1. GMC Policy Presentation
VA Tech WABAG 1
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2. Disclaimer
Salient features of the Policy are given in this presentation. For Complete Information Please Refer the Policy Documents. 2
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3. What is Mediclaim Insurance ?
The insurance provides cashless/ reimbursement of hospitalization expenses incurred in India for the treatment of illness/diseases or injuries sustained by the insured person during the period of insurance .
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4. Policy Conditions
Sum Insured : The Amount up to which a claim for medical hospitalization can be made. Coverage is individually (Rs / Rs / Rs )
Current Policy period :16/06/2013 to 15/06/2014
Major exclusions applicable for standard policies are waived in this policy. Hence the policy has wider cover as follows:
All pre existing diseases are covered from day one
First 30 days waiting period not applicable.
1 year, 2 years & 4 years exclusions for specific ailments/treatments not applicable
Family definition: Self, Spouse , 2 dependent children and 2 dependent parents
New born baby covered from day one
Internal Congenital disease covered under life threatening circumstance 4
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5. Hospital / Nursing Home
Any institution in India established for Indoor care and treatment of sickness and injuries and which either:
has been 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 comply with minimum criteria as under:
At least 15 in-patient beds (for class C cities 10)
Fully Equipped operation Theatre of its own wherever surgical Operations are carried out.
Fully Qualified Nursing staff under its employment round the clock
The term Hospital/Nursing home shall not include an establishment ,which is a place of rest, a place for the aged , a place for drug addicts or for alcoholics , a hotel or a similar place 5
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6. What are the expenses Reimbursable?
The below given medical Expenses are payable If any insured person suffers an illness or accident during the policy period which requires the hospitalization as an inpatient
Room Rent, Boarding Expenses & Nursing: 1% of S.I + Rs.2000 *
Intensive care Unit:2% of S.I + Rs.4000 *
A Medical practitioner,
Anesthesia, Blood , Oxygen, Operation theatre charges , surgical appliances
Medicines, drugs and consumables
Diagnostics procedures
The cost of prosthetic and other devices or equipment if implanted internally during a surgical procedures
Disease wise Capping: Cataract Rs Per eye and No Capping for other diseases
Hospitalization: Admission into hospital for medically necessary treatment as an inpatient for continuous period of at least 24 hours
* Proportionate clause applicable if room rent exceeds eligibility limit 6
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7. Maternity Benefit
Maternity expenses are covered for 2 children. The insured person who are already having two or more living children will not be eligible for this benefit
Normal Delivery Expenses Capped To : Rs.25000
Cesarean (C-section) Delivery Expenses Capped To:Rs.50000
9 months waiting period waived
Pre-natal and post-natal expenses are not covered unless admitted in Hospital/Nursing Home and treatment is taken there
New Born Baby covered from day one 7
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8. Pre and Post Hospitalization
Pre-Hospitalization:
The Medical Expenses incurred due to an Illness in the 30 days immediately before the Insured Person was Hospitalized, provided that:
Such Medical Expenses were in fact incurred for the same condition for which the Insured Person’s subsequent Hospitalization was required
Post-Hospitalization:
The Medical Expenses incurred in the 60 days immediately after the Insured Person was discharged post Hospitalization provided that:
Such costs are incurred in respect of the same condition for which the Insured Person’s earlier Hospitalization was required 8
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9. Day care procedure
Treatment undertaken in a hospital/Nursing Home on the recommendation of medical Practitioner for the following diseases, Illness or injury which requires hospitalization for less than 24 hours:
Dialysis
Chemotherapy
Radiotherapy
Eye Surgery
Lithotripsy (Kidney stone removal)
Tonsillectomy
Dilatation & Curettage
Hydrocele Surgery
Hernia Repair Surgery
Sinusitis
Coronary Angiography 9
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10. Policy Exclusion
LASIK surgery for correction of eyesight, Contact lens, Spectacles, Hearing aids including Cochlear implants
Dental treatment unless arising due to accident
Medical termination of pregnancy / abortion within 12 weeks
Sterilization procedures, treatment of infertility/sub-fertility/ Assisted conception procedures
Plastic and cosmetic surgery, vaccination, inoculation, circumcision
External “congenital” disease, anomalies, defects
Intentional self injury / suicide attempt, psychiatric and psychosomatic disorders
Direct / indirect effects of use of alcohol / intoxicating drugs
AIDS and related syndromes
“Technical admission” –Admission for diagnostic/evaluation without active line of treatment
Expenses on vitamins or general tonics
Naturopathy treatment

11. Policy Exclusion Pre and post expenses related to maternity claim
Unproven procedure/ treatment, experimental or alternative medicine/treatment including acupuncture, acupressure, magneto-therapy, RFQMR, etc.
Genetic disorders/stem cell implantation/surgery
External equipments like CPAP, CAPD, infusion Pump etc., ambulatory devices like walker/ crutches/ belts/ collars/caps/ splints/ slings/ braces/ stockings/ diabetic foot-wear/ glucometer/ thermometer & similar related items & any medical equipment which could be used at home subsequently
Treatment for obesity or condition arising therefrom (including morbid obesity) and any other weight control program/ services/ supplies.
Massages/ Steambath/ Surodhara & alike Ayurvedic treatment.
Any kind of service charges/surcharges, admission fees/registration charges etc. levied by the hospital.

12. Actionable By Employee:
E - Login
Actionable By Employee:
Login to
Click on “Login” link in the website
Click on “Corporate Employee”
Login through below given credentials
Update Your Mobile Number & ID under “Employee Contact Details”
Check Data under “Beneficiary Details”
Change Password by Clicking “Forgot Password” in Login Page
Always click “Log out” after accessing your account
Employee login:
Username :
Password : vatechwabag
Snapshots are given in following slides for easy reference. 12
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13. E – Login Cont… 13
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14. E – Login Cont… 14
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15. E – Login Cont… 15
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16. Pre-Authorization Process
Cashless Facility
Planned Admission
(48 hrs in advance)
Emergency Admission
Insurance Help Desk
at the Hospital
Hospital
Insurance Help Desk
Admission
Pre-Authorization Process

17. Process of Reimbursement
Please submit the following documents in original along with completed claim form within 15 days from the date of discharge
Discharge Summary
Final Hospital Bill (with detailed break-up) & Receipts
Medicine Bills along with Doctor’s Prescriptions
Investigations & Test Reports with Doctor’s prescriptions. If original is required for future treatment, please submit photocopies duly attested by the treating doctor with his signature & seal
In case of non-availability of prescriptions, kindly ask your Physician to countersign on the reverse of pharmacy bills 17
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18. Please send all the documents to18
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19. Escalation Matrix 19
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20. Thank you… Wish You & Your Family A Healthy & Happy Future !!!
-Team & Medi Assist 20
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