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GMC Policy (2017)
GMC Policy (2017)
Policy Parameters
Insurer
TPA
UNITED INDIA INSURANCE COMPANY LIMITED
Vipul MedCorp Insurance TPA Pvt. Ltd.
Policy Coverage Policy covering Employee (Self) + Spouse + 2 Children + Parents
Family Floater: The Sum Insured per family is on 'Floater' basis
Sum Insured INR 3Lacs, INR 3.5 Lacs, INR 4.5 Lacs
Claim Intimation 48 hrs. before admission and 24 hrs before discharge,
for both cashless and reimbursement
Claim Submission Within 30 days from the date of discharge
Claim Arising during the policy period (01/01/2017 to 31/12/2017)
Treatment taken in a registered HOSPITAL or NURSING HOME
The admission in a hospital is medically justified
Duration of hospitalization and justified treatment is more than * 24 Hrs. (*Except for a few listed Day Care procedures wherein 24 hr. hospitalization is not required)
The Hospitalization claim will be passed, when it fulfils the following conditions:
The Policy provides financial assistance to your family against Hospitalization Expenses towards disease/illness/injury in India along with host of value additions/options.
What All is Covered
Standard Hospitalization Covered
Maternity Covered as INR 50000 for Normal & C-sec
Pre-post Natal Covered for Hospitalization cases only
Day care Treatment Covered
Pre 30 Days & Post 60 Days
Hospitalization Covered
Baby Cover
Baby Day 1 : Covered within Family SI Baby Expenses : Up to Discharge within Maternity Limit
Policy Coverage
DAY CARE PROCEDURES
Expenses on Hospitalizations for minimum period of 24 hours are admissible. However
this time limit will not applicable for specific treatments i.e.
1. Adenoidectomy 19. FESS
2. Appendectomy 20. Haemo dialysis 3. Ascitic/Pleural tapping 21. Fissurectomy/Fistulectomy
4. Auroplasty 22. Mastoidectomy 5. Coronary angiography 23. Hydrocele
6. Coronary angioplasty 24. Hysterectomy 7. Dental surgery 25. Inguinal/ventral/umbilical/ Femoral hernia
8. Dilatation & Curettage 26. Parenteral chemotherapy
9. Endoscopies 27. Polypectomy 10. Excision of Cyst/Granuloma/lump 28. Septoplasty
11. Eye surgery 29. Piles/fistula 12. Fracture/dislocation excluding hairline fracture 30. Prostate
13. Radiotherapy 31. Sinusitis
14. Lithotripsy 32. Tonsilectomy
15. Incision and drainage of abcess 33. Liver aspiration
16. Colonoscopy 34. Sclerotherapy 17. Varicocelectomy 35. Varicose Vein Ligation 18. Wound suturing
Room Rent Limit (Per day)
• INR 4000 for sum insured of INR 3 lac and INR 3.5 lacs • INR 5000 for sum insured of INR 4.5 lacs • Not applicable for ICU cases
Ambulance charges INR 2000 per claim
Pre existing disease Covered
Waiver First 30 Days exclusions, first 1 and 2 year exclusion
Other Coverages • Terrorism and epidemic coverage • Infertility Coverage (for IVF only) upto INR 50,000
Policy Coverage
• Room and boarding
• Doctors fees
• Intensive Care Unit
• Nursing expenses
• Surgical fees, operating theatre, anaesthesia 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
• Costs of prosthetic devices if implanted during a surgical procedure
• Radiotherapy and chemotherapy
• Organ transplantation charges
Reimbursement of expenses related to
•Toiletries/cosmetics/ personal comfort or convenience items •Elements of room charge •Administrative or non-medical charges •Administrative expenses
LIST OF NON PAYABLE ITEMS
STANDARD EXCLUSIONS (NOT COVERED)
OPD Expenses
Physiotherapy treatment on OPD basis
Dental expenses unless
Hospitalization under the influence of drugs/alcohol
External Congenital disorder, convalescence, general debility
Any hospitalization for observation/investigation
Plastic Surgery or any treatment/surgery related to beautification
All expenses arising out of any condition caused/ associated with HIV/AIDS / LAV or HTLV-III.
Intentional self injury and use of intoxication drugs / alcohol
Expenses on Vitamins and Tonics, Vaccination
or inoculation
Cost of spectacles, contact lenses and hearing
aids.
Referral fee to the doctor, outstation expenses
Registration charge /Personal Comfort charge
Obesity treatment and its complications
including morbid obesity
treatment relating to all psychiatric and
psychosomatic disorders
Circumcision expenses unless necessary for
treatment of any disease.
Medical termination of pregnancy will not be paid unless a case of emergency.
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
At the time of Discharge from the hospital Insured/attendant to the patient signs the Discharge Summary Final Bill and also pays for the non payable items 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.
Cashless extended in two portions - Initial Approval at the time of discharge sent in the range of 50-70 % of requested amount. Balance at the time of discharge
TPA 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. Validity is 10 days.
Intimate TPA prior to Admission and provide Pre-authorization request form through Hospital
Approach nearest network hospital and submit ID card and send pre-auth request form within
24 hours of admission
IN CASE OF PLANNED
HOSPITALISATION IN CASE OF EMERGENCY
HOSPITALISATION
Cashless Process
AUDIT Verification
Claim verified by TPA Doctor within 7 working days after the receipt of the claim documents.
Query sent to the insured and after the receipt of the query reply again sent for Doctor processing
NEFT Issuance within 2 days after the receipt of claim
Financial settlement of the Claim within 5 working days after doctors processing
Reimbursement Process
Query No Yes
Claim Submission: Within 30 days after discharge
If the query reply is not submitted even after 3 reminders (every reminder sent after 15 days) the claim shall be closed and shall opened only after it is condoned by the insurer
Online : http://www.vipulmedcorp.com/ > Claim intimation (left side
menu options)
Email : [email protected]
SMS/Call : Vipul SPOC
In email/SMS, please share the patient name, Vipul ID no., Hospital name, date of
admission
Claim Intimation
24/7 IVR based call center : The call center can be accessed
for assistance and real time query resolution . We also back this
up with 24/7 mobile helpline at all locations.
Other Client Assistant Service:
IVR Service
Vipul MedCorp Interactive Voice Response (IVR)
Insured can dial Vipul MedCorp Toll free No (1800-102-7477) or 27x7 call Centre (0124-4833900 (100 lines ),which is on Interactive Voice response (IVR) System & they can Punch their Numeric card number .
For Corporate clients , the system will give a welcome message with corporate name & employee can access following details :
Claims ( Intimation / Settlement ) Cashless (Approval) Enrollment (Re-print / dispatch)
Retail Insured can directly access the above on IVR
Escalations Level 3 :
Escalations Level 1 :
Escalations Level 2 :
Primary Contact for All Services:
Relationship Matrix
Name Designation Mobile No. Email ID
Mr. Abhishake Bahl Relationship Manager-
Corporate 9311986332 [email protected]
Name Designation Mobile No Email ID
Mr. Mukesh Kapoor AGM- Corporate 9599598885 [email protected]
Name Designation Direct No Mobile No Email ID
Mr. Anil K.G AGM -
Operations 0124-4629805 9311986346 [email protected]
Name Designation Direct No Email ID
Mr. Pawan Choube Dy. CEO 0124-4629802 [email protected]
Branch Contacts
Branch No.
Primary
Contact Designation Mobile No. Email ID
Hyderabad Mr. Sai Prasad Branch Manager 9849667956 [email protected]
Kolkata
Mr. Abu S
Salim
Operation
Manager 9378178896 [email protected]
Mumbai Mr. S. Swain Branch Manager 9323446630 [email protected]
Pune
Mr.
Sabbyasachi Asst. Manager 7757041659 [email protected]
Chennai Dr Hari Dy Manager 9566777297
om
Bangalore Harish Asst. Manager 9342569214 [email protected]
Marsh Contact Details
Levels Name Mobile No. Email ID
1st level Mr Manish pundhir 8377907994 [email protected]
2nd Level Mr Sumeet Pallav 0124 4149259 [email protected]
