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INSURANCEMANUAL
FORMEDICLAIM&LIFETERMINSURANCE
POLICYSERVICES

EMPLOYEEBENEFITPROGRAM
TheMOLSynergyMarine(MarshallIslands)Inc.EmployeeBenefitProgramisdesignedin
partnershipwithShriissthyInsuranceandFinancialServices.Thisprogramhasbeencreatedto
betterserve,andmostimportantlymeettheneedsoftheSeafarerandtheirfamilies.
TheEmployeeBenefitProgramcomprisestwoinsurancecoverageschemesfortheSeafarer
andtheirfamilies:
GroupFloaterMediclaimPolicy:TheMediclaimCovercanbeavailedbyanyoneorany
numberofmembersinthefamilythatarecoveredinthepolicy.TheOfficersfamilyiscovered
forafixedSumInsuredandanyoneinthefamilycanavailtheadvantagetillthelimit(Sum
Insured)isexhausted.

GroupLifeTermPolicy:TheGroupLifeTermpolicyofferscompensationincaseofdeathtothe
Insuredpersonsnominee,directlyandsolelyasaresultofaNormaloranAccident.
POLICYDETAILS

PARTICULARS

PolicyName

Insurer

SumInsured

PolicyNumber

PolicyPeriod

ThirdParty
Administrator

MEDICLAIMPOLICY

GroupFloaterMediclaimPolicy
(GFMP)

TheNewIndiaAssuranceCompany
Ltd.

INR.5Lakhs

GROUPLIEFTERMPOLICY

GroupLifeTermInsurancePolicy
(GLTI)

LifeInsuranceCorporationofIndia

130400/34/14/04/000000009

GINP/706000977

01/09/2014TO31/09/2015

N/A

01/09/2014TO31/09/2015

HealthIndiaTPAServicesPvt.Ltd

INR.30Lakhs

THEKEYCOMPONENTSOFTHEGROUPFLOATERMEDICLAIMPOLICY

SumInsuredofINR.5lakhbasedontheofficersandtheirdependents
Familyfloaterforself,spouseandthreechildren
AvailabilityoftheThirdPartyAdministrator(TPA)facilityforClaimsettlement
AvailabilityofCashlessandReimbursementfacilities
Cashless
Reimbursement
PreHospitalization(30daysbeforeHospitalization):Doctorconsultationfees,medical
reportsandrelatedmedicationissued30dayspriortohospitalization(admission)can
beReimbursed
PostHospitalization(60daysafterHospitalization):DoctorConsultationfees,medical
reportsandrelatedmedicationissued60daysafterhospitalization(Discharge)canbe
reimbursed.

WHATISCOVERED?

FirstyearStandardExclusions
Preexistingdiseases
30dayswaitingperiod(Therefore,claimsarisingfromthefirstdayoftheinceptionof
thepolicywillgetpaid)
MaternityBenefituptoFirst2children
Newbornchildcoveredfromday1
Ninemonthperiodwaived
EyeandTeethtreatmentresultingONLYoutofanAccident
CataractSurgery:TheamountpayableforCataractSurgeryislimitedtoactualora
maximumofRs.24,000,whicheverislesseitherforCashlessorReimbursement.
AdditionalBenefitofCyberknifeTreatmentremovalofCancerousmalignanttumor
MEDICLAIMMANAGEMENT

TYPESOFCLAIMS
CASHLESS:servicewhereintheinsuredisnotrequiredtopayanymoneyatthetimeof
admissionordischargefromthehospital.Thisbenefitisprovidedonlyinthehospitals
empanelledbytheThirdPartyAdministrator.NonMedicalexpensesandServiceTaxispayable
bytheInsured,forwhichaSecurityDepositisrequiredbytheHospitals

TPANetworkofHospitals:CashlesscanbeavailedonlyattheTPA,HealthIndias
networkhospitals.ListisavailableonTPAwebsite:www.healthindiatpa.com
NOTE:ShriissthyInsuranceandFinancialServicesistheCOORDINATORbetweenthe
ClaimantandtheTPA,andisNOTtheTPA.

CashlessDenial:DenialofCashlessServiceshouldNOTbeconstruedasadenialof
treatment.Insuchacasetheinsuredisadvisedtofiletheclaimforreimbursementand
theTPAwillsettletheclaimsubjecttothepolicystermsandconditions.

REIMBURSEMENT:Whenyoudonotgotooneofthehospitalsthatsnotempanelledwith
theTPA,youwouldusuallyenduppayinghospitalbillsyourself.Butyoucanproducethebills
laterandgetthemreimbursed.
CLAIMINTIMATIONREQUIREMENTS
Shriissthymustbeintimatedattheearliestforbothplannedandemergencyhospitalizations.
ForClaimIntimation,1stIntimationforReimbursementorCashlessshouldbesentto
ShriissthyInsuranceandFinancialServicesviaemailat:patrashefale@gmail.com;
shefale1757@yahoo.com;shaikhsalim554@yahoo.com;salimsk09@gmail.com;
vignesh.k@synergyship.comwiththefollowinginformation:

CompanysName
CrewName
CompanyCrewIDandRank
NameofthePatient,AgeandRelationship
NatureorIllness/Accident
HospitalDetails,DoctorsName,HospitalAdmissionandDischargedate
PersonalContactinformation(AddressandNumber)
Commencementdateofsymptomofthediseaseincaseofanillness
AccidentCase:Dateandtime,locationofaccident,FIRReport,andSelfDeclaration

REIMBURSEMENTCLAIMPROCEDURE:IMPORTANTNOTES

ClaimIntimationshouldbemadewithin7workingdaysafterdischargefromhospital.

Onclaimintimation,ShriissthywillemailalistofOriginalReimbursement
Documentstobecompletedandcourieredtouswithin25daysofdischarge
fromthehospitalforclaimsettlement

ClaimpaymentsarenowbeingmadethroughNEFT/RTGS,thereforeacopyofa
cancelledchequeofyourresidentbankaccount(notNRE)iscompulsoryalongwiththe
submissionoftheclaimdocuments.SendShriissthyanacknowledgementonreceiptof
payment
Pleaseretainacopyofallclaimrelateddocumentssubmittedincasequeriesareraised
regardingtheclaimorasabackupincasedocumentsaremisplacedetc.
Claimsettlementtakesaminimumof1monthtoprocess,howeverifdeficienciesin
documentsubmissionsarisethenthesettlementcanbedelayed

DoctorsFeespaidincashshouldnotexceedthelimitofRs.10000.Aspertherulesof
theinsurancecompanycashpaidaboveRs.10000isnotpayable.
Prehospitalization:AlltheOriginalClaimdocuments,billsandreportsofPre
hospitalizationmustbecourieredtoShriissthywithin25daysofdischargefor
reimbursement
Posthospitalization:Allbillsaccrued60daysPosthospitalizationmustbecourieredto
Shriissthywithin90daysofdischargeforreimbursement

CASHLESSCLAIMPROCEDURE:IMPORTANTNOTES

ClaimIntimation:IntimateShriissthyandpatient/relativemustproceedtotheTPAdesk
attherespectivehospitalwithIDProof&ecard(accesstodownloadecardisprovided)
PreauthorizationProcedure:

CollectpreauthorizationformfromtheTPAdeskandproceedtothetreating
doctortobefilledandthenreturntotheTPAdesk
TheTPAdeskwillfaxtheformandrelevantdocumentstoHealthIndiaTPA
(EnsurethattheTPAdeskfaxes/emailsthedocumentsandpatient/relative
mustinformShriissthyviaphoneoremail.Shriissthywillhelpfacilitatea
smoothercashlessauthorization)
HealthIndiaspanelofDoctorswillscrutinizethedocumentstoauthorizethe
cashless(IncaseofanydocumentdeficienciesHealthIndiawillinformthe
HospitalsTPADesk.Itisimportantthatthepatient/relativeconstantlymonitor
thedevelopmentsbetweentheTPAandHospital)

OnCashlessauthorizationtheTPAwillsanctionaninitialamounttothehospitalbefore
admission(Pleasenoteitwillnotbethefullamount)
SecurityDeposit:Thepatientwillbechargedasecuritydepositbythehospital.This
depositismaintainedintheeventthatcashlessisdeniedornonpayableitemswhich
arenotpayablebytheinsurancecompanywillbededucted.
Discharge:
TakethedischargedocumentstothehospitalsTPADesk,whowillsenditacross
totheTPA.Again,ensurethattheHospitalsTPAdesksendsthedocumentsto
theTPAandinformthesametoShriissthyviaphoneoremail
OnreceiptofthedocumentstheTPAwilltakefewhourstoverifythe
documents.IncaseofanydocumentdeficienciesHealthIndiawillinformthe
HospitalsTPADesk.Itisimportantthatthepatient/relativeconstantlymonitors
thedevelopmentsbetweentheTPAandHospital
Afterclearanceofdeficiencies(ifany)theFinalbillamountwillbesanctionedto
thehospitalafterdeductionsofnonpayableitems.

SecurityDeposit:Thedepositwillnotbereimburseduntilthehospitalreceivesthe
claimsettlementchequefromtheInsuranceCompany(Thisproceduremaytakea
monthstime)

NOTE:THROUGHEVERYSTEPOFCASHLESSPROCEDUREINTIMATESHRIISSTHYVIA
PHONE/EMAILTOFACILITATESMOOTHCOORDINATIONWITHTHETPA.
MANDATORYDOCUMENTS
Whilesubmittingtheclaims(ReimbursementandCashless)forthebelowlistedAilments,the
correspondingmandatorydocumentsmustbesubmittedalongwithotheressentialclaim
relevantdocuments:

CataractSurgery:A'Scanreport&IOLSticker(IflensisaboveRs.10,000thena
purchaseinvoiceisrequired)
Fractures:Xrayreportswithplates(IncludingHip&KneeReplacement)
Accidents:MLC/FIR/Selfdeclarationfrompatient
Angiography:FinalReportwiththeDiagram
ImplantsinBones/HerniaMesh:IfitisaboveRs.10,000thenapurchaseinvoiceis
required
EarSurgery:Audiometryreport
Pneumonia:XrayChestreport
PreexistingDisease:DetailedHistorywithdurationofAilmentslikeDiabetes,
Hypertension,Asthma,Fits/Epilepsy,HeartDiseases,KidneyStones,Arthritis,TB
Paralysis:CTscan/MRIReport

GROUPLIFETERMPOLICY:CLAIMSETTLEMENTPROCEDURE

ClaimIntimation:ShouldbesenttoShriissthywithin48hoursaftertheofficersdeath,
sothatShriissthycanguidethedeceased'sfamilyforthebeststepsforward.Aformal
lettershouldalsobesentfromthecompany'sendprovidingtherelevantinformation
ThesameintimationissenttotheclaimhuboftheInsurancecompany
Requirements:
PostMortemReportismandatory
DeathCertificateismandatory
F.I.Rifapplicable
Latestsalaryslip(sentbythecompany)
Claimformdulyfilledbythedeceasedsfamilymember
Declarationbyafamilymemberstatingthecaseofdeath
Iftheclaimispayable,thentheclaimamountforLifeTermpolicywillberaisedinthe
nameofthecompany,andnotthedeceasedsfamilydirectly

ONLINE:ECARDOFFAMILYMEDICLAIM
TheinsuredcanaccesstheECardorClaimStatuswiththefollowing:

Logontohttps://www.healthindiatpa.com/DownloadEcard.aspx
SelectCorporate
EnterEMPID
ClickonECardandPrint
Pleaseensuretocheckforcorrectdetailsenteredontheecardandrevertincaseyou
noticeanydiscrepancies.Pleaseemailusatourgivenids.
Mostimportantly,pleaseintimateyourcompanyforanyadditionssuchasmarriageand
childbirthsothatthenewfamilymemberscanbeincludedunderthepolicy.

TPASNETWORKHOSPITALS
TheTPAHealthIndiashospitalsinitsnetworkcanbeaccessedwiththefollowing:

Logontowww.healthindiatpa.com
ClickonHospitalontheRighthandsideofthewebpage
SelectState,City,Location

SHRIISSTHYINSURANCEANDFINANCIALSERVICESCONTACTINFORMATION

Primacycontact:Mrs.ShefalePatraManagingDirector
Email:shefale@shriissthy.com,shefale1757@yahoo.com
Phone:+919892009036/+919820103003
SecondaryContact:Mr.SalimShaikhOperationsManager
Email:salim.shaikh@shriissthy.com,salimsk09@gmail.com
Phone:+919987206258/Landline:+912226334291
WorkingHours:(MonFri)(10am6pm)Sat(10am2pm)
Address:207/C,Vriddhi,KalyanComplex,YariRoad,Versova,AndheriWest,
Mumbai400061