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About Paramount Health Services (TPA)


Your Id Card How and when to use your card.
Call center General information and queries
How to intimate paramount
How to avail cashless services
Documents that you need to submit for a reimbursement claim.
FAQs

About Paramount Health Services (TPA)


Paramount Healthcare Services (TPA) Pvt. Ltd is a leading Third Party Administrator
(TPA) in the Indian insurance industry. Operating since 2002, it is an ISO
9001:2008 Certified Company. It is promoted and run by medical professionals
supported by personnel from diverse background like IT, Insurance & Customer
Relations etc.
Paramount Health Services operates in 27 states with over 1200 employees working
to ensure outstanding service and support to over 2 crore customers including over
3000 corporate clients. Headquartered at Mumbai, Paramount has four regional
offices at Delhi, Chennai, Kolkata, Bangalore and various other branch offices in
major cities spread across the country.
Today Paramount has become an inspirational story followed by others in India and
is widely accepted as the best in this field. With our experience, we have made world
of differences in many lives.

Your ID card - How & when can you use your card?
On the basis of details provided by the insurance company, Paramount issues a
Health Card to each member covered under the policy. Your card is attached
alongside this booklet. Please preserve this card and carry it with you at all times. It
is not a credit or debit card but an Identity Card, which will identify you as the insured
and will you give access to our network of Hospitals.
Beside Physical Cards we have made provision to access Electronic Card (E-Cards)
on our website as well as our mobile app. Provide your ID No. and the insurance
company name whenever you call the Paramount help line no. Ensure you give your
ID No. in all your correspondence.

Call Center Services- Paramount


Call Center works 24 /7 with a dedicated helpline number that is provided to all our
clients.
At Paramount we believe a stitch in time saves nine, hence we strive to give
correct and precise information to the client through our call centre.
Sample queries handled by the call center are :Cashless

Procedure for cashless hospitalization.


Confirmation of faxes received for cashless hospitalization.
Replying to Cashless Status (Add. Info. Requirement, Denial of Cashless
service, Issue of Authorization Letter)

Reimbursement

Receipt of Claim documents


Availability of Data
Claim status (Deficiency requirement, Repudiation of Claim, Clearance of
claim)
Reopening of claim.

General

Cards Status
Provider Status (Network Hospital Status)
Brief on Policy Details
Sum Insured Details
Website Details
Claim Intimations

What to do in case of Hospitalization - what is Intimation


Claim Intimation is the process of notifying a claim to Paramount by specifying the
timelines as well as the Hospital Name / Address / Contact number to which it
should be notified.
Insured has to notify / Intimate Paramount 48 Hours prior to any Planned
Hospitalization.
In case of Emergency Hospitalization, Insured has to notify / Intimate Paramount
within 24 Hours of Hospitalization

Insured should notify the Hospitalization by calling at Paramount 24X7 Call Centre, Online
Intimation on our website (www.paramounttpa.com) or E-mail on
claim.intimation@paramounttpa.com

Jain Certificate is mandatory for all type of Claims without which no claims
will be entertained. Insured need to submit Jain Certificate at the time of
Cashless Hospitalization and even at the submitting Reimbursement Claim.

How to avail cashless services

Insured has to arrange for the Request for Hospitalisation (RAL) from
Hospital, also known as Provider immediately after obtaining due details from
the treating doctor in the preauthorization form prescribed by the Authority.
The RAL shall be sent along with all the relevant details in the
electronic form / Fax/ Email to the 24-hour authorization /cashless
department of Paramount along with contact details of treating physician
and the insured.
In case of planned admission- the RAL shall reach the authorization
department of Paramount prior to the expected date of admission.
The RAL form shall be duly filled with clearly mentioning Yes or No and/or the
details as required. The form shall not be sent with nil or blanks replies.
Paramount guarantees payment only after receipt of RAL , Jain
Certificate and the necessary medical details, subject to Policy Terms and
Conditions.

What will happen at Hospital Deposit


In certain cases, a deposit may be required, payable to the hospital to cover non-medical
expenses, for example Telephone / diet of attendant etc .
Cashless Hospitalization Documents
At the time of discharge insured needs to sign duly filled Claim form and necessary
hospital documents. Hospital will submit all those documents to TPA for further
processing of Claim.
What happens at backend if Cashless is requested?
On receipt of request for Cashless hospitalization at Paramount, Medical team at
Paramount will determine whether the condition requiring admission and the treatment
are covered by your health insurance policy. They will also check with all the other terms
and conditions of your insurance policy. Non-medical expenses will not be payable.

In case coverage is available, Paramount will issue an approval to the


hospital for a specified amount depending on the disease, treatment, how
much you are insured for, etc. This is sent by fax and/or email (if
available). The approval is called a Preauthorization. This
preauthorization entitles you to avail cashless facility at the hospital
without paying for the medical expenses. Note: Further enhancement
approvals may be issued on enhancement request, subject to terms and
conditions of the policy.

In case of any deficiency or query, an additional information letter will be sent


to the Hospital. On receipt of the required and complete information, the request
will be processed.

Based on the processing of the claim, a denial or approval is executed.

Please note- That denial of a preauthorization request is in no way to be


construed as denial of treatment or denial of coverage. You can go ahead
with the treatment, settle the hospital bills and submit the claim for a
possible reimbursement.

At the time of discharge, please make sure that you check and sign
the original bills and discharge summary. Please carry home a copy
of the signed bill, discharge summary and all your investigation
reports. This is for your reference and will also be useful during your
future healthcare needs.

What if the final bill is higher at the time of discharge?


If treatment cost is increased during hospitalization, hospital may send request to
Paramount for an additional sanction. Paramount will sanction additional cashless, subject
to availability of balance Sum Insured and as per policy terms and conditions.
In case of no further guarantee of payment from Paramount, Insured needs to settle the
remaining amount prior to discharge.
Please be aware of room rent eligibility. If admitted in a room higher then admissible ie.
Room Rent Limit 2500/- Per day, as per the policy terms, there will be a deduction of a
proportionate amount of the claim after excluding cost of medicines etc. Sample of
Deduction Calculation Refer Last Page
How to file a claim if insured gets hospitalized in non network hospital
Reimbursement claims can be submitted to Paramount through courier, post or in person at
any of our branches. Claim Documents should be sent to Paramount as per policy
guidelines issued by insurer. Claim form can be collected from the nearest Divisional /

Branch Office of the Insurance Company / Paramount office or Claim forms can be
downloaded from our website. www.paramounttpa.com. Issuance of claim form does not
mean guarantee of payment or any liability, under the policy on the part of the insurers.

Documents that you need to submit for a hospitalization


reimbursement claim are:
1.
2.
3.

Jain Certificate is mandatory


Original completely dully filled Claim form
Covering letter stating your complete address, contact numbers and email
address (if available), along with Schedule of Expenses.
Copy of the Paramount ID card or current policy copy and previous years'
policy copies (if any)
Original Discharge Card/ Summary
Original hospital final bill
Original numbered receipts for payments made to the hospital
Complete breakup of the hospital bill
All bills for investigations done with the respective reports
All bills for medicines supported by relevant prescriptions
Cancelled Cheque for quicker transfer of claim amount directly into your
bank account through NEFT.

4.
5.
6.
7.
8.
9.
10.
11.

Note: You are advised to keep Photo Copy of the entire set of claim documents
submitted to us.

FAQs
Why are there deductions in my reimbursement claim?
Charges for the certain facilities are not covered by insurance co. and those expenses are
deducted from the reimbursement claims.

What are these expenses that are not covered?


The following few expenses are not reimbursable as per standard policy conditions.

Telephone/Fax
Food & Beverages for relatives
Barber
Non Medical expenses
Diet charges whish are not part of the administered treatment etc.

"National Electronic Funds Transfer - NEFT Details


By providing the bank account particulars (including the IFSC code of your bank) you are
ensuring, quicker transfer of claim amount directly into your bank account.
It is very important to note that the policyholder can benefit from the quicker electronic
payment systems (RTGS/NEFT) only if they are able to furnish their bank account details
accurately in their claim forms. Also arrange to send Cancelled Cheque for verification of
NEFT Payment.
When can my claim settlement get delayed?

In case the documents are not submitted appropriately.


In case the document are not submitted completely.
In case Bank details are not provided.

Deduction Calculation Example 1

Incremental Charges Calculation Sheet (Excluding Medicine, Consumble &


non payable charges)
Per Day Amt
Room rent Caping as per policy per day

2500.00

Room rent Charges as per bill per day

5000.00

Particular

Spent
Amount

Payble Amt

Incremental
Deduction
Amt

Room Charges ( For 1 Day)

5000.00

2500.00

2500.00

Surgeon Charges

50000.00

25000.00

25000.00

Operation Theatre Charges

25000.00

12500.00

12500.00

Anasthesia & Anasthesist Charges

30000.00

15000.00

15000.00

Doctor Visit Charges

14000.00

7000.00

7000.00

Investigation Charges

5000.00

2500.00

2500.00

Others Charges

3000.00

1500.00

1500.00

Medicines Charges

8000.00

8000.00

0.00

140000.00

74000.00

66000.00

Total Charges

Deduction Calculation Example 2

Incremental Charges Calculation Sheet (Excluding Medicine, Consumble &


non payable charges)
Per Day Amt
Room rent Caping as per policy per day

2500.00

Room rent Charges as per bill per day

4000.00

Particular

Spent
Amount

Payble Amt

Incremental
Deduction
Amt

Room Charges ( For 1 Day)

4000.00

2500.00

1500.00

Surgeon Charges

50000.00

31250.00

18750.00

Operation Theatre Charges

25000.00

15625.00

9375.00

Anasthesia & Anasthesist Charges

30000.00

18750.00

11250.00

Doctor Visit Charges

14000.00

8750.00

5250.00

Investigation Charges

5000.00

3125.00

1875.00

Others Charges

3000.00

1875.00

1125.00

Medicines Charges

5000.00

5000.00

0.00

136000.00

86875.00

49125.00

Total Charges

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