1. as
Consultants
with
Service providers
GMC
Process & Orientation
for

2. Summary IT Tool : Experience : Physical Locations : Hospital network :
Empanelled and working with all General Insurance companies in India since 2004 : Both Public (all 4 PSUs) and Private sector companies
Single window payment system available with UII, OIC and private companies
1800+ group policies
Physical Locations :
Hyderabad Mumbai Chennai Bhuvaneshwar Bangalore New Delhi Pune Kolkatta Madurai Coimbatore Cochin Vishakhapatnam
Hospital network :
Current hospital network spans over 450 cities.
4800+ hospitals networked across the country, 240 preferred partner network.
IT Tool :
Web based Software with VPN connectivity of all our offices
First company to implement a complete ‘Scanned Document Management’ System allowing maximum transparency in operations and information dissemination
Linux based software system to provide a virus free and controlled environment of users.
Java and Oracle based system scalable to meet all requirements

3. Accessibility Always available
We Offer 24 X 7 X 365 day functioning of ALL our offices including the ‘Nurse Line’
Easy to remember single access and single fax number across the country available at a LOCAL CALL rate at all locations apart from a Toll Free Line
Talk to us : ;
Fax us :
Toll Free :
Response to your phone within 5 rings, no attachment of IVR system, attended to personally by a trained personnel
/ On line web chat with us through our website at any time
75% of the customer interaction issues resolved at within first call (complete scanned document management system)
Every service call or is recorded at our office for tracking purposes
Claim filing on the internet – GHPL Help Desk to scan and upload all documents from your office and generate ‘Claim Control Number’
Can be called from any network including mobiles
Auto ticket no. for every mail

4. In case of need Smooth Hospitalization
Pre-arrangements done at all times in case of ‘planned’ hospitalizations
Live web-chat with customer service team through the website and call center
10 day Reimbursement Claim processing promise
Other TATs
Emergency cases – first response 30 minutes
E-cards – 48 hrs
Pre-authorization – 2-4 hours
Reimbursement claim – first response within 72 hours
Any other query Response – first response within 24 hours
Dependent on the Case to Case , Accidents cases may get delayed

5. Your Policy Coverage’ Staff Who all are covered – Floater Basis
Self, Spouse, 2 Dependent Children – 2 Dependent Parents
Policy Coverage's
Sum Insured Rs.2 lac Family Floater
Pre Existing Diseases are Covered
Coverage from Date of Joining
30 Days waiting period is waived. Further, 1st, 2nd, 3rd and 4th year exclusions are waived.
MATERNITY- Maternity covered without a waiting period of 9 months. .
Admissibility for Maternity claims restricted to Rs.25,000 for normal & 35,000 for C Section
New born covered from Date of Birth within the overall family floater SI and also subject to family size not exceeding stipulated as above on inclusion of the child
Room rent capped to 1% per day & ICU capped to 2% of Sum Insured
Pre 30 days and Post 60 days hospitalization covered to the max of 10% of Sum Insured - except Maternity
10% Co-Pay on all admissible claims
Cataract admissibility capped to INR 20,000 per eye
Day care procedure covered – Any new medical procedure or drugs that replace less than 24 hours hospitalization to be included as day care procedure, including animal bites treatments e.g. Dog, Snake bites
CLAIMS SUBMISSION All supporting documents relating to the claim must be submitted to the TPA within 21 days from date of discharge
Ensure you Declare all your dependants

6. Room Rent Room Rent and Boarding
Limited to a 1% of Sum Insured for Normal Hospitalization and 2% of Sum Insured for ICU Hospitalization.
Should you opt for a room of a higher category or rate, you are responsible for bearing the additional proportional charges associated with such room.

7. Type of Hospitalization
Cashless
Planned Treatment or Hospitalization
Approach Network Hospital’s Insurance Desk & Fill PreAuth Form
For Planned Hospitalization request 48 hours prior to admission
Emergency Hospitalization
Approach nearest Hospital, if in network, fill PreAuth Form
If Non-Network, Pay Up front and collect All Documents * in Original
Reimbursement
Claims
Submission Original Documents with 30 Days from date of Discharge
Ensure to submit Original Documents as per the list*
Claim will be processed and settled as per Terms & Conditions of the Policy
Query in Claims
Within 5 workings days GHPL shall intimate shortfall in claim docs by raising a query
Pre & Post Hospitalization Claims
30 Days preceding date of Hospitalization, excluding maternity
60 Days succeeding Date of Discharge
The Total admissible amount is max to 10% of sum insured per hospitalization
* Detailed list in next slide
Updated list available at
All Documents to be submitted in Originals

8. List of Documents Cashless Documents required Reimbursement
GHPL eCard –
Employee ID –
Govt. issued any Photo ID cards –
Reimbursement
Claim Form
Original detailed discharge summary
Original Hospital Bill with Detailed or Itemized Break-Up
Cash paid receipts
Incase of surgical packages – detail breakup of the package
Medicine bills with prescriptions
Original investigation reports, MRI/X-Ray/CT Scan Reports
MLC or ARC from the hospital in the case of Road Traffic Accident
Obstetrics History (Gravida Details) in the case of maternity claims
Copy of GHPL ID / Copy of Patient’s Photo ID
Pre & Post Hospitalization Claims
Except for Maternity – As Maternity is not have pre-post coverage
Original investigation reports along with bills & receipts
Consultation receipts & Prescriptions
Ensure you sign the bills at Discharge

9. Day Care Coverage’ Treatment Covered under Day Care - To name few,
Appendectomy
Heamo dialysis
Coronary angiography
Hydrocele
Coronary angioplasty
Hysterectomy
Colonoscopy
Parental chemotherapy
Inguinal/ventral/ umbilical/femoral hernia
D&C
Eye surgery
Piles/ fistula
Sclerotherapy
Prostrate
Radiotherapy
Sinusitis
Lithotripsy
Tonsillectomy
Incision and drainage of abscess
Liver aspiration
Cashless can be availed for this list

10. General Exclusions General Exclusions under policy , to name few
Circumcision unless necessary for treatment
Vaccination / Inoculation
Correction of Eyesight
Cosmetic / Plastic Surgeries
Spectacles, Contact lens, Hearing aids
Dental treatment unless arising from Accident
Debility, Obesity, Psychiatric, Psycho somatic
Infertility , Sterilization, Venereal diseases
Vitamins and Tonics
Alcohol / Drug Intoxication
Maternity expenses for third delivery, Voluntary termination of Pregnancy
Genetic Disorders
STD
Naturopathy / Magnetic / Acupuncture / Other experimental therapies
Hospitalization less than 24 hours
Non Medicals, Administration Charges
Congenital External Disease
Suicide / Homicidal attempt
Alternative Medicines
Admission primarily for Investigation / Observation / Evaluation without active line of management
Claims are not admissible for this list

11. Do’s & Don'ts Do’s Don’ts
Carry your ID card/ E-Card at the time of admission at network hospitals
In case of emergency admission, kindly contact GHPL within hrs of hospitalization
In case of emergency, kindly refer our Company’s name and your Employee ID (number) at the time of admission
Take a pre-approval from GHPL for elective cases. Sign on the claim form / final bill at the time of discharge from the hospital.
Kindly ensure submission of claims within 30 days from date of Discharge from Hospital
Don’ts
Avoid a hospital with less than 15 bed capacity.
Avoid requesting for Pre-Authorization approval in 1 or 2 hours.
Avoid Domiciliary hospitalization, it is not covered.
Do not leave any bill / receipt uncollected from the hospitalization.
Avoid any mid-term inclusions of dependents except new born and spouse
Please save
GHPL #

12. Special Concern Please Remember
Hospitalization for Evaluation/Diagnostic purpose  is not payable
Expenses for Investigation/Treatment irrelevant to the disease for which admitted or Diagnosed are not payable
Room Rent Eligibility :- Rs.2000/- for Normal Hospitalization & Rs.4000/- for ICU Hospitalization per day
Higher Side Room Rent Implication :- Rooms on higher category chosen by the Claimant and any revision in Cost of Medicals resulting from higher category opted for will borne by the Claimant. There will be proportionate deductions.
OPD is not covered, it does not fall under Day Care Procedures,
Day Care Procedures are defined by Insurance company
Please check
Your room rent

13. Accessibility Matrix Yuvaraj G G.Yuvaraj@mahindra.com +91-9731400244
Swapnendu Das
K Saiprasad
Reach us out – we will be there to address the need

14. Accessibility Matrix Anand Kumar M anand.m@ghpltpa.com +91 98443 11100
Krishnamurthy R B – Mgr CRM
Krishnamurthy’s Mobile
Dr. Navya – Manager
Dr. Navya' Mobile
Reach us out – we will be there to address the need

15. Thank You