Presentation of Services

Medi Assist India Pvt Ltd

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Qwest
Qwest Telecom
Telecom Software
Software Services
Services Pvt
Pvt Ltd
Ltd

TPA
TPAServices
Services

United
UnitedIndia
IndiaInsurance
InsuranceCo.
Co.Ltd
Ltd

28/04/2010  
28/04/2010   To
To    27/04/2011
27/04/2011

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MEDI CLAIM POLICY

The Mediclaim Policy Reimburses Expenses incurred

due to
Disease
Illness
or Accident.
The Mediclaim Policy stipulates that a claim is
admissible when the insured (beneficiary)
is admitted in a hospital
for a minimum of 24 hours and
treatment of a positive illness
Insurance reimburses Reasonable, Customary &
necessary expenses.
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 Cont…
 24 hours hospitalization is not applicable for:
 Dialysis, Chemotherapy, Radiotherapy,
 Eye Surgery,
 Tonsillectomy,
 Lap Appendicectomy, lithotripsy, Hernia Repair,
 Coronary Angioplasty,
 Fracture or dislocation, Prostrate surgery,
 Other surgeries done under Anaesthesia taken in the
Hospital/Nursing Home and the Insured is
discharged on the same day.
 The treatment will be considered under
hospitalization Benefit and has to be availed as An
inpatient only.
 Definition of Hospital
 An institution established in India for indoor care &
treatment of sickness

 Registered with local authorities

 Under supervision of registered & qualified medical

practitioner

 Minimum of 15 inpatient beds( In Smaller cities/ towns

the same is reduced to 10 beds)

 Fully equipped operation theatre

 Fully qualified nursing staff 24/7

 Fully qualified doctors 24/7 5

 Policy Benefits

 Sum Insured- 2 Lacs /Family

 Family Definition- Employee, Spouse, 2
Children and 2 parents
 All Pre- existing ailments are covered.
 No 30 day waiting period.

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 Expenses Payable

A. Room Rent, Boarding, Nursing Charges and ICU charges restricted to Rs.
3500/-. This also includes RMO charges, IV fluids/blood transfusion or
Injection administration charges & similar expenses.
B. Surgeon, Anaesthetist, Consultants, Medical Practitioner, Specialist fees.
C. Anaesthesia, Blood, Oxygen, O. T. charges, Surgical Appliances, Medicines
& drugs, Artificial Limbs, Cost of Prosthetic Devices like pacemaker,
Implants, and Relevant Laboratory/Diagnostic test and Similar expenses
D. Pre Hospitalization Expenses: Expenses incurred 30 days prior to date of
admission( Consultation / Test Charges )
E. Post Hospitalization: Expenses incurred up to 60 days from the date of
discharge.
F. Ayurvedic, Homeo patic and Unani Treatment covered if taken in a
registered hospital based on line of treatment on the scrutiny of the
document under reimbursement claim.

Please note the Pre & Post Natal Expenses is not payable. If new born does not
have any complication claim not admissible

10% co-pay applicable for parents claim 7

Maternity Benefits

 Maternity benefits covered for employee/ spouse

Rs. 50,000/-
 Maternity & Child Coverage from Day One
Expenses incurred on any disease / complication,
arising during maternity for new born child will be
covered from day 1, within Floater SI
 Child data to be given to HR within 30 days.
 Maternity expenses are covered for first TWO
children.

 Normal baby expenses not payable.

 Expenses Not Payable

Admission/Registration
Telephone charges
Attendant's charges
Home Visit/Nursing charges - at residence after discharge
Assistant fee/Follow up charges in advance
Sundry/Medico Legal Charges/Diabetic chart charges
Thermometer Charges
Container for Specimen/Disposable Bag charges
Admission Kit
External Surgical Aids: Lumbo-sacral/Collar belt /Knee cap/Knee
brace/ walker/hot water bag/baby kit/urine pot / traction kit/
folding commode etc
Inhaler/ Nebulizer /Glucometer or any other equipments
Diet charges
Special/protein diet/health drinks unless prescribed by the doctor
Documentation/Folder/Stationery/In Patient chart charges 9
 General Policy Exclusions

 Injuries or diseases caused by war and war like operations

 Circumcision, Vaccination, Inoculation, Cosmetic treatment, Plastic surgery
 Corrective eye surgery, Spectacles, Contact lenses, Hearing Aids
 Dental Treatment without hospitalization unless arising due to an accident
 Convalescence, General weakness, Sterility, Venereal disease, Alcohol use,
Self injury
 AIDS
 Diagnostic expenses not followed by active treatment for the ailment.
 Vitamins and Tonics unrelated to treatment
 Injuries or diseases caused by nuclear weapons
 Abortion during first three months of pregnancy ( Voluntary)
 Naturopathy treatment & Alternate Medicine / Therapy
POLICY PARAMOUNT
At all times the policy issued by the Insurer shall prevail & supersede this
presentation.

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 TPA SERVICES

 ENROLMENT
 ID cards – Photo ID cards

 CLAIMS ADMINISTRATION

 CASHLESS HOSPITALISATION (THROUGH NETWORK

available at website www.mediassistindia.com)

 Reimbursement claim

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Provider Network-Cashless
4800+ Hospitals across the
country

Covering 20 states

Average 25 Hospitals being added

every month

Complete hospital list available at

www.mediassistindia.com

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 Cashless Hospitalisation

 This service enables the customer to avail treatment at the Network

Hospital without being required to pay for the treatment.

 All expenses incurred will be paid to the Hospital deducting the non
medical expenses

 Please produce your Identity Card and photo ID proof of claimant at the
hospital on network where you wish to avail treatment.

 Kindly fill in the Medi Assist Card Number, Name of the Patient, Age &
Contact Number in the Cashless Request Form

 The treating doctor/ hospital will fill in the remaining part of the Request
Form & Fax it to Medi Assist for approval.
 For Emergency Request- TAT – maximum 4 - 6 hours
 Planned Admissions: Approval can be availed 3 days in advance. 13
 Procedure for cashless Hospitalization

Treatment
Admission PA request Info Approval &
Discharge

Pre-auth request is In case any further Approval or denial

submitted to Medi info is required, the is issued as per the
You are Assist by the hospital is asked to terms and
advised hospital and is submit the info and conditions of your
admission by processed at Medi processing happens insurance policy
your doctor Assist
Procedure For Reimbursement of Claims

Please submit the following documents in original

Discharge Summary. (Original )
 Hospital Bill (with detailed break-up) &Cash paid Receipts
(Original)
Medicine Bills along with Doctor Prescriptions.
Investigations & Test Reports. (Original)
Duly Filled claim form with Signature to be submitted.

Note: In case of non-availability of prescriptions, kindly ask your

Physician to countersign on the reverse of pharmacy bills.

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Turn Around Time [TAT]
 Identity Card -
 - 8 working days

 Cashless Hospitalisation
 – planned admission: 48 to 72 hrs
 - Emergency : 6 to 8 hrs hours

 Reimbursement claims
Maximum of 10 working days
Subject to complete documentation &
availability of all information required
to settle a claim

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Customer Service
CALL CENTRE: 1800 4259 449
Single Toll free number, accessible
from any location in India
Full-fledged call centre working
24x7x365
Multi lingual support
Other Prime Number-
080-26537870
 Address for correspondence
Customer Care In charge: Ms. Triveni B N
Email: trivenibn@mediassistindia.com

Medi Assist India Private Limited

No:797, Annapoorna,
10th Main Road, 4th Block , Jayanagar
Bangalore- 560 011
Ph: 26538790/91/92

 Toll Free No: 1800 4259 449

 Toll Free Fax: 1800 4259 559
Wish you a healthy and
happy future !
Thank you

Medi Assist India Pvt. Ltd.

www.mediassistindia.com