Chola MS HELP Health Claims PresentationM/s VA Tech Wabag Group Health Cover2009-2010
When does your cover start?You and your dependents are covered from the time you join the company and send in the MIS form.In case of a new dependent addition (Spouse by marriage and newborn by birth) - please enroll within 30 days of the event.When does your cover end?Termination of Insurance PolicySeparation from the company Group Mediclaim Cover
Hospitalization Insurance CoverIncludes:Only in-patient hospital expenses.Listed day care procedures ( 141 ailments) (pre-authorization is required for availing treatment in non-network hospitals)Excludes:Non - Medical Expenses.Out Patient (OPD) treatmentOther standard exclusions
VA TECH COVERAGES
Individual Sum Insured of Rs 1 Lac - Rs 5 Lac Plz contact HR for your SIEmployee+5 dependants covered in the policyPre existing diseases covered30 days and 1st year exclusion covered Pre and post hospitalization covered for 30 and 60 days respectively.Rs 1000 payable for expenses incurred towards Ambulance, per person per policy year
VA TECH COVERAGES cont.Maternity BenefitsDay 1 Maternity Cover Sub limit Rs.50000 for normal Rs.50000 for caesarianPre and Post Natal OPD Expenses eligible up to 5% of caesarian limit or rs 1000 whichever is morePre and Post Natal Expenses on in-patient basis up to the maternity limitBaby expenses payable up to 5% of caesarian limit or rs 1000 whichever is more
STANDARD EXCLUSIONS OF THE POLICYHospitalization for diagnostic / investigation purpose onlyDomiciliary hospitalizationCircumcision unless necessary for treatment of diseasesDental treatment of any kindCongenital internal & external diseases, defects or anomaliesHospitalization for convalescence, general debility, intentional self-injury, use of intoxicating drugs/ alcohol.Injury or disease caused directly or indirectly by nuclear weaponsCosts incurred on all method of medical treatment except allopathic Cost of spectacles, contact lenses, hearing aidsAny cosmetic or plastic surgery except for correction of injuryVitamins and tonics unless used for treatment of injury or diseasesVaccinations and inoculationsInfertility treatmentHIV / AIDS and Venereal diseases
In house card printing monitored by Enrolment Dept Issuance of cards within 72 hours
What the ID card would contain;
Name of the insured Unique alpha-numeric ID noDate of BirthAgeGenderPolicy No.Valid from dateHelp Line & Toll Free NoAddress of the claims office
Till date 2173 hospitals networked
Additional hospitals have been identified and to be empanelled on priority
Total hospitals spread across 300 cities / towns
Availing Cashless facility from Chola MS Help:
Planned HospitalizationIdentify the network hospital from the list provided by Chola HELP.Approach the hospital at least 48 hrs prior admission and flash the ID card in the billing dept.Hospital will capture the information of the patient in a Pre-auth request, provided by us, and will fax the same to our toll free faxOn receipt of the request our panel of doctors will scrutinize the same as per policy terms and conditions and fax the approval back to the hospital.TAT 6 hoursOn receipt of the approval the hospital will extend cashless hospitalizationCertain non medical expenses like registration fee, admission fee, diet etc has to be born by the claimant.After discharge, the hospital send the bills to Chola HELP and gets it reimbursed.
Availing Cashless facility from Chola MS Help Contd.Emergency HospitalizationPatient get admitted as per the hospital procedureAttendant flashes ID card in the billing deptHospital will capture the information of the patient in a Pre-auth request, provided by us, and will fax the same to our toll free faxOn receipt of the request our panel of doctors will scrutinize the same as per policy terms and conditions and fax the approval back to the hospital.TAT 6 hoursOn receipt of the approval the hospital will extend cashless hospitalizationCertain non medical expenses like registration fee, admission fee, diet etc has to be born by the claimant.After discharge, the hospital send the bills to Chola HELP and gets it reimbursed.Please note that unless the ID flashed, the hospital will not know that the patient is covered under mediclaim and may ask for a advance.
Reimbursement claim documents can be submitted to any of our regional/branch offices
Supported by experienced domain knowledge and medical team
Settlement of reimbursement claims would be made within 15 working days
Electronic Fund Transfers to Corporate
REIMBURSEMENT CLAIM PROCESSReimbursement claim can be submitted when hospitalization is to a non network hospital or when cashless is not availed from a network hospital.The claims documents have to be submitted to Chola HELP within 30 days from date of dischargeThe detailed list of documents required for reimbursement claims are provided in a separate word format along with this presentation, however following is the gist of the sameClaim form duly filled and signed (Soft copy provided with this presentation)Original detailed Discharge Summary, Original main bill, all original lab reports with bills, all original pharmacy bills with prescriptions.Any documentation required further will be communicated to the claimant in writingTAT 15 working days for settlement of claims
Chola MS HELP LINE will operate 24/7 basis. CRM team will be available between 7AM to 9PM. After 9 PM, calls will be forwarded to a pre-designated mobile
The customer care number is All India Toll Free no ( 1800-200-5544) and is also supported by Toll free fax (1800-425-2200).