Copyright 2011 by Health and insurance. All rights reserved

Presented By

Rahul Agarwal (CEO)

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Copyright 2011 by Health and insurance. All rights reserved

INSURANCE BROKERS

Insurance brokers are independent intermediaries who represent the client and not the insurance company, unlike an insurance agent who normally represents the company 

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AND WHAT DO WE DO FOR YOU…

Identify and evaluate your needs

• Design your Insurance Portfolio

Choose the Right Product• Claims Handling• Legal Representation

Negotiate with the Companies for the most competitive rates

Assist in documentation

Claims Management- After all money matters

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ADVANTAGES OF GROUP HEALTH

Floater cover for Entire Family so higher cover at lower cost Lower Premiums than Individual Plans Easy Claims Settlement Pro Rate Premium if people leave Maternity Benefit Pre Existing Diseases Covered so all disease covered from day

one* Parents can be covered too without any Medical Tests upto age 80 some exclusions are there

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DETAILS OF GROUP HEALTH COVER NORMALLY TAKEN

Floater cover for Self+Spouse+2 Children upto 21 years of Age. Parents can be covered but the proportionate premium to be paid by the

Individuals Coverage

• Basic Hospitalization including 30 Days Pre and 60 Days Post Hospitalization

• Pre-Existing Diseases Covered • Maternity Cover subject to a limit of Rs 25000 for Caesarean and Rs

15000 for normal • Cashless Facility • Accidental Coverage only for the Employee

We need to divide your work group into 3-4 Tiers and give the Coverage Proportionately like Rs 5 lacs for Top Management, Rs 3 for Middle Mgmt., Rs 2 lacs for Lower Management and Clerical Staff and Rs 1 lac for Peon, Drivers, etc.

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ADVANTAGES WITH IDEAL INSURANCE

With Respect to Policy Designing

We help our clients get the best deal from across all Insurance Companies We provide Custom Designed Cover to suit client needs as well as to control claims in

the long term We take complete responsibility of any service/claims/other issues during the policy

period.

With Respect to Claims

Your employee needs to give us intimation during an unfortunate event of a claim and we take over from there managing all documentation, liasioning with the TPA and Insurer for speedy cashless/recovery and other necessary work

We will train all your employees about the procedure of claims so that the claim process becomes hassle free for them

We will provide a 24 hr. Helpline number for any Assistance We will give you One dedicated Service Manager for day-to-day requirements

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Wellness Programme

Benefits of Good Health are many like Better Efficiency, Less Absenteeism, Lesser Attrition, Lesser Claims, lesser Premium outflow, etc

Taking a Health Insurance cannot ensure good Health for your Employees.

At Ideal Insurance, we go that extra mile for our clients by creating a Wellness Programme specially customized for your People which includes

• Naturopathy Sessions with Specialists• Yoga Sessions • Regular Mails and News Letters on Wellness Ideas• Health Check-Ups (Cholesterol, blood pressure and glucose screening

programs)• Healthy Eating, etc

ADVANTAGES WITH IDEAL INSURANCE

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Wellness Programme

Procedure:

Phase I: Conducting the survey in the company to judge the requirements

1. Stress Management2. Smoking Cessation3. Weight Management4. Work-related health issues (in case any)5. Motivation for healthy routine (Good breakfast, Basic Exercise, Climbing Up, etc)

Phase II: Analyze the survey results to design a plan

Phase III: Implement the plan in the organization

ADVANTAGES WITH IDEAL INSURANCE

OUR GROUP HEALTH INSURANCE BUSINESS

We manage Group Health for more

than 20 Corporate clients

Total number of lives served is more

than 20000

We also provide Health Insurance to

more than 10000 individuals

We settle more than 1 claim every day

Our claims settlement ratio is 100%

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ABOUT YOUR POLICY

Insurer:

THIRD PARTY ADMINISTRATOR:

Coverage

Basic Hospitalization Expenses Incl. 30 Days Pre-Hospitalization and 60 Days Post Hospitalization

Cashless Facility (At Network Hospitals of TPA)

Pre-Existing Diseases

First Year Exclusion Waived

Maternity Expenses (9 months waiting period subject to the sub-limits)

25000 for Normal & 35000 for Caesarian Section

Exclusion

AIDS, Domiciliary Hospitalization, Day Care (Less than 24 Hrs)

Cost of Spectacles, Lenses, Cosmetic Surgeries, Pre Natal Defects

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ENROLMENT

You will be given

a HEALTH CARD

Please report any

error immediate

ly to us

This card entitles you

for identificatio

n as a member

Please carry a photo

identification with you

This card does not

entitle you to cashless

without pre authorization

This is NOT a credit card

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GUIDELINES FOR HASSLE-FREE CLAIMS

Approach Network Hospital on recommendation of Physician & Show Cashless Card at the Hospital• If the Disease is not covered

• Information sent is insufficient • Request for Cashless is not sent in time• However, you need to pay the bills which can be reimbursed later

Obtain a Pre-Authorization form and get it filled and signed by the treating doctor and submit to Hospital which will then fax it to the TPA along with other necessary reports• Submit the Pre-Authorization Form available with the Hospital

• Show your Cashless Card, Doctor’s Advice Letter, Probable Date of Admission so that • You will get the Cashless approval even before admission to the Hospital if cashless is approved by the

TPA

After investigation, TPA will fax the approval for Cashless to Hospital

Cashless can be rejected

In case of Planned Hospitalization

In case of Emergency Hospitalization

Go to the Hospital at least 72 Hours before admission and

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CLAIMS REIMBURSEMENT

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If Cashless is not approved or if you visit a Non-Network Hospital

• At the time of Discharge, settle the Hospital Bills in full and collect all the original BILLS, DOCUMENTS, REPORTS and DISCHARGE SUMMARY

• Lodge your claim with the TPA by filling the CLAIM form and attaching Necessary Documents within 7 Days of Discharge

Documents to be Submitted:

• Claims Notification - Within 3 Days of Admission via Letter/Fax/Email• Discharge Summary in Original with all Necessary Details• Detailed Bill –

• Proper Bills with Break-up of all the items/medicines/tests• Doctor’s Bills must be stamped, with Doctor’s Reg. No.

• All Supporting Prescriptions and Reports• Payment Receipt – Must be stamped and signed by Hospital Authorities• Any expenses not pertaining to the Medical Treatment are not covered

DO’S AND DON'TS

Store our Helpline No’s and Also give it to other Family Members

Find out whether the disease is covered in the policy or not

Always carry Cashless Card while going to the Hospital

Maintain All Bills inc. pre and post Hospitalization

Take the bill also from the family/consulting doctor

Never Disclose the amount of coverage to the Hospital

Do not go for very expensive treatment

Enquire about the Approx. cost of Treatment beforehand

Do not panic. Procedures and Rules have to be followed

No Need to call at Weird Hours

Push the Hospital Authorities to send all papers to TPA and

Follow up continuously

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REMINDERS

Your single point of contact with Ideal Insurance is • 98302 00799

Please provide your name, Insurance

Company, ID card no and phone number to

makes it easier for us to service you

Always carry your Health Card, it gives you faster access to

emergency healthcare

Do not wait till the last moment for a planned

treatment; it may become an emergency

any moment – GET THE PRE-

AUTHORIZATION DONE

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Thanks

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