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Simplifying Healthcare Multiplying Prosperity North Shore Technologies Pvt Ltd
Simplifying Healthcare
Multiplying Prosperity
North Shore Technologies Pvt Ltd
POLICY COVERAGE
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Medi Assist | All Rights Reserved
Policy Conditions Coverage
Family Composition1 + 5 – Employee + Spouse + up to 2 Dependent Children + Parents
Family CompositionMax. Age for the dependent children is 23 yrs. Dependent parents covered up to 80 years
Sum Insured 3 Lakhs OR 5 Lakhs
Sum Insured Details
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Basic Coverage
Policy Conditions Coverage
Pre Existing DiseaseWaived off
First 30 days Waived off First 1 year ,2nd Year &Forth year Exclusion Waived off
Maternity Benefit
9 months waiting period
Waived off
Maternity CoverNormal delivery limit up to Rs 35,000/ and caesarean section limit up to Rs 45,000 Upto 2
living births onlyDisease wise sub limit Cataract-Rs 25,000/ per Eye
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Expense CoveragePolicy Conditions Coverage
Room RentRoom Rent Capping covered upto Rs 5,000/ or actual whichever is lower per day for hospital stay in non ICU room and covered upto Rs 10,000/ or actual whichever is lower per day for hospital stay in ICU
Domiciliary Hospitalisation
Not Covered
Pre Hospitalization
Medical expenses incurred up to 30 days prior to hospitalization on disease/illness/injury sustained will be part of Hospitalization Expenses claim
Post Hospitalization
Medical expenses incurred during period up to 60 days after Hospitalization on disease/illness/injury sustained will be part of Hospitalization Expenses claim
Coverage according to policy
Pre and Post Hospitalization expenses payable in respect of each hospitalization shall be the actual expenses incurred subject to a maximum of 10% of the Sum Insured.
Coverage according to policy
CONGENITAL INTERNAL DISEASE Covered.
Coverage according to policy
EMERGENCY AMBULANCE CHARGES Actual subject to a maximum of Rs. 1500/-
MEDICAL expenditure such as :
• Room & Boarding Expenses.
• Nursing Expenses.
• Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees.
• Anaesthesia, Blood, Oxygen, OT charges, Surgical expenses.
• Medicines & Pharmacy Expenses.
• Diagnostic materials and X-ray Expenses.
• Dialysis, Chemotherapy, Radiotherapy Expenses.
• Cost of pacemaker, Artificial Implants & similar expenses.
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What will your policy Pay?
• All Non Medical Expenditure, Food purchased from Hotels / or brought from home.
• Surgery for correction of eye sight cost of spectacles, contact lenses, hearing aids,Cosmetic Surgery, etc.
• Naturopathy Treatment.
• Cost of vitamins/tonics unless forming part of treatment for the covered disease.
• Treatment for Infertility
• Beauty Treatment of any description.
• Plastic surgery (other than necessitated due to accident).
• Circumcision unless required for treatment of an illness.
• Genetic disorders and stem cell implantation / surgery
• Injury / disease directly caused by War, Invasion, act of foreign enemy, warlike operations.
• Admission to the hospital only for the tests / investigations (without treatment).
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What will your policy NOT Pay?
• Treatment of AIDS, HIV, VD (STD).
• Accident treatment under the influence of Alcohol or intoxicating drugs.
• Congenital Disease, defects or anomalies.
• Out patient treatment.
• Injury or diseases contributed by Nuclear weapons / materials.
• Disease or accident due to adventure sports.
• Intentional self Injury.
• Family planning Operations (Vasectomy or Tubectomy) etc.
• Dental treatment unless arising due to accident
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What will your policy NOT Pay?
For Hospitalization/Daycare Reimbursement claim.
A) - Original Detailed Discharge Summary of Hospital/Nursing Home.
B) - Original Detailed Final Bill of Hospital/Nursing Home.
C) - Detailed Break-Up of Final Bill.
D) - Receipt of Payment of Final bill (Advance & Balance Amount).
E) - All Doctor Prescriptions for Medicines & Lab Investigations.
F) - All Lab Investigation Reports and films of X-ray / CT / MRI Done.
G) - All Medicines/Pharmacy/Medical Store Bills.
H) - All stickers and invoice of implants / lens used
I) - Hospital registration certificate with details No. of Beds, ICU facility, 24 Hrs, Nursing Staff facility, Emergency services in Hospital.
J) - Complete filled and signed claim form
K) - Copy of Medi assist card and ID proof of the patient
L) - Hospital should be minimum of 15 beds
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Document Checklist
In Case of Fracture
• Original X-Ray Film.
In Case of Road Traffic Accident
• Non-Alcohol Influence Certificate by the Treating Doctor.
• Medico Legal Certificate (MLC Copy) / Copy of FIR
In case Of Maternity
GPLA History (Gravida Para Living Abortion) Certified by the Treating Doctor.
For Pre/ Post Hospitalization Reimbursement Claim
A)-Receipt of Payments.
B)-All Doctor Prescriptions for Medicines & Lab Investigations.
C)-All Lab Investigation Reports.
D) - All Medicines/Pharmacy/Medical Store Bills.
Employee Signature-_________________. Date-__________________.
Please Bind/ Steples /Clip all the Documents of Reimbursement Claim.
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You initiate your eCashless hospitalization with MediBuddy from the comfort of your home.
The hospital receives your request and enters the estimate cost of treatment
Medi Assist send a provisional, passcode-protected preauthorization to the hospital; You receive your secure passcode
On the date of admission, you present your passcode at the insurance desk to “unlock” the provisional preauthorization.
eCashless
The provisional preauthorization becomes a valid approval only after the passcode is validated and the hospital obtains your ID proof and signatures on the preauthorization form.
Lower cost of care as a result of planning –preferred tariffs contracted by Medi Assist
A truly green channel experience since you reserve your room in advance
The most convenient and secure way to plan a cashless hospitalization
Full visibility into the status of your request, anytime, anywhere, with your app
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Please send Re-imbursement Documents to the following:
Mr. Surya Prakash
Email:- Email:[email protected]
Contact No:-9599593264
Address: Medi Assist Insurance TPA Pvt. Ltd.
Tej Building, Plot No 8B, 2Nd Floor, Bhadurshah Zafar Marg(ITO), Near Times of India Building,New Delhi:- 110002
ORMr. Manish Kumar
Email:- Email:[email protected]
Contact No:-: 9310580716
Address: Medi Assist Insurance TPA Pvt. Ltd.
Tej Building, Plot No 8B, 2Nd Floor, Bhadurshah Zafar Marg(ITO), Near Times of India Building, New Delhi:- 110002
Medi Assist | All Rights Reserved
Points to remember
Well-documented governance matrix
Name: Surya Prakash
Contact No.: 9599593264
Email:[email protected]
Name: Manish Kumar
Contact No.: 8448697084
Email:[email protected]
Name: Manoj Kumar
Contact No.: 8448697086
Email:manoj.kumar@medibuddy.
Level 1 Level 2Level 3
SPOC Escalation Key Account Manager
Subodh-9313158255 [email protected]
Voice Channel
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Happy to partnerMedi Assist India TPA Pvt Ltd.Tower D, 4th Floor, IBC Knowledge Park, 4/1 Bannerghatta Road,Bangalore - 560 029
[email protected] | www.mediassistindia.com
Disclaimer:
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Medi Assist or its affiliate companies. All other product and service names mentioned are the trademarks of their respective companies. Data contained in this document serves
informational purposes only. Some of the illustrations indicated in this document are only for informational purposes and may not have relation to Medi Assist’s products or services.
These materials are subject to change without notice. These materials are provided by Medi Assist and its affiliated companies (“Medi Assist Group”) for informational purposes only,
without representation or warranty of any kind, and Medi Assist Group shall not be liable for errors or omissions with respect to the materials. The only warranties for Medi Assist
Group products and services are those that are set forth in express warranty statements accompanying such products and services, if any. Medi Assist shall in no event be held liable to
any party for any direct, indirect, implied, punitive, special, incidental or other consequential damages arising directly or indirectly from any use of this material, which is provided as is,
and without warranties.
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