604200/46/10/8500000031
Index
Policy Highlights
Payments under Standard Mediclaim Policy of The National Insurance company limited for any hospitalization in India Family Floater Cover Sum Insured of Rs. 1,50,000/- per family Coverage for Employee + Spouse + 2 Children + 2 Dependent Parents (1+5) Female employees can either add parent or parent-in-laws
Policy Highlights
Special Benefits
Pre-Existing Diseases Cover from Day One
Maternity Benefit Cover from Day One with the limit of up to Rs. 25,000/for normal & Rs. 50,000/- for Caesarian section
New Born Child Cover from Day One (Provided there is intimation of babys birth within 7 days after birth) Waiver of First Year Exclusions Waiver of 30 Days Waiting Period Waiver of Pre-health check up
Policy Highlights
Specific Limits
Room, Boarding & Nursing Expenses limited to 1% of Sum Insured per Day or Rs. 2500/- whichever is lower
ICU Unit Expenses limited to 2% of Sum Insured per day or Rs. 5,000/- which ever is lower
Policy Highlights
You can avail benefits If you are already in employment before 15th April 2010, then immediately If you have joined recently, then after your enrollment process is completed as per intimation from HR.
The Insurance cover ends on Standard Termination of the Policy i.e. 14th April 2011 at 12:00 midnight Separation from Total OutSource India Pvt Ltd
Policy Highlights
The insurance cover Pays for. Only Inpatient Expenses i.e. only when you are hospitalized & Treated for disease (minumum 24 hrs hospitalization) Pre-Hospitalization Expenses for 30 days prior to date of Admission in hospital & related to same illness Post-Hospitalization Expenses for 60 days after the date of Discharge from hospital & related to same illness But does Not Pay for. Out Patient Expenses i.e. Diagnostics, investigations, consultations etc. which do not result into hospitalization Non Medical Expenses like Telephone Charges, Food Bill of attendants, Registration Charges, Toiletries, Service Charges etc.
Health Insurance is for common good, use it judiciously
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Standard Exclusions
HIV and AIDS Intentional Self-Injury, Use of intoxicating drugs/alcohol Venereal Diseases, Naturopathy
All psychiatric & psychosomatic disorders Injury or Disease caused directly or indirectly by nuclear weapons /war Expenses on Vitamins/Tonics unless forming part of treatment Cost of Spectacles or Contact Lenses, Correction of eye sight, Hearing Aid etc.
Standard Exclusions
Any cosmetic or plastic surgery except for correction of injury Any hospitalization for Diagnostic tests only
Infertility treatment Any hospitalization less than 24 hours except for specific treatments like Dialysis, Chemotherapy, Radiotherapy, Cataract Surgery, Lithotripsy, Tonsillectomy etc.
Any Non Medical Expenses like Registration Fees, Admission Fees, Charges for Medical Records, Cafeteria Charges, Telephone Charges, Service Charges etc.
Any dental treatment or surgery which is corrective, filling of cavity, root canal etc.
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Standard Exclusions
Expenses incurred for investigation or treatment or irrelevant to the diagnosed during hospitalization Genetical disorders & stem cell implantation / surgery Change of treatment from one stream to the other (for example switching over from allopathy to homeopathy etc) recommended by consultant Treatment of Obesity & any other weight control program
Any treatment required arising from insureds participation in any hazardous activity Any stay in the hospital for any domestic reason or no active regular treatment is given Massages, Steam bathing, Shirodhara & alike treatment under Ayurveda
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Standard Exclusions
Doctors home visit charges, Attendant/Nursing Charges during pre & post Hospitalization Treatment which is continued before & after hospitalization for an ailment / disease / injury different from one for which hospitalization was necessary. Voluntary Termination of Pregnancy Outpatient Diagnostic, Medical or Surgical procedures or treatments, non-prescribed drugs & Hormone replacement Therapy, Sex Change
Any treatment received in convalescent home, convalescent hospital, health hydro, nature care clinic
Health Insurance is for common good, use it judiciously
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Enrollment
Enrollment for dependants will be through online process use the following steps to submit the enrollments.
Log on to https://www.medimanage.com
Use your Employee ID followed with an underscore and 8-digit DOB in DDMMYYYY format to login-in. Password will be your 8-digit DOB in DDMMYYYY format. (Example: If your Employee ID is 123456 & date of birth is 05-Nov1969, then your login-in ID will be 123456_05111969 and password will be 05111969)
On completion of enrollment, confirmation will be sent to your a. Official email ID b. SMS to your mobile no. c. Email is sent to your private/personal email ID.
Health Insurance is for common good, use it judiciously
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Enrollment
Update status changes in the family within 30 days If Married, provide info about spouse (Name/DOB/Relationship) Had a baby, provide info about baby (Name/DOB/Relationship) If any member covered under plan Expires, Please inform.
Please note that you cannot change your dependents during the currency of the policy except for the events like Marriage & New Child Birth. The details given by you at commencement of policy would be FINAL.
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Select a category of support request. Enter a Subject of your request & then enter the Message describing your request.
Attach documents if any and then Submit the Support Request.
A Ticket No. will be generated and will be reflected in the History of all your requests.
Health Insurance is for common good, use it judiciously
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When Medimanage representative responds to your Message, you will get an alert about the same on the registered e-mail ids.
To check the response from Medimanage, pick the particular Message
from the History or Search with Ticket no. Or Subject of your Message.
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HOSPITALISATION AT NON NETWORK HOSPITAL If the hospitalization is in the Non-network Hospital, you complete your hospitalization, pay the bills & follow process of Reimbursement of expenses.
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Mediassist will fax the Authorization Letter to the concerned hospital within 24 hours.
You can get hospitalized & the treatment can start.
On discharge, Sign the bills, claims form & pay the non-medical charges only.
Health Insurance is for common good, use it judiciously
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Cashless Hospitalization
Please Remember. Mediassist will only pay for the Medical Expenses You need not make any payment for any of the medical expenses. You must pay for the non-medical expenses on discharge or whenever asked by hospital The bills for medical expenses would be sent to Mediassist by the hospital & they would directly settle the same with hospital
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Reimbursement Claims
All Main Hospitalization bills should be submitted for claim within 30
All Post-Hospitalization bills can be separately submitted or claimed within 60 days from Date Of Discharge after completion of the treatment.
NOTE: In case of Post hospitalization treatment ensure to provide appropriate
intimation to HR dept upon discharge to enable to process the pre / main hospitalization claims separately & post hospitalization claims separately. In case no intimation is provided while submitting main bills the post hospitalization claims would not be considered for further processing.
Health Insurance is for common good, use it judiciously
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Manjunatha
Claims Executive
All India
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Thank You
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