1. …creating a collaborative ecosystem to simplify healthcare

2. Mediclaim Policy
Mediclaim Policy reimburses expenses incurred towards the treatment of a disease or illness for which hospitalization is warranted.
The policy is issued by The New India Assurance Company Limited
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3. What is Mediclaim Policy ?
Mediclaim Policy reimburses expenses incurred towards the treatment of a disease or illness for which hospitalization is warranted.
There are 2 ways through which a claim can be preferred-
Cashless Hospitalization- Enables employee to avail treatment from network hospitals.
Reimbursement Claim- Treatment is taken in non network hospital & claim submitted for reimbursement.
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4. Documents Required for Reimbursement Claim
Duly Filled & Signed Claim Form
Original Discharge Summary
Original hospital bills/ receipts & supporting annexures. . (please make sure patient name is mentioned on every bill/document submitted)
Final / Advance paid receipt with receipt no.
All investigation & test reports- including ECG, X-Ray, Ultra-Sound, CT Scan, MRI
All pharmacy bills & prescriptions.
All consultation papers/documents against bill/receipt submitted along with Claim form .
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5. Hospital/ Nursing Home- Definition
Hospital is a medical institution in India where sick or injured people are given medical or surgical care. The Hospital has to be either registered as a hospital or nursing home with the local authorities and
Is under the supervision of a registered and qualified medical practitioner Or
Should at least have minimum of 15 beds (for class C cities 10)
Fully Equipped Operation Theatre
Fully Qualified Nursing Staff for 24 Hrs.
Fully Qualified Medical Practioneer -24 Hrs
Maintains Daily Medical Records
Is not a Place of rest , Place for aged /drug addicts /alcoholics .
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6. Tata Power Co. Ltd.– Policy Benefits-1
Policy Period- 1st April st March 2017
Sum Insured- Family Floater as per eligibility.
Room Rent- Room rent is restricted to 1%. Incase of ICU room rent is restricted to 2.5% (Union Category no capping is applicable)
Pre Hospitalization Expenses: Expenses incurred 30 days prior to hospitalization
Post Hospitalization: Expenses incurred up to 60 days from the date of discharge forming part of the treatment for which hospitalization was required.
Lasik Treatment is covered for eye power beyond 5.5.
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7. Tata Power Co. Ltd– Policy Benefits-2
All Pre Existing Diseases are covered.
Duration of Hospitalization: Minimum 24 hours. However the following illness/ disease the 24 hours duration is not applicable.
Congenital external to be covered.
Infertility treatment - 1 lac - IVF including OPD basis.
Ambulance charges covered upto Rs, 10,000/-
HIV/AIDS cover within S.I.
Cataract is covered Upto Rs /- per eye. (Union Category no capping is applicable)
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8. Tata Power Co. Ltd– Policy Benefits-3 Day Care Procedures :
Cataract
Haemo -Dialysis
Parenteral Chemotherapy
Radiotherapy
Dental Surgery- Following an accident
Lithotripsy
Dilatation & Curettage
Anti- Rabies Vaccination
Appendectomy
Hysterectomy
Piles /Fistula
Prostrate
Fracture/ dislocation excluding hair line fracture
Sinusitis
Gastrointestinal System
Stone in Gall Bladder, Pancreas
Hydrocele
Urinary Tract Syste,
Coronary Angiography
Coronary Angioplasty
Tonsillectomy
Inguinal / Ventral/ Umbilical/ Femoral Hernia Repair
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9. Expenses Payable under the policy
Room Rent & Nursing Expenses. Room rent is restricted to 1% of sum insured . Incase of ICU room rent is restricted to 2.5% of sum insured .(Union Category no capping is applicable)
Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees. (All these should form part of hospitalisation bill)
Anaesthesia, Blood, Oxygen, OT charges, Surgical expenses.
Medicines & Pharmacy Expenses.
Diagnostic materials and X-ray Expenses.
Dialysis, Chemotherapy, Radiotherapy Expenses.
Cost of pacemaker, Artificial Implants & similar expenses.
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10. Pre-Authorization (PA) & Reimbursement claim Process
Pre-Authorization (PA) Process
Reimbursement claims Process
Customer visits the Medi Assist network hospital for admission, hospital sends PA request with copy of photo ID proof to Medi Assist
Post hospitalization, employee submits duly filled claim form along with all original documents to Medi Assist help desk executive at Head office
Employee have to send all the claims documents to corporate office.
Medi Assist registers the claim and sends acknowledgement to employee through SMS/
Medi Assist registers Pre-Auth request and Liability checks done as per policy terms and conditions
Medi Assist validates the claim and carries out liability check as per policy terms and conditions
If more information required, Medi Assist to seek Information Required from hospital.
SMS/ alerts are sent at every stage of the processing; alongside access to MediBuddy:
Queries
Registration
Information Required (IR)
Approval
Denial
Settlement
If more information is required, Medi Assist sends Information Required (IR) letter to employee
Medi Assist to process Pre-Authorization (Approved/Denied)
On receipt of complete documents, Medi Assist processes the Reimbursement Claims
Hospital to send the Discharge summary and Final bills to Medi Assist for PA settlement
Approves
Denies
Payment is done through NEFT and settled
Denial letter is sent
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11. Medi-Buddy Portal
Once the enrollment is done employees can view below mentioned details from Medibuddy portal
Steps:
1) Login to portal.medibuddy.in from Mozilla Firefox or Google chrome
2) Give username as (Ex: if Empid. is 1234, then the username should be - and password: tatapower ).
Employee login:
Username :
Password : tatapower
Note : Medibuddy portal is under preparation will start at the earliest.
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12. Medibuddy| Employee Login Pages | Login Page
Enter your User Name
Your Password
Username :
Password : tatapower
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13. Medibuddy| Employee Login Pages | Home Page
Click here to know the claim status
Click on
Click here to download the E card
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14. How can I track claims- Medi-Buddy
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15. Medi-Buddy | Medi Assist’s mobile solution
Send claims intimation ahead of emergency / planned hospitalization Send reimbursement claim intimation for speedy claims processing
Find the nearest / most conveniently located network hospital View your Medi Assist e-card and list of beneficiaries
Track the status of your claims at real-time even without signing in Get instant notification on approval of pre-authorization for cashless hospitalization
Purchase discounted wellness packages; enroll for corporate annual health checks Get reminders and alerts for upcoming health checks / appointments with your doc
Order medicines and health supplements for door delivery Carry your health records and claims history in digital format
Visit or
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16. Get On Speedy
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17. Medi Assist- Relationship Team
For any queries / clarification feel free to contact :
Ms. Tejeshree Gujar
Designation: Executive – Customer Relation
Id:
Hand Phone:
For Escalations you can contact :
Escalation Level 1:
Name: Ms. Smita Khedekar
Designation: Asst. Manager Corporate Customer Relation.
Hand Phone:
Escalation Level 2:
Name: Mr. Nikhil Ashokan
Designation : CRM Manager
Hand Phone:
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18. Wishing you good health
Medi Assist India TPA Pvt Ltd.
1ST Floor, North Wing, Plot No. 7,
Excom House, Saki Vihar Road, Saki Naka, Andheri East, Mumbai |
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