1. GROUP MEDICLAIM POLICY (2018-2019)
MANKIND PHARMA LTD
GROUP MEDICLAIM POLICY ( )

2. Policy Details Insurer THE NEW INDIA ASSURANCE COMPANY LIMITED TPA
Vidal Health Insurance TPA Services
Broker
Global Insurance Brokers Pvt. Ltd.
Policy Start Date
Policy End Date
Coverage Type
Family Floater
Dependent Coverage
Employee + Spouse + 2 Kids + Parents/In Laws

3. Policy Coverages Pre existing diseases Yes
Waiver of 1st year exclusion
30-day Waiting Period
Waived
Waiver of 1,2,3,4 year
Maternity benefits
Waiver of 9 months waiting period for Maternity
Yes /- for normal and 50000/- for C section for Sum insured 3lacs and for rest Sum insured 50000/- for both Normal & C section. Pre & Post Natal Expenses are covered in case of Hospitalizations within maternity limit.
Baby cover day 1
Yes Covered within family sum insured
Pre-Post Hospitalisation Expenses
Pre- 30 days, Post- 60 days
Capping on Room rent + Nursing Charges per Day -
2% of S.I for normal room , 5% of S.I for ICU
Day Care Expenses
Covered
Sum Insured
3,4,5,6,7 Lacs/Family Floater Basis
11/14/2018

4. Co-Payment
Co-payment clause for Reimbursement claims
For cashless - 7.5% on 3 Lacs S.I, 5% on 4 Lacs S.I. & Nil for others.
For Reim. - 3Lacs S.I 15% (Excluding Critical & Accidental Cases), 15% on 4 Lakhs S.I. & 10% on others (Excluding Critical & Accidental Cases)
Pre-post natal
Covered within maternity limit
Ayurvedic Treatment & Unani Treatment -
For S.I 4Lacs and above covered Upto 25% Of Sum Insured for employees only (Hospitalisation cases)
Physiotherapy –
For SI 4Lacs and above covering up to Rs for employees only (Applicable only for hospitalization cases)
Claim documents submission
Within 10 days from date of discharge
Internal Congenital Diseases
Covered

5. CASHLESS CLAIM
PROCESS

6. Cashless Access for Hospitalization
Hospital faxes
Pre Authorization to
Vidal on Toll Free
Number
Request received at Vidal
Pre Auth dept.
Patient approaches
Network hospital Based on
recommendation
of physician and displays Id card
CYCLE TIME
3 hrs.
Claims Dept checks
for coverage and
eligibility
Authorization
faxed to Hospital
Medical Dept checks for
Treatment costs and also verifies
tariff
If query raised to the
Hospital, a dedicated helpdesk
at Vidal calls the hospital
and closes the query.
Help Desk at Select Hospitals: Authorization & Billing
11/14/2018

7. REIMBURSEMENT CLAIM
PROCESS

8. Claims Reimbursement ECS Claim Settlement Insured submits Claim to
Vidal help desk/ courier
Validation of
customer Id
Document
Completion
Verification No
Communication sent
to Customer for
Documents within
3 working days
Yes
Discharge
Voucher with claim
Computation sent
To insured
CYCLE TIME
10 Working days
Claims registered and
Pre computation taken
Receipt Of
Missing Document
Claim checked & validated
by Insurance executives.
Claim Approval
Claim validated By
Medical professionals
ECS Claim Settlement
11/14/2018

9. MANDATORY DOCUMENTS FOR CLAIM SUBMISSION
DULY FILLED & SIGNED CLAIM FORM
DOCTOR CERTIFICATE
DETAILED DISCHARGE SUMMARY IN ORIGINAL
HOSPITAL BILLS WITH DETAILED BREAKUP
NUMBERED PAYMENT RECEIPT
CONSULTATION / SURGEON FEE BILL
PHARMACY BILL WITH PRESCRIPTION
LAB BILLS & REPORTS IN ORIGINAL WITH DR REQUEST
FIR IN CASE OF ACCIDENT CASES/ ATTENDING DOCTOR’S CERTIFICATE
PATIENT ID/ AGE PROOF
COPY OF INTIMATION LETTER/ REFERENCE OF ONLINE INTIMATION

10. LIST OF HOSPITALS COVERED
LIST OF HOSPITALS COVERED
Refer the Website of Vidal Health Care

11. Escalation Matrix Vidal Health Insurance TPA Pvt Ltd
Levels
Contact Peroson Name
Contact No
Ids
First Level
Mr. Sunil
Second Level
Mr. Ritesh Kumar
Mr. Dhamodharan
Third Level
Ms. Sheenu Mathur
Mr. Rachit Baijal

12. Thank you