Group Mediclaim Policy 15-16

LIC Club Agents’ Group Mediclaim Policy 2015-16

Life Insurance Corporation Of India Ltd.
cover from
New India Assurance Co. Ltd.
serviced by
Medi Assist India TPA Pvt. Ltd

Definitions

Illness means a sickness or a disease or pathological condition leading to the impairment of normal physiological functions which manifests itself during the policy period and requires medical treatment

  • A Hospital means any institution established for in-patient care and day care treatment of sickness and / or injuries and which has been registered as a hospital with the local authorities, wherever applicable, and is under the supervision of a registered and qualified medical practitioner and must comply with all minimum criteria as under:
  • has at least 10 inpatient beds, in those towns having a population of less than 10,00,000 and 15 inpatient beds in all other places;
  • has qualified nursing staff under its employment round the clock;
  • has a qualified medical practitioner (s) in charge round the clock;
  • has a fully equipped operation theater of its own where surgical procedures are carried out
  • maintains daily records of patients and will make these accessible to the Insurance company’s authorized personal

Special Features of the Mediclaim Policy

  • Policy Period : 01st Sept 2015 to 31st Aug 2016.
  • Coverage : For Self only ( Age 18yrs to 85 yrs.)
  • Sum Insured : Various SI depending upon the Grades –From Rs. 40K to Rs.1.25 Lakhs
  • Room Restriction : Normal Room up to 1% and for ICU up to 2% of Sum Insured.
  • Maternity : For Normal delivery Rs.25K and for C section Rs.50 K
  • Pre/Post expenses: 30 days per hospitalization and 60 days post hospitalization charges are covered.
  • Pre existing ailments are covered.
  • Waiting period (1st year / 2nd year / 3rd year ) is waived off
  • 30 days waiting period not applicable
  • Ambulance charge up to 1 % of SI payable for transportation from home to hospital.
  • Ayurvedic /Homeopathic/ Unani Treatment are admissible up to 25% of the sum insured   provided the treatment for illness/disease and accidental injuries, is taken in a Government hospital or in any institute recognized by Government

Expenses Payable

  • Room, Boarding, Nursing Charges
  • ICU charges.
  • Surgeon, Anesthetist, Consultants, Medical Practitioner, Specialist fees.
  • Anesthesia, Blood, Oxygen, O. T. charges, Surgical Appliances, Medicines & drugs, Artificial Limbs, Cost of Prosthetic Devices like pacemaker, Implants and Relevant Laboratory/Diagnostic test and Similar expenses
  • Pre Hospitalization Expenses: Expenses incurred 30 days prior to date of admission( Consultation / Test Charges)
  • Post Hospitalization: Expenses incurred up to 60 days from the date of discharge.

The Company will pay to the Insured Person expenses of

  • Room, Boarding, Nursing Charges
  • ICU charges.
  • Surgeon, Anesthetist, Consultants, Medical Practitioner, Specialist fees.
  • Anesthesia, Blood, Oxygen, O. T. charges, Surgical Appliances, Medicines & drugs, Artificial Limbs, Cost of Prosthetic Devices like pacemaker, Implants and Relevant Laboratory/Diagnostic test and Similar expenses
  • Pre Hospitalization Expenses: Expenses incurred 30 days prior to date of admission( Consultation / Test Charges)
  • Post Hospitalization: Expenses incurred up to 60 days from the date of discharge.

Expenses Not Payable (Cashless & Reimbursement)

  • Admission/Registration
  • Telephone charges
  • Attendant’s charges
  • Home Visit/Nursing charges – at residence after discharge
  • Assistant fee/Follow up charges in advance
  • Sundry/Medico Legal Charges/Diabetic chart charges
  • Thermometer Charges
  • Container for Specimen/Disposable Bag charges
  • Admission Kit
  • External Surgical Aids: Lumbo-sacral/Collar belt /Knee cap/Knee brace/ walker/hot water bag/baby kit/urine pot / traction kit/ folding commode etc.
  • Inhaler/ Nebulizer /Glucometer or any other equipment’s
  • Diet charges
  • Special/protein diet/health drinks unless prescribed by the doctor
  • Documentation/Folder/Stationery/In Patient chart charges

Day care procedures/treatments payable under the policy

Anti Rabies VaccinationHysterectomyAppendectomy
Inguinal/Ventral/Umbilical/Femoral HerniaCoronary AngiographyLithotripsy (Kidney Stone Removal)
Coronary AngioplastyParenteral ChemotherapyDental surgery following an accident
Piles / FistulaDilatation & Curettage (D & C) of CervixProstate
Eye surgeryRadiotherapyFracture / dislocation excluding hairline Fracture
Stone in Gall Bladder, Pancreas, and Bile DuctGastrointestinal Tract systemTonsillectomy
Haemo-DialysisUrinary Tract SystemHydrocele
Sinusitis

Medi Assist | Documents Required for Reimbursement Claim

  1. Duly Filled & Signed Claim Form
  2. Original Discharge Summary
  3. Original hospital bills/ receipts & supporting annexes , detail breakup of the main bill.
  4. Copy of Indoor case paper.
  5. All investigation & test reports- including ECG, X-Ray, Ultra Sound, CT Scan, MRI
  6. All pharmacy bills & prescriptions
  7. Cancelled cheque.
  8. For claim above Rs.1 lac , Pan Card Copy is also required.

How to download E Card

Step 1 : Type www.mediassistindia.com on web browser.
Step 2 : Click on E-Cards option on top right section.
Step 3 : Click on E-Cards option on top right section.
Step 4 : Enter your Employee ID/Agent code
Step 5 : Once the details are entered, you get the E-card
Step 6 : Save the E-card to utilized at the time of hospitalization.

How to view claim status

Step 1 : Type www.mediassistindia.com on web browser
Step 2 : Click on Track your claim option on top right section
Step 3: Select any desired option from the choice to enter the specific detail
Step 4: Enter your Employee ID/Agent code or if know the MAID number or claim number
Step 5: If any additional documents are requested please submit the documents to your nearest Medi Assist Branch.
Step 6: Once the documents are received and query is completed the claim will be processed.

Medi Assist | Toll free call centre services

  • Interactive Voice Response System (IVRS )
  • State of art call center located at Bangalore supporting PAN India Call Center operations
  • 24×7 availability
  • Cooperative and Multilingual speaking staff
  • Toll free numbers
  • Recording and Monitoring of all calls
  • Regular training to all executives to sensitize towards various policies & issues.

Contact Details: 1800 419 1151

Happy to Partner

Medi Assist India TPA Pvt Ltd.
Sri Krishna Arcade, 47/1, 9th Cross, 1st Main Road, Sarakki Industrial Layout, 3rd Phase, J P Nagar, Bangalore – 560 078
Tel: +91 80 2658 4811

info@mediassistindia.com         |         www.mediassistindia.com

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