final health presentation for insurance

7/29/2019 Final Health Presentation for insurance

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Understanding the business Competitive quotes

Tailor made risk covers

Management of risk Liaison between insurance company and the insured

Maintain the data

Premium reminders

Claims facilitation (Help Desk) Claims service

MIS analysis, suggestions to curtail claim ratio


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Mandate

Data from corporate

Broker slip

Proposal form


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GROUP MEDICLAIM


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7/19

Definition of family: Self + Legal spouse + Dependent children Covers hospitalization and related expenses Floater sum insured Room, boarding, nursing expenses usually 1% of SI. ICU/ICCU chargesDoctors fees surgeon, anesthetist, consultant,Anesthesia, blood, O2, OT charges, surgical appliances,

medicines, all relevant laboratory tests done, dialysis,chemotherapy, radiotherapy, cost of artificial limbs, cost ofprosthetic implanted devices like pacemaker.

Ambulance services usually 1% of SI or max Rs. 2000 whicheveris less.

Pre-post hospitalization Specified day care procedures


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Pre-existing disease coverage

Waiting period waivers

Maternity coverage- Max limit Rs. 50000 for LSCS and

ND

New born baby coverage from Day 1


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Cosmetic surgeries, vaccinations, obesity,Dental treatments not arising from or due to

disease or traumaHIV, AIDS, HTLV 3, LAV, STD.Hospitalization primarily for investigationGenetic disordersCongenital external defects, sterility, infertilityAlcoholism related, abuse of drugs, intentional self

injury, suicideExternal medical/non medical equipmentsNon medical expenses


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Cashless can be obtained through network hospitals.Cashless is provided by insurer through TPA.

Reimbursement, wherein treatment is taken in a non-network hospital or if in network hospital, cashlesscould not be obtained due to some reason.


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Constant coordinationwith Insurance Company for Float Fund arrangement/ Endorsements / Claim discussions.

Constant coordinationwith TPA for claims settlements / data management.

Frequently Asked Questions prepared for clients employees which could bereferred through intranet.

PowerPoint Presentation on Health Insurance designed clients employees tounderstand Cashless / Reimbursement claims procedures in detail along withthe policy coverages.

Physical ID Cards / E-Cards to be arranged on timely basis through TPA.

Deficiency Letters/Claim Settlement Letters routed to client

coordinator/employees (e-mail ids of employees required) via mail/hard copywith a copy marked to client coordinator.


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TAT

Cashless Claims 2 to 3 working hours from thetime of receipt of Completely Filled Pre-Authorization /Cashless form.

TAT Reimbursement Claims 10 to 15 working days

from the receipt of Complete Claim File.Re-imbursement Claim File Submission EIBPL shall

submit the complete claim file within 1 working day to TPA

Duplicate / Correction ID-Cards EIBPL shall arrange

for the same from TPA within 3 working daysAdmission in Non-Network Hospital An intimation is

a must to EIBPL / TPA


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provides coverage and security to employees incase of death or bodily injury due to anaccident during the policy period.


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Death,

Permanent total disability,

Permanent partial disability,

Temporary total disability.


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Suicide/ Intentional self injury,

Death due to Pregnancy/child birth etc,

Accident while under influence of alcohol/drugs,

Sexually Transmitted Infections,

Participation in a criminal act

Participation in a hazardous sport

War, civil war, terrorism, similar situations etc.


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Sum Insured

Personal accident policy takes the basis of earningcapacity of the member to decide the capital sum

insured.

Premium

Occupation of the Insured person

Table of benefits availed, etc.


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CHECKLIST Weekly Benefit Claims

Claim form Attending Doctor's Report Disability Certificate from the Doctor, if any Investigation /Lab reports (x-rays &reports etc.)

Original Admission/discharge card, if hospitalized Employers Leave Certificate, with grade/designation Details of salary-Latest Salary Certificate.

Death Claims Claim form Attending Doctor's report

Original Death Certificate Original / Attested Post Mortem / Coroner's report Attested copy of FIR / Panchanama Police Inquest report, where applicable


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final health presentation for insurance

Documents