Presentation on Group Mediclaim policy benefits for students of

SIDDAGANGA INSTITUTE OF TECHNOLOGY

About Group Mediclaim

Group Health Insurance covers hospitalization and medical expenses incurred as an inpatient by students who are covered under the Group Medicalim policy of SIT students .

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• The policy is issued by the National insurance co. ltd.

• The policy is valid for a period of 1 year.

• Vidal Health TPA (Formerly known as TTK Health Care TPA Pvt. Ltd.)

is the Third party Administrator to serve this policy (i.e. enrolling the members, processing cashless & claims on behalf of insurance Co.)

Group Mediclaim

About Us

• Vi dal Heal t h TPA Pvt . Lt d. ( f ormerl y Known as TTK Heal t h Care TPA Pvt Lt d )was est abl i shed i n Apri l 2002; wi t h t he mi ssi on t o provi de t op qual i t y TPA servi ces t o Medi cl ai m pol i cyhol ders and be t he most pref erred TPA i n I ndi a.

• We are l i censed by I RDA (I nsurance Regul at ory & Devel opment Aut hor i t y - Li cense No. 016) and have been empanel l ed by l eadi ng i nsurance compani es, bot h publ i c sect or and pr i vat e, across di f f erent regi ons of t he count ry.

• We, at Vi dal Heal t h TPA Pvt . Lt d. (Formerl y known as TTK Heal t h Care TPA

Pvt Lt d), bel i eve cust omer sat i sf act i on i s of ut most i mport ance and const ant l y st r i ve t o achi eve t he same.

• We have a pan I ndi a presence wi t h 14 branches wi t h t eam of more t han

1400 members.

• Our Corporat e & head Of f i ce i s l ocat ed at Bangal ore .

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Role of TPA

Vidal Health

TPA Demanding better service, more information, and greater convenience

Policy Holders

Striving to reduce premiums. Make better policies. Aim at Claims Control

Insurance Co

Providers

Desiring less administrative burden, greater autonomy, faster payments

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Policy Coverage details

• Coverage only to students of SIT.

• Covers only the inpatient hospitalization treatment.

• Sum Insured : maximum Rs.75000/- per year.

• 1ABC Clause is applicable :

1A .:-Maximum limit under Section 1 A - 25% of the sum insured per illness / injury

Room charges subject to 1% of sum insured per day and Intensive care unit (ICU) charges subject to 2% of sum insured per day

(including nursing care, RMO charges, IV fluids / blood transfusion / injection administration charges).

1B :- Maximum limit under Section 1 B - 25% of sum insured per illness / injury .

Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees .

1 C :- Maximum limit under Section 1 C - 50% of sum insured per illness / injury .

Anesthesia, Blood, Oxygen, OT charges, Surgical appliances (any disposable surgical consumables), Medicines, drugs,

Diagnostic material & X-Ray, Dialysis, Chemotherapy, Radiotherapy, cost of pacemaker, artificial limbs, Cost of Stent & Implants

• The coverage holds valid from the day one of policy.

• Ambulance Charges covered up to Rs.750/-

• Room rent is restricted to maximum of Rs.750/- per

day, in case of ICU Rs.1500/- per day.

• The treatment should be only in registered hospitals.

• Hospital should be of Minimum 15 beds.

Policy Coverage details

• Room and boarding

• Doctors fees

• Intensive Care Unit

• Nursing expenses

• Surgical fees, operating theatre, anesthesia and oxygen and their administration

• Drugs and medicines consumed on the premises

• Laboratory and diagnostic charges

• Dressing, ordinary splints and plaster casts

• Costs of prosthetic devices if implanted during a surgical procedure

• Radiotherapy and chemotherapy

A) The expenses shall be reimbursed provided they are incurred in India and within the policy period..

Reimbursement expenses covered

B) Expenses on Hospitalization for minimum period of 24 hours are admissible. However this time limit will not

apply for specific treatments i.e. Dialysis, Chemotherapy, Radiotherapy, Eye surgery, Dental Surgery,

Lithotripsy (kidney stone removal), Tonsillectomy, D & C taken in the Hospital/Nursing home and the insured is

discharged on the same day of the treatment will be considered to be taken under Hospitalization Benefit.

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Standard Hospitalization

Post-hospitalization Expenses

Definition If the Insurer accepts a claim under immediately following the Insured

Person’s discharge, he requires further medical treatment directly related

to the same condition for which the Insured Person was Hospitalized, the

Insurer will reimburse the Insured Person’s Post-hospitalization Expenses

Applicable Yes

Duration 60 Days

Pre-hospitalization Expenses

Definition If the client is diagnosed with an Illness which results in his or her

Hospitalization and for which the Insurer accepts a claim then the Insurer

will reimburse the Insured Person’s Pre-hospitalization Expenses for up

to 30 days prior to his/her Hospitalization as long as the 30 day period

commences and ends within the Policy Period.

Applicable Yes

Duration 30 Days

√ Applicable

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Pre & Post Hospitalization Expenses

Room Rent

Room Rent –

Normal Room permitted maximum per day is :-

1% of Sum Insured :- 750 per day.

I.C.U :-

ICU rent permitted maximum per day is :-

2% of Sum Insured :- 1500 per day.

Please remember, higher the room category, higher will be

the cost of treatment.

√ Restriction

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Room Rent

•Injury or disease directly or indirectly caused by or arising from or attributable to War or War-like situations

•Circumcision unless necessary for treatment of disease

•Dental treatment of any kind unless requiring hospitalization

•Congenital external diseases or defects/anomalies

•HIV and AIDS

•Hospitalization for convalescence, general debility, intentional self-injury, use of intoxicating drugs/ alcohol.

•Venereal diseases

•Injury or disease caused directly or indirectly by nuclear weapons

•Naturopathy, Ayurvedic, Homeopathy

•Any non-medical expenses like registration fees, admission fees, charges for medical records, cafeteria charges,

telephone charges, TV etc

•Cost of spectacles, contact lenses, hearing aids

•Any cosmetic or plastic surgery except for correction of injury

•Hospitalization for diagnostic tests only

•Vitamins and tonics unless used for treatment of injury or disease

•Infertility treatment

•Voluntary termination of pregnancy during first 12 weeks (MTP)

• Luxury tax, Service tax, sales tax etc.

• Hired attendants, Barber charges etc

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General Exclusions

Cashless hospitalization means the TPA may authorize

upon a Policyholder’s request for direct settlement of

eligible services and it’s according charges to a Network

Hospital.

In such case the TPA will directly settle all eligible

amounts to the Network Hospital to the extent of these

services covered under the Policy.

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Cashless Hospitalization

Client approaches VIDAL Network hospital to avail cashless.

Hospital sends Cashless request to VIDAL

Request received at VIDAL & the same is acknowledged to hospital & an SMS to client.

Processing team scrutinizes the documents checks for coverage and eligibility.

Medical Dept. checks for Treatment, costs and policy conditions.

Decision communicated to Hospital & client (approval / rejection).

Deficiency Query

is communicated

to hospital.

Cashless Process

All documents are fulfilled

to take decision.

Reimbursement Claim Process

In case the treatment is taken by client by paying the

hospitalization expenses by him the claim need to be

submitted to Vidal for reimbursement within 15days from the

date of discharge.

Please ensure all documents related to hospitalization is

submitted to us in original like :

Discharge Summary, IP Bill with detailed breakup, Cash paid

receipts, lab reports, images & films etc.

Note: Please retain with you photocopies of all documents submitted to us.

Reimbursement Claim Process

Documents received at VIDAL

Claims registered and computation completed.

Scrutiny of claim on fitment of policy TnC by

Claims Officers.

Scrutiny of claim By Medical officers.

Payment made to SIT account

through NEFT.

Validation of customer Id

Claim Approved.

Settlement letter sent

to insured.

Documents fulfilled to take decision.

Docs

complete

and

Payable

Docs

Incomplete

Insufficient Documents to proceed claim.

Document Verification completed.

Claim denied and the

file referred to insurer.

Deficiency Query

is communicated

to Client.

Claim form & Checklist for reimbursement claims

Claim form A:-

Claim form B:-

Detailed Checklist of documents needed :-

Vidal Health TPA brings its service now on your finger tip

Anytime & Anywhere

Vidal Health Vire

How To Download

• Android & iOS

• Play Store & App Store

For internal use only and should not be distributed without permission

Login

For internal use only and should not be distributed without permission

Download Vidal Health Mobile App and get the following services

on your finger tips

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Vidal Health Vire

• Health E card – Enables you to view, share and save on your mobile.

Vidal Health Vire

• Hospital Search – Search by Name, Distance & Location

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Vidal Health Vire

• Claims – Intimate claims and

check your Cashless &

Reimbursment Claim status

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Vidal Health Vire

Claim Status – Check your claims

status with specific remarks on the

claim and any shortfalls

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Vidal Health Vire

• Contact Us – The Branch Address and Contact number for reference.

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Vidal Health Vire

• Document Checklist for both Pre-authorization and Reimbursement

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Vidal contact details

• Emergency Cont act number : 18004258885 24X7 • For Cl ai m i nt i mat i on pl ease wri t e t o / cal l &

i nf orm t o : i nt i mat i on@vi dal heal t ht pa.com / t ol l f ree18004258885

• For any general queri es : bl rcs@vi dal heal t ht pa.com

• Vi dal websi t e : www.vi dal heal t ht pa.com • Phone number : 080 40125600 • Vi dal branch address: Vi dal heal t h TPA Pvt . Lt d. 1st f l oor , Tower 2, SJR I Park, EPI P Area, Whi t ef i el d,Bangal ore-560066

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Thank you

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