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Cashless Process

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TPA Services

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Mediclaim Policy

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Medi Assist India Tpa Private Limited
We are a Third Party Administrator (TPA) of Health Insurance Policies and we form a vital link connecting all other stakeholders of the Health Care Domain. We enable cashless hospitalization at pre designated points of healthcare delivery like hospitals and nursing homes, and in case of reimbursement claims, we assure speedy settlement of the same.
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Nature of Business

Service Provider

Legal Status of Firm

Limited Company (Ltd./Pvt.Ltd.)

Annual Turnover

Rs. 100 - 500 Crore

GST Number

32AACCM8044R1Z2

Cashless Process
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Cashless Process

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This section will guide you through various aspects of Mediclaim policy with particular reference to the Claims Settlement and Cashless service procedures.

What is Cashless Hospitalization?

Cashles hospitalization Process & Procedures are described below

 

  • Cashless hospitalization can be availed only at Medi Assist network of hospitals. The essence of cashless hospitalization is that the insured individual need not make an upfront payment to the hospital at the time of admission.
  • Note : The listed network hospitals in the booklet issued may have undergone changes in the form of additios and deletions. Please check the website for the updated list of network hospitals.
  • Once you are covered under a Health Insurance policy administered by us, you will be issued a Medi Assist ID card.
    Please note that this card is issued only for identification and information purposes.
  • At the time of hospitalization at a network hospital, you will have to produce this card as proof of being covered by a health insurance policy. In case your Medi Assist ID card is not a photo card (as in the case of some large corporates), it is advisable to carry some form of photo ID (Ration card, Driving license, Voted Id card, etc.) with you in case the hospital wants to verify your identity
  • The network hospitals have a preauthorization request form available with them. This form can also be downloaded from this website. The form has to be jointly filled in by you and your treating doctor. Please make sure all the details asked in the form are completely filled. This will ensure speedy processing of your request.
  • This form is faxed to the Medi Assist toll free fax number.
  • At Medi Assist, we receive the request and process it. The medical team will determine whether the condition requiring admission and the treatment plan are covered by your health insurance policy. They will also check with other terms and conditions of your insurance policy.
  • In case coverage is available, Medi Assist will issue an approval to the hospital for a specified amount depending on the disease, treatment, how much you are insured for, etc. This is sent by fax and/or email (if available). The approval is called a "Preauthorization". This preauthorization entitles you to avail cashless facility at the hospital without paying for the medical expenses. Note: Further enhancement approvals may be issued on request, subject to terms and conditions of the policy.
  • At the time of discharge, please make sure that you check and sign the original bills and discharge summary. Please carry home a copy of the signed bill, discharge summary and all your investigation reports. This is for your reference and will also be useful during your future healthcare needs.
  • The hospital will ask you to pay for all the Non-Medical Expenses in your bill. You have to make this payment before discharge.
  • In case, for whatever reason, the preauthorization request cannot be approved, a letter denying preauthorization will be sent to the hospital. In this case, you will have to settle the hospital bill in full by yourself.
  • Please note that denial of a preauthorization request is in no way to be construed as denial of treatment or denial of coverage. You can go ahead with the treatment, settle the hospital bills and submit the claim for a possible reimbursement.
  • For the Complete Process kindly refer Preauthorization Procedure

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TPA Services
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TPA Services

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Under Regular TPA Services, we offer the following: Enrolment of insured employees and their families
  • Issue of Health Insurance ID cards to the insured employees and families
  • Enabling cashless hospitalization for employees and their families
  • Healthcare Claims Processing
  • Analysis of claim data pertaining to the corporate

As a part of these services, we enter into Service Level Agreements for issuing ID Cards, turn around Time for Reimbursement Claim Settlement, & turn around time for Pre-Authorization response, and endeavour to honor the same.

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Insured
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The essence of our service offering ends here when we deliver various services to the Insured. We serve all the insured, who are covered under the TPA Services of Medi Assist.

Kindly visit the insurer's website for more details on the various insurance policies being offered by them

New India Assurance Company Ltd.
National Insurance Company Ltd.
Oriental Insurance Company Ltd.
United India Insurance Company Ltd.
Reliance General Insurance Company Ltd.
ICICI Lombard General Insurance Company Ltd.
Cholamandalam MS General Insurance Company Ltd.
Royal Sundaram Alliance Insurance Company Ltd.

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Non Admissible Expenses

Non Admissible Expenses

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IRDA on Critical Illnesses
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Mediclaim Policy

Mediclaim Policy

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Notice Of Claim
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Notice Of Claim

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Upon the happening of any event which may give rise to a claim under the health insurance policy, a notice with full particulars of the event has to be sent to the Insurance Company within 7 days of the event.

Once the treatment is complete, the claim has to be filed within the policy specified duration from the date of discharge

The notice of claim and filing of claim apply especially to reimbursement claims.

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Pre & Post Hospitalization Expenses
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What are Pre-Hospitalization & Post-Hospitalization Expenses?

When one falls sick, one usually consult a family physician and gets relevant investigations done. On the advice of the physician, one gets hospitalized for further management of the disease if required. Such medical expenses incurred before hospitalization are called Pre-Hospitalization expenses.

During hospitalization, a major part of the treatment is complete but some part of the treatment extends beyond the hospitalization. It may involve follow-up visits to the doctor, medicines to be taken or further investigations to be done. Such medical expenses are called Post-Hospitalization expenses.

There is provision to claim these expenses through your health insurance policy.These expenses are payable for a policy-defined period. Both pre-hospitalization and post-hospitalization expenses can be claimed only after the settlement of the main hospitalization claim.

The claim submission process for pre-hospitalization expenses and post-hospitalization expenses is the same as Reimbursement.

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