…crea&ngacollabora&veecosystemtosimplifyhealthcare

LICClubAgents'GroupMediclaimPolicy2015-16

MediAssistIndiaTPAPrivateLimited|Private&Confiden&al|NotforCircula&on 2

LifeInsuranceCorpora0onOfIndiaLtd.

coverfrom

NewIndiaAssuranceCo.Ltd.

servicedby

MediAssistIndiaTPAPvt.Ltd

MediclaimPolicySlides

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Defini&ons•  Illness

•  Illnessmeansasicknessoradiseaseorpathologicalcondi&onleadingtotheimpairmentofnormalphysiologicalfunc&onswhichmanifestsitselfduringthepolicyperiodandrequiresmedicaltreatment

•  Hospital•  AHospitalmeansanyins&tu&onestablishedforin-pa&entcareanddaycaretreatmentofsicknessand/orinjuriesandwhich

hasbeenregisteredasahospitalwiththelocalauthori&es,whereverapplicable,andisunderthesupervisionofaregisteredandqualifiedmedicalprac&&onerandmustcomplywithallminimumcriteriaasunder:

•  hasatleast10inpa&entbeds,inthosetownshavingapopula&onoflessthan10,00,000and15inpa&entbedsinallotherplaces;•  hasqualifiednursingstaffunderitsemploymentroundtheclock;•  hasaqualifiedmedicalprac&&oner(s)inchargeroundtheclock;•  hasafullyequippedopera&ontheatreofitsownwheresurgicalproceduresarecarriedout•  maintainsdailyrecordsofpa&entsandwillmaketheseaccessibletotheInsurancecompany’sauthorizedpersonnel

•  PolicyPeriod:01stSept2015to31stAug2016.•  Coverage: ForSelfonly(Age18yrsto85yrs.)

•  SumInsured: VariousSIdependingupontheGrades–FromRs.40KtoRs.1.25Lakhs•  RoomRestric0on: NormalRoomupto1%andforICUupto2%ofSumInsured.

•  Maternity: ForNormaldeliveryRs.25KandforCsec&onRs.50K

•  Pre/Postexpenses:30daysperhospitaliza&onand60daysposthospitaliza&onchargesarecovered.

•  Preexis&ngailmentsarecovered.•  Wai&ngperiod(1styear/2ndyear/3rdyear)iswaivedoff•  30dayswai&ngperiodnotapplicable•  Ambulancechargeupto1%ofSIpayablefortransporta&onfromhometohospital.

•  Ayurvedic/Homeopathic/UnaniTreatmentareadmissibleupto25%ofthesuminsuredprovidedthetreatmentforillness/diseaseandaccidentalinjuries,istakeninaGovernmenthospitalorinanyins&tuterecognizedbyGovernment

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SpecialFeaturesoftheMediclaimPolicy

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ExpensesPayable

•  Room,Boarding,NursingCharges•  ICUcharges.•  Surgeon,Anaesthe&st,Consultants,MedicalPrac&&oner,Specialistfees.

•  Anaesthesia,Blood,Oxygen,O.T.charges,SurgicalAppliances,Medicines&drugs,Ar&ficialLimbs,CostofProsthe&cDeviceslikepacemaker,ImplantsandRelevantLaboratory/Diagnos&ctestandSimilarexpenses

•  PreHospitaliza&onExpenses:Expensesincurred30dayspriortodateofadmission(Consulta&on/TestCharges)

•  PostHospitaliza&on:Expensesincurredupto60daysfromthedateofdischarge.

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TheCompanywillpaytotheInsuredPersonexpensesof:

•  Room,Boarding,NursingCharges•  ICUcharges.•  Surgeon,Anaesthe&st,Consultants,MedicalPrac&&oner,Specialistfees.•  Anaesthesia,Blood,Oxygen,O.T.charges,SurgicalAppliances,Medicines&drugs,

Ar&ficialLimbs,CostofProsthe&cDeviceslikepacemaker,ImplantsandRelevantLaboratory/Diagnos&ctestandSimilarexpenses

•  PreHospitaliza&onExpenses:Expensesincurred30dayspriortodateofadmission(Consulta&on/TestCharges)

•  PostHospitaliza&on:Expensesincurredupto60daysfromthedateofdischarge.

AsaSPECIALPREVILEGESProportionatedeductionwaivedoff

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ExpensesNotPayable(Cashless&Reimbursement)

•  Admission/Registra&on•  Telephonecharges•  Akendant'scharges•  HomeVisit/Nursingcharges-atresidenceamerdischarge•  Assistantfee/Followupchargesinadvance•  Sundry/MedicoLegalCharges/Diabe&cchartcharges•  ThermometerCharges•  ContainerforSpecimen/DisposableBagcharges•  AdmissionKit•  ExternalSurgicalAids:Lumbo-sacral/Collarbelt/Kneecap/Kneebrace/walker/hotwaterbag/babykit/urine

pot/trac&onkit/foldingcommodeetc.•  Inhaler/Nebulizer/Glucometeroranyotherequipment's•  Dietcharges•  Special/proteindiet/healthdrinksunlessprescribedbythedoctor•  Documenta&on/Folder/Sta&onery/InPa&entchartcharges

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Daycareprocedures/treatmentspayableunderthepolicy

An&RabiesVaccina&on Hysterectomy

Appendectomy Inguinal/Ventral/Umbilical/FemoralHernia

CoronaryAngiography Lithotripsy(KidneyStoneRemoval)

CoronaryAngioplasty ParenteralChemotherapyDentalsurgeryfollowinganaccident Piles/Fistula

Dilata&on&Curekage(D&C)ofCervix Prostate

Eyesurgery Radiotherapy

Fracture/disloca&onexcludinghairlineFracture

StoneinGallBladder,Pancreas,andBileDuct

Gastrointes&nalTractsystem Tonsillectomy,

Haemo-Dialysis UrinaryTractSystemHydrocele Sinusi&s

10MediAssistIndiaTPAPrivateLimited|Private&Confiden&al|NotforCircula&on

Pre-Authoriza&on(PA)&ReimbursementclaimProcess

CustomervisitstheMediAssistnetworkhospitalforadmission,hospitalsendsPArequestwithcopyofphotoIDproof

toMediAssist

MediAssistregistersPre-AuthrequestandLiabilitychecksdoneasperpolicy

termsandcondi&ons

Ifmoreinforma&onrequired,MediAssisttoseekInforma&onRequired

fromhospital.

MediAssisttoprocessPre-Authoriza&on(Approved/Denied)

MediAssisttoapprovePre-Authoriza&on.Incasedenied,willclaim

forpossibleReimbursement.

HospitaltosendtheDischargesummaryandFinalbillstoMediAssistforPA

seklement

Posthospitaliza&oncustomertosubmitdulyfilledclaimformalongwithalloriginaldocumentstoMediAssist

MediAssistregisterstheclaimandsendacknowledgementtocustomerthrough

SMS/e-mail

Valida&onofclaimsandliabilitychecksdoneasperpolicytermsandcondi&ons

Ifmoreinforma&onrequired,MediAssisttosendInforma&onRequired(IR)

lekertocustomers.

MediAssisttoprocessReimbursementclaims(Approved/Denied)

PaymentdonethroughNEFTandsekled.Ifdenied,Deniallekerissent.

ReimbursementclaimsProcessPre-Authoriza0on(PA)Process

SMS&e-mail’saretriggeredatbelowClaimsstages•  Queries•  Registra&on•  Approval•  Denial•  Seklements•  Informa&onrequired

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MediAssist|DocumentsRequiredforReimbursementClaim

1.  DulyFilled&SignedClaimForm

2.  OriginalDischargeSummary

3.  Originalhospitalbills/receipts&suppor&ngannexures,detailbreakupofthemainbill.

4.  CopyofIndoorcasepaper.

5.  Allinves&ga&on&testreports-includingECG,X-Ray,Ultra-Sound,CTScan,MRI

6.  Allpharmacybills&prescrip&ons

7.  Cancelledcheque.

8.  ForclaimaboveRs.1lac,PanCardCopyisalsorequired.

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HowtodownloadECardStep1.Typewww.mediassis0ndia.comonwebbrowser

Step2ClickonE-Cardsop0onontoprightsec0on

Step3:-Selectanydesiredop0onfromthechoicetoenterthespecificdetail:

Step4:-EnteryourEmployeeID/Agentcode Step5:Oncethedetailsareentered,yougettheE-card

Step6:SavetheE-cardtou0lizedatthe0meofhospitaliza0on.

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HowtoviewclaimstatusOnlineStep1:Typewww.mediassis0ndia.comonwebbrowser Step2:ClickonTrackyourclaimop0onontoprightsec0on:

Step3:Selectanydesiredop0onfromthechoicetoenterthespecificdetail

Step4:EnteryourEmployeeID/AgentcodeorifknowtheMAIDnumberorclaimnumber: Step5:Ifanyaddi0onaldocumentsarerequestedpleasesubmitthedocumentstoyournearestMediAssistBranch.Step6:Oncethedocumentsarereceivedandqueryiscompletedtheclaimwillbeprocessed.

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MediAssist|TollfreecallcentreservicesØ  Interac&veVoiceResponseSystem(IVRS)

Ø  StateofartcallcentrelocatedatBangaloresuppor&ngPANIndiaCallCentreopera&ons

Ø  24x7availability

Ø  Coopera&veandMul&lingualspeakingstaff

Ø  Tollfreenumbers

Ø  RecordingandMonitoringofallcalls

Ø  Regulartrainingtoallexecu&vestosensi&zetowardsvariouspolicies&issues

ContactDetails18004191151

HappytopartnerMediAssistIndiaTPAPvtLtd.SriKrishnaArcade,47/1,9thCross,1stMainRoad,SarakkiIndustrialLayout,3rdPhase,JPNagar,Bangalore-560078Tel:+918026584811

info@mediassis&ndia.com|www.mediassis&ndia.com

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changewithoutno&ce.ThesematerialsareprovidedbyMediAssistanditsaffiliatedcompanies(“MediAssistGroup”)forinforma&onalpurposesonly,withoutrepresenta&onorwarrantyof

anykind,andMediAssistGroupshallnotbeliableforerrorsoromissionswithrespecttothematerials.Theonlywarran&esforMediAssistGroupproductsandservicesarethosethatareset

forthinexpresswarrantystatementsaccompanyingsuchproductsandservices,ifany.MediAssistshallinnoeventbeheldliabletoanypartyforanydirect,indirect,implied,puni&ve,special,

incidentalorotherconsequen&aldamagesarisingdirectlyorindirectlyfromanyuseofthismaterial,whichisprovidedasis,andwithoutwarran&es.

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