic, Medical or Surgical procedures or treatments,
non-prescribed drugs & Hormone replacement Therapy, Sex Change
Any treatment received in convalescent home, convalescent hospital,
health hydro, nature care clinic
Health Insurance is for common good, use it judiciously 12
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Basic Health Plan Services Enrollment ID Card for identification at network hospitals How to avail Basic Insurance Services? How to use Medimanage Portal? Claims Settlement Medimanage Contact Details for Insurance related queries
Health Insurance is for common good, use it judiciously 13
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Enrollment
Health Insurance is for common good, use it judiciously
Enrollment for dependants will be through online process use the following
steps to submit the enrollments.
Log on to https://www.medimanage.com
Use your Employee ID followed with an underscore and 8-digit DOB in
DDMMYYYY format to login-in. Password will be your 8-digit DOB in
DDMMYYYY format.
(Example: If your Employee ID is 123456 & date of birth is 05-Nov-1969, then your login-in ID will be 123456_05111969 and password will
be 05111969)
On completion of enrollment, confirmation will be sent to your
a. Official email ID
b. SMS to your mobile no.
c. Email is sent to your private/personal email ID.
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Enrollment Update status changes in the family within 30 days
If Married, provide info about spouse (Name/DOB/Relationship)
Had a baby, provide info about baby (Name/DOB/Relationship)
If any member covered under plan Expires, Please inform.
Please note that you cannot change your dependents during the
currency of the policy except for the events like Marriage & New Child
Birth. The details given by you at commencement of policy would
be FINAL.
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ID Cards for Hospitalization Identifies you as Total OutSource India Pvt LTD. Health Plan member
Photo for identification
If hospital insists on photo identification, can be produced along
with any other Photo ID like Total Outsource I.D.
Each Health Plan member gets separate card.
Non-Transferable
Provides you Emergency admission at Network hospital
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How to use Medimanage portal? Log-on to your account by using the alternate e-mail id as log-in id and
your DOB in DDMMYYYY as the password.
You will view the main Dashboard Member Central of the application.
Please click on the My Communication tab to proceed further.
Select a category of support request.
Enter a Subject of your request & then enter the Message describing
your request.
Attach documents if any and then Submit the Support Request.
A Ticket No. will be generated and will be reflected in the History of all
your requests.
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How to use Medimanage Portal Immediately after you submit a request, you will receive a
acknowledgement e-mail on the registered e-mail ids.
When Medimanage representative responds to your Message, you will
get an alert about the same on the registered e-mail ids.
To check the response from Medimanage, pick the particular Message
from the History or Search with Ticket no. Or Subject of your Message.
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How to avail Basic Insurance Services? HOSPITALISATION AT NETWORK HOSPITAL
If the hospitalization is in the Network Hospital of Mediassist, you
need to fill up Cashless Request Form & follow process of
Cashless Route
HOSPITALISATION AT NON NETWORK HOSPITALIf the hospitalization is in the Non-network Hospital, you complete
your hospitalization, pay the bills & follow process of
Reimbursement of expenses.
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In case of Planned Hospitalization Obtain the Pre-Authorization Form from Mediclaim Desk of Network Hospital
Fill by yourself the details like
Name of the person to be hospitalized
Mediassist ID & Employee ID No.
Relationship (Self/Spouse/Son etc.)
To be filled by Treating Doctor
Proposed date of admission
History of illness / ailment
Approximate duration of hospitalization
Approximate Expenses (to be filled in by Hospital administration)
Health Insurance is for common good, use it judiciously 20
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In case of Planned Hospitalization Hospital Administration would fax the Pre-authorization Form to Mediassist
The Mediassist Staff would scrutinize the form
Mediassist will fax the Authorization Letter to the concerned hospital within24 hours.
You can get hospitalized & the treatment can start.
On discharge, Sign the bills, claims form & pay the non-medical charges
only.
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In case of Emergency Hospitalization
Get the patient hospitalized at the desired / nearest network hospital
In case, if the hospital insists for deposit, pay the same & get it
returned once Mediassist settles the claim with the Hospital.
Let the patient stabilize
Follow up the standard Pre-Authorization process
Follow the standard discharge process
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Cashless Hospitalization Please Remember.
Mediassist will only pay for the Medical Expenses
You need not make any payment for any of the medical expenses.
You must pay for the non-medical expenses on discharge or
whenever asked by hospital
The bills for medical expenses would be sent to Mediassist by thehospital & they would directly settle the same with hospital
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Non Network Hospitalization
You get hospitalized in any hospital registered with local municipal
authority or a hospital having minimum 15-beds
Get Discharge Summary after making all the necessary payments.
Also obtain the Hospital Registration No.
Submit all the necessary documents (in ORIGINAL) along with Claim
Form within 30 days to your HR dept.
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Documents to be submitted for ReimbursementClaims
All documents mentioned herein should be submitted in ORIGINAL
Discharge Card / Summary
Detailed Hospital Bill
Pre-numbered Cash Paid Receipts for payments made to hospital
Prescriptions, Reports & Bills for all Diagnostics Tests (No Films, only
Reports)
Prescriptions & Bills for all Medicines purchased
Gravida Status (No. of Living Children) in case of Maternity
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Reimbursement Claims All Main Hospitalization bills should be submitted for claim within 30
days from Date Of Discharge.
All Pre-Hospitalization bills should be submitted for claim along with the
main bills only.
All Post-Hospitalization bills can be separately submitted or claimed within
60 days from Date Of Discharge after completion of the treatment.
NOTE: In case ofPost hospitalization treatment ensure to provide appropriate
intimation to HR dept upon discharge to enable to process the pre / main
hospitalization claims separately & post hospitalization claims separately. In case no
intimation is provided while submitting main bills the post hospitalization claims would
not be considered for further processing.
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Important Contact Numbers
Health Insurance is for common good, use it judiciously
Contact Person Role Voice Contact Details Responsibility
Manjula RFor Enrollment &
queries+ 91 97390 10123 All India
Vanitha Cashless Coordinator +91 97422 46961 All India
Manjunatha Claims Executive +91 98864 98076 All India
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Thank You
Health Insurance is for common good, use it judiciously28