GROUP MEDICLAIM INSURNACE POLICY FOR THE REGULAR

EMPLOYEES OF INDIAN STATISTICAL INSTITUE AND

THEIR DEPENDANT FAMILY MEMBERS

1.NAMEOFTHESCHEME: ThenameoftheproposedschemeisGroupMediclaimInsurancePolicyforthe
regularemployeesoftheISI.

2. BENEFICIARIES : All workers of the Indian Statistical Institute who are eligible to be covered under the

exitingCS(MA)[CentralServices(MedicalAttendance)Rules].

3.INSURANCECOVERAGE:

(A)
InpatientbenefitsTheinsuranceSchemeshallpayexpenses(subjecttopolicylimitations)incurred
incourseofmedicaltreatmentavailed ofbythebeneficiariesina registeredhospitals/nursingHomeswithin
thecountry,arisingoutofeitherillness/disease/injuryand/orsickness.Thetreatmentmustrequireatleast24
hour hospitalization. A list of insurance company empanelled hospitals/nursing homes are available where
cashlesstreatment(subjecttopolicylimitations)canbeavailed.

(B)
CoverageofPreexistingdiseasesPreexistingdiseases,ifany,shallbecoveredfromdayoneunder
thisinsurancescheme.Forexample,apersonsufferingfromanydiseaseoralreadyhavingimplantsand/orany
internalcongenitaldiseasepriortotheinceptionofthepolicyshallalsobecoveredinthisscheme.

(C)
Post hospitalization benefit All expenses (subject to policy limitations) during the post
hospitalizationperiodofupto60daysrequiredduetothetreatmentofthesicknessforwhichhospitalization
wasdonewouldbecoveredinthisscheme.

(D)
Day Care procedures Given the advances made in the treatment techniques, many medical
treatments,formerlyrequiringhospitalization,cannowbetreatedonadaycarebasis.Theschemewouldalso
providefordaycarefacilities(whichrequirelessthan24hourshospitalization)forsuchidentifiedprocedures.
However, OPD services shall not be part of Day Care facilities. Day care facilities would be available for the
followingmedicaltreatment:

1.EyeSurgery
2.Lithotripsy(kidneystoneremoval)
3.Tonsillectomy

4.D&C

5.Dentalsurgeryfollowinganaccident

6.SurgeryofHydrocele

7.SurgeryofProstrate

8.FewGastrointestinalSurgery

9.GenitalSurgery

10.SurgeryofNose/Throat/Ear

11.SurgeryofUrinarySystem
12.Dialysis

13.Chemotherapy

14.Radiotherapy

15.Treatmentrelatedtodogbite/snakebiteetc.
16. Treatment of fractures/dislocation, Contracture releases and minor reconstructive procedures of
limbswhichotherwiserequirehospitalization.

17.Laparoscopictherapeuticsurgeriesthatcanbedoneindaycare
18. Identified surgeries under General Anesthesia or any procedure mutually agreed upon between
insurerandhealthcareprovider.
1


NOTE:TheexhaustivelistofDayCareProceduresisavailablewithMERU.ForOPDtreatmentoranyothertreatments
whichdonotrequireanyhospitalization,theexistingreimbursementsystemusingMERUshouldbeused.Thereisalist
of nonadmissible items (for example, gloves, diaper, bed sheet etc.) costs of which are not covered by any medical
insurance policy. Therefore, even a cashless treatment may require payment for these nonadmissible items at the
hospitalwhenthepatientwillbereleasedfromthehospital.

(E)

MATERNITYANDNEWBORNBENEFITS

A.MaternityBenefit

(a)
Includes maternity related procedure/treatments arising from childbirth (including both normal
delivery/Caesareansection,includingmiscarriageorabortioninducedbyaccidentorothermedicalemergency)
treatedinaregisteredhospital/nursinghome.

(b)
ThisbenefitwouldbelimitedtoonlyfirsttwolivingchildreninrespectofDependentSpouse/Female
EmployeeasperCS(MA)rule.
(c)Thenewbornbabywillbecoveredbytheinsurancepolicyfromthedayonewithoutanywaitingperiod.
Theparents/guardiansofthebabymustreportthebirthofthechildtoappropriateISIauthorityattheearliest
butnotlaterthanoneweek.

(d)
ThecostofmaternityprocedureislimitedtoRs.25,000/fornormaldeliveryandtoRs.50,000/for
Caesareandelivery.

B.NewbornBenefit

(a)
Newbornchild(single/twins)toaninsuredmotherwouldbecoveredundertheschemefromdayone
for the expenses (subject to policy limitations) incurred for treatment taken in registered Hospitals/Nursing
Homes/DayCareClinicsasaninpatientandwillbetreatedasapartofthemother.

(b)
If,infirstpregnancy,twinsarebornthenthebenefitstandceasesforsecondpregnancy.However,if
insecondpregnancytwinsarebornthenboththechildrenwillbecovered.

(c)

Congenitaldiseasesofnewbornchildshallalsobecoveredunderthisscheme.

4.CONCESSIONSFORFAMILY:
A.DefinitionFamilymeansemployees
(a)

Husband/Wifeincludingmorethanonespouse(aspergovernmentrule)andalsojudiciallyseparated
wife.

(b)

Parents and Stepmother In case of adoption, only the adoptive and not the real parents will be
covered.Iftheadoptivefatherhasmorethanonewife,thefirstwifeonlywillbecovered.Afemale
employee has a choice to include either her parents or her parentsinlaw. Option exercised can be
changedonlyonceduringtheserviceperiod.

(c)

Children including legally adopted children, stepchildren and children taken as wards subject to the
followingconditions:

UnmarriedSon:Tillhestartsearningorattainstheageof25years,whicheverisearlier.

Daughter:Tillshestartsearningorgetsmarried,whicheverisearlier,irrespectiveofagelimit.

Sonsufferingfrompermanentdisabilityofanykind(physicalormental):Noagelimit.

(d)

Widoweddaughtersanddependentdivorced/separateddaughtersirrespectiveofagelimit.
2

(e)

Sisters including unmarried/divorced/abandoned or separated from husband/ widowed sisters

irrespectiveofagelimit.

(f)

Minorbrothers.

B.Dependency

Theincomelimitfordependencyofthefamilymembers(otherthanspouse)isRs.3500/permonthplusthe
DearnessReliefadmissibleonRs.3500/onthedateofconsiderationoftheclaim.

NOTE:ThedefinitionofdependentshallbegovernedasperguidelinesissuedbytheCentralGovernmentfrom
timetotime.

C.Addition&DeletionofFamilyMembersduringtheRunningPolicy
(a)

(1)
(2)

Additiontothefamilyisallowedinfollowingcontingenciesduringthepolicy:

(b)

DeletionfromFamilyisapplicableinfollowingcontingencies:

Marriageofthebeneficiary(requiringinclusionofspousesname),or
Parentsbecomingdependants

(1)
Deathofcoveredbeneficiary
(2)
Divorceofthespouse
(3)
Memberbecomingineligible(onconditionofdependency)

D.NewEmployees

Asregardstothenewincumbents,thecoverageinthegroupinsuranceschemeiscompulsoryandstartsfrom
thedateofjoining.

5. IDENTIFICATION OF FAMILY: Beneficiaries shall be identified by a Photo Smart Card issued by the
insurer.ThiscardwouldbeusedacrossthecountrytoaccessHealthInsuranceBenefits.Thephotographembeddedin
theCardwillbetakenastheprooffordeterminingtheeligibilityofthebeneficiaries.

6.SUMINSUREDANDBUFFER/CORPORATESUMINSURED:

(a)
SumInsured:TheSchemeshallprovidecoverageformeetingallexpensesrelatingtohospitalization
of beneficiary members up to Rs. 4,00,000/ per family per year in any of the registered Hospital/Nursing Home/Day
CareUnitsubjecttostatedlimitsoncashlessbasisthroughsmartcards.Thebenefitshallbeavailabletoeachandevery
member of the family on floater basis i.e. the total reimbursement of Rs.4,00,000/ (Rupees four lakhs only) can be
availedeitherbyoneindividualorcollectivelybyallmembersofthefamily.

(b)
Buffer/Corporate Sum Insured : An additional Sum Insured of Rs. 20 lakhs shall be provided by the
Insurer as Buffer/Corporate Floater in case hospitalization expenses of a family (per illness or annual) exceed the
original suminsuredof Rs.4,00,000/.Insureris required toinform the ISIAuthority with the detailson case tocase
basisandonlytheISIAuthoritywilldecidethedistributionanddisbursementofthebuffercorporatesuminsured.For
thistheemployeemustsubmittheapplicationtotheDirectorthroughproperchannel.

(c)
Limitations:

(i)
RoomRentLimit:1%ofSumInsuredperday,howeverifadmittedinICUnitlimitis2%ofsum
insuredperday.Overalllimitunderthishead:25%ofSumInsuredperillness.
(ii)
Surgeon, Anesthetist, Medical Practitioner, Consultants Special fees, Maximum Limit per
illness25%ofSumInsured.

(iii)

(iv)
(v)

Anesthesia, Blood, Oxygen, OT charge, Surgical appliances, Medicines, Drugs, Diagnostic

Material&XRay,Dialysis,Chemotherapy,Radiopathy,CostofPacemaker,ArtificialLimbsand
costofstentandimplant.Maximumlimitperillness50%ofSumInsured.
Hospitalizationexpensesofpersondonatinganorganduringthecourseoforgantransplant
willalsobepayablesubjecttothelimitation(iii)aboveasapplicabletotheinsuredperson.
Reimbursement of Ambulance charges: Maximum Rs. 1000/ in a policy year will be
reimbursed provided registeredambulance is used. Thisbenefit is availableonlyforshifting
patientfromresidencetohospitalifadmittedtoICUorEmergencyWardorfromonehospital
toanother.

Intherarestofrarecases,thelimitationisrespectof(i),(ii)and(iii)abovemayberelaxedasadvisedbythe
appropriateISIAuthority.

7. PROCEDURE FOR AVAILING CASHLESS ACCESS SERVICES IN NETWORK HOSPITAL/ NURSING

HOME:

1.

Claims in respect of Cashless Access Services will be through the list of the network/empanelled
Hospitals/NursingHomes.
2. Cashlessservicesforallplannedmedicaltreatmentaresubjecttopreadmissionauthorization.
3. In case of emergency, the TPA should be contacted immediately after admission preferably through the
hospital/nursinghome.
4. Bothforitems(2)and(3)above,theTPAshall,upongettingtherelatedmedicalinformationfromtheinsured
persons/networkprovider,verifythatthepersoniseligibletoclaimunderthepolicyandaftersatisfyingitself
willissueapreauthorizationletter/guaranteeofpaymentlettertotheHospital/NursingHomementioningthe
sumguaranteedaspayablefortheailmentforwhichthepersonisseekingtobeadmittedasapatient.Incase
of emergency, this authorization procedure is to be processed by TPA within 4 hours on receipt of (fax)
documents.
5. PreauthorizationforCashlessAccessServicesinNetworkHospital/NursingHomeiswithintheauthorityofTPA
and will be given after verification of required documents pertaining treatment of the insured to the
satisfaction of TPA. Any inconvenience regarding the items above should be brought to the notice of
appropriateISIauthorityattheearliest.
6. Preauthorization for cashless treatment may still require deposition of an initial sum in the network/
empanelled hospital/ nursing home. This deposit usually caters for the cost of nonadmissible items/charges
withrespecttoreimbursementbytheinsurancecompany.
7. A panel of 25 Hospitals/Nursing Homes selected by the ISI Authority is available where admission will be
processed without any deposit (cashless in absolute term). However, the employee has to pay for charges
relatedtononadmissibleitemsasmentionedearlier.
8. Claims for hospitalization in nonnetwork or nonempanelled hospital will be reimbursed by the Insurance
CompanyaftersubmittingtheclaimdocumentstotheTPA.

8. Claim Documents for nonCashlessServices: Claim document which includes all hospital receipts and
billsinoriginal,Cashmemos,reports,dischargecertificates,filledclaimformetc.shouldbesubmittedtotheinsurance
companyorTPAwithin30daysfromthedateofdischargefromtheHospitalandwherePosthospitalizationtreatment
isnotcompleted,itshallbewithin30daysfromthedateofcompletionofPosthospitalizationtreatment.

Theclaimdocumentsmustinclude:

(a)
Originalbills,receiptsanddischargecertificate/cardfromthehospital

(b)
Medicalhistoryofthepatientrecordedbythehospital
(c)
OriginalCashmemofromthehospital(s)/chemist(s)supportedbyproperprescription
Originalreceipts,pathologicalandothertestreportsfromapathologist/radiologistincludingfilmetc.
(d)
supportedbythenotefromattendingmedicalpractitioner/surgeondemandingsuchtests
(e)
Certificatesandbills,receiptsfromattendingConsultants/Anesthetists/Specialist
(f)
Surgeons original certificate stating diagnosis and nature of operation performed along with
bills/receiptsetc.
AnyotherinformationrequiredbytheTPA/InsuranceCompany.

(g)

Timeline:

1. Reimbursementclaimstobesettledwithin25daysofsubmissionofcompletedocuments.
2. Statusofclaimswillbeupdatedwithin7days.
3. AfterreceivingtherequestoftheInsuredpersonsettlementadvice/certificateistobeissuedbytheTPA
within10daysofsettlementofclaim.
4. Waiver of this condition may be considered in extreme cases of hardship where it is proved to the
satisfaction of the Company that under the circumstances which the Insured was placed it was not
possible from him/her or any other persons to give such notice or file claim within the prescribed time
limit.

9.(a) EXPENSESNOTCOVEREDUNDERTHEPOLICY

Admission/RegistrationCharges
TelephoneCharges
AttendantsChanges
HomeVisit/NursingChargeatresidenceafterdischarge
Assistantfee/FollowupChargesinadvance
ThermometerCharges
ContainerforSpecimen/DisposableBagCharges
AdmissionKit
External Surgical Aids: LumboSacral/Collar belt/ Knee cap/Knee brace/Walker/Hot water bag/Baby
kit/Urinepot/Tractionkit/Foldingcommodeetc.
Inhaler/Nebulizer
DietCharges
Special/Proteindiet/HealthdrinksunlessprescribedbytheDoctor
Documentation/Folder/Stationery/InPatientchartCharges
Surcharge

Theabovelistisonlyanindicativeoneandmaychangefromtimetotime.

(b)

PERMANENTPOLICYEXCLUSIONS

Injuriesordiseasescausedbywarandwarlikeoperations
Circumcision,Vaccination,Inoculation,Cosmetictreatment,Plasticsurgery
Spectacles,Contactlenses,HearingAids
Convalescence,Generalweakness,Congenitalexternaldisease,Sterility,Venerealdisease,Alcohol
use,Selfinjury
Diagnosticexpensesnotfollowedbyactivetreatmentfortheailment
VitaminsandTonicsunrelatedtotreatment
Injuriesordiseasescausedbynuclearweapons
Abortionduringfirstthreemonthsofpregnancy
Naturopathytreatment
Injuriessustaineddueasaresultofactiveparticipationinanyhazardoussports
Diagnostics, XRay or Laboratory examination not consistent with our incidental to diagnosis of
positive existence and treatment of any ailment, sickness or injury for which confinement is
requiredatHospital/NursingHome
Instrument used in treatment of Sleep Apnea Syndrome and Continuous Peritoneal Ambulatory
DialysisandOxygenConcentratorforBronchialAsthmaticCondition
Geneticdisordersandstemcellimplantation/surgery
TreatmenttakenoutsideIndia
Experimentalandunproventreatment
All non medical expenses including convenience items for personal comfort such as telephone,
television,Ayah,PrivateNursing/Barberorbeautyservices,DietCharges,BabyFood,Cosmetics,
TissuePapers,Diapers,SanitaryPads,Toiletryitemsetc.

SpecialServicestobeprovidedbyTPAtoISI

(1)
(2)
(3)
(4)
(5)
(6)
(7)

TPAwillsetupHelpDeskatISI,Kolkata.
Claimchequetobeissuedinfavourofemployee.
ListofnonadmissibleitemsistobeprovidedbytheTPA.
TPAwillprovide24x7exclusiveHelplinephonenumberforISI.
NabjivanHospital/NursingHomeatGiridihtobeincludedinthenetworkofTPA.
PhotographstobecollectedattheHelpDesk.
AnynamewhichisnotinthelisttobereferredtoISIAuthority.

TPANameandAddress:MediAssistIndiaTPAPvt.Ltd.

1stFloor,53ARaffiAhmedKidwaiRoad,Kolkata700108.

24x7HelplineNumber:
CONTACTPERSON

Kolkata

JONAKICHATTERJEE(9831070594)

VICTORMITA(9331218005)

Delhi

PRAVEEN(9210808030)

NIRAJ(9311000000)

Bangalore

SASHIKUMAR(9379424436)

Chennai

DAVID(9344264426)

Hyderabad

ANJALI(9394645004)

Giridih

VICTORMITRA(9331218005)

Mumbai

VICTORMITRA(9331218005)

Forfurtherclarification,pleasecontact:

ShriAnjanMookherjee
Sr.AdministrativeOfficer
DirectorsOffice
IndianStatisticalInstitute
203BarrackporeTrunkRoad
Kolkata700108

:25753302

Email:anjan@isical.ac.in

ScopeoftheInsuranceCoverageScheme

TheMediclaimPolicyreimbursesexpensesincurredduetoaDisease,IllnessorAccident.

TheMediclaimPolicystipulatesthataclaimisadmissiblewhentheinsuredisadmittedinaHospital/NursingHome
foraminimumperiodof24hoursforthetreatment.

24hoursclausenotapplicableifthetreatmentcompletedwithinaday/ordaycareprocedureduetoadvancement
oftechnology(fordetailskindlyreferclause3Dofthescheme).

Claims regarding the indoor treatment other than the Network Hospital even in the Govt. Hospital will be
reimbursedbytheInsuranceCompany.However,thecashlessfacilitywillnotbeavailableinsuchcase.

ISIPolicyBenefits

SumInsuredRs.4lakhsperfamilyfloaterwithMaternity.

LimitoftheRoom/BoardingExpenses:1%ofsuminsuredperday(i.e.Rs.4000/perday)fornormalroomand2%of
sum insured for ICCU per day (i.e. Rs.8000/ per day). Overall limit under this head is 25% of sum insured (i.e.
Rs.1,00,000/)perillness.

SurgeonCharges/Doctorsfeesmaximum25%ofsuminsured.

Medicineinvestigationandothercharges(referto6c)ismaximum50%ofsuminsured.

WaiverofexclusionclauseduetoPreexistingdiseases.

Posthospitalizationupto60days.

MaternitybenefitRs.25,000/fornormal,Rs.50,000/forcaesariansection.

AmbulanceCharges:Rs.1,000/(IfthepatientadmittedtoICCUoremergencyworkorshiftingfromonehospitalto
another).

Expensesnotcoveredunderthisscheme(Refer9a&9b)ofthescheme.

FREQUENTLYASKEDQUESTIONS(FAQs):

1.

AreGovernmentHospitalincludedinthispackage?

Cashless facility is not available in Government Hospitals but the treatment expenses will be
reimbursedbytheInsuranceCompanyaftersubmittingtheclaimdocumentstotheTPA.However,
in such cases employee can draw the medical advance and adjust the same after receiving the
reimbursementfromtheInsuranceCompany.

2.

Istheamountincurredfortreatmentinhospitalfullyreimbursed?

Entireexpensesincurredwillbereimbursedafterdeductingexpensesduetothenonadmissible
items(refer9A&9Bofthescheme).

3.

Indoor treatment as per CS(MA) rules does not have an upper cap. How will this be
commensuratewithpresentscheme?

The treatments in the Government Hospitals are inexpensive and it is highly unlikely it would
exceedRs.4.00lakhsperfamilylimitinoneyear.Incaseofsucheventsadditionalpaymentcanbe
adjustedfromtheBuffer/CorporateFloaterfund.

It may also be noted that as per CS(MA) rules cost for Angiography/ Angioplasty / CABG /
Pacemaker/Cataract/Kneereplacement/Hipreplacementetc.arereimbursedasperthepackage
ratewhichismuchlessthatthepresentInsuranceScheme.

Theinsurancepolicycoverstreatmentcostsforanumberofprivateorsemiprivatehospitalsmost
of whose charges are generally either not payable or payable to a very limited extent as per
CS(MA)rules.

4.

HowwillemployeesascertainthattheTPAwouldcooperateandrespondefficiently?

A Standing Committee has already been constituted to review the performance of the TPA.
Feedback from individuals availing medical insurance will be solicited. TPA will provide 24 x 7
exclusivehelplinenumberforISI.

5.

Whatwillbethetimelimitforreimbursement?

Allclaimswillbesettledwithin25daysofsubmissionofcompletedocuments.Statusoftheclaim
willbeupdatedwithin7days.

6.

Can anyone draw medical advance for treatment in the hospital/Nursing Home/Government
Hospitalwherecashlessfacilityisnotavailable?

Anemployeecanappealtothecompetentauthorityforthemedicaladvance.Dependinguponthe
meritofthecaseauthoritymayapprovetheadvance.

7.

IsthereanoptiontoremainintheCS(MA)indoortreatment?

ThenewsystemincorporateallthefeaturesoftheCS(MA)rules.However,ifanyonefeelsmay
remainintheoldsystem.

HOWTOAVAILTHEMEDICALINSURANCEFACILITY

PLANNEDADMISSION

InsuredshouldinformtheTPAatleast3workingdayspriortohospitalizationalongwiththeDoctorsadvice
forHospitalization.

TPA issues an authorization/detail letter to Hospital/Nursing Home for covered service as per policy terms &
conditions.

CashlesstreatmentisextendedbyregisteredHospitalbasedonTPAsauthorizationletter.

Atthetimeofdischargeinsuredsignstheclaimform;alltherelevantbills&alloriginaldocumentsincluding
photocopyofIDCardwillbekeptbythenetworkhospital.Somepaymentmaybenecessarytocoverthecost
ofnonadmissibleitemsrequiredduringtreatment.

EMERGENCYADMISSION

Insuredapproachesregisteredhospital&submitsthecopyofIDCard.

NetworkhospitalforwardsrequestlettertotheTPA.

TPAwillissuetheauthorizationasperthepolicyterms&conditions.

Atthetimeofdischargeinsuredsignstheclaimformandalltherelevantbills&alloriginaldocumentsincluding
thephotocopyoftheIDCardwillbekeptbytheregisteredhospital.Somepaymentmaybenecessarytocover
thecostofnonadmissibleitemsrequiredduringtreatment.

TreatmentasnonCashlessbasis

Insuredgettreatmentsfromregisteredhospitalandnursinghomes.InformtheTPAassoonaspossible.

Atthetimeofdischargeinsuredpaysforallbills,collectallreports,bills,receiptsinoriginal.

Withnext10daysinsuredsubmitsclaimformalongwithadmissionadvice,alltreatmentrelatedbills,receipts,
prescriptions,cashmemos,dischargecertificatesetc.toTPAorinsurancecompany.Theclaimwillbesettled
by the insurance company within 25 days and the status of the claim will be intimated within 7 days of
applicationforreimbursement.

REIMBURSEMENTOFPOSTHOSPITALISATIONEXPENSES

Asperthepolicytheexpensesincurredupto60daysafterdischargerelatedtodiseaseforwhichinsuredhave
been hospitalized is entitled to get reimbursement. Original prescription & bill/receipt related to this should be
submittedtotheTPAalongwithallotherdocuments.Pleasenotethatoncefitnesscertificatehasbeenissuedbythe
Doctor,insuredisnotentitledtoanyreimbursementofexpensesincurredbeyondfitnessdate.

AVAILINGSERVICESATNONNETWORKHOSPITAL

Insured is required to intimate TPA at least 34 days prior to hospitalization or within 24 hours in case of
emergencyhospitalization.
Intimationshouldbeinwritingandthefollowingpointsshouldmentionedinit:
(a)
NameofthePatient

(b)
DateofHospitalization
NameoftheHospital&NameoftheDoctor

(c)

Thepatientpartyshouldpaytheentiretreatmentcostandafterdischargesubmitsthecompleteclaimformalongwith
allthedocumentstotheTPAsHelpDesk.

IMPORTANT

1.
2.
3.

Pleaseprovidealldocumentsinoriginal
Pleasekeepaphotocopyofallrelevantdocumentsforrecord.
ClaimFormcanbeobtainedfrom
a. TPAsWebsite
b. TPAsHelpDesk
c. InsuranceCompany

DOs

1.
2.
3.
4.
5.

6.

Approachnetworkhospitalatleast3workingdayspriortoadmissionforplannedhospitalization.
ProduceMedicalCardandOfficeIdentityCardtothenetworkhospitalforavailingcashlesstreatment.
Submitalloriginaldocumentstothenetworkhospital.
SubmitalldocumentstotheTPAwithin60daysfromdateofdischargeorfitnesswhicheverislaterin
caseofnonnetworkhospitalization.
IntimateTPA:
a. Atleast3workingdayspriortohospitalizationforplannedadmission.
b. Within24hoursofhospitalizationforemergencyadmission.
CooperatewithTPAforearlyprocessingandsettlementofclaim.

DONTs

1.
2.
3.

Dontinsistonselfadviced/unwarrantedinvestigationorevaluationonHealthcheckup.
Dontcarrybackanyoriginaldocumentsatthetimeofdischarge(incaseofcashlessservices).
Dontforgettopayforallinadmissibleexpenseslikeambulancecharges,diet,etc.

10