OSI Consulting Pvt Ltd

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OSI Consulting Pvt Ltd

• Presentation on Group Mediclaim

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Parties Involved..
Insured OSI Consulting Pvt Ltd.,
Underwriter National Insurance Company Ltd
Third Party Administrator Medi Assist India TPA Pvt Ltd
Insurance Brokers Visista Insurance Broking Services Pvt Ltd
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Group Mediclaim Policy..

• Scope of Cover
• Covers Medical Expenses of an employee arising
  out of an accident or disease.
• Medical Expenses are reimbursed provided
  Hospitalization takes place

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Coverage Details..

• Room Rent is Restricted to 1 of S.I. /-in
  case of normal hospitalization and 2 of S.I.-
  in case of ICU.
• Nursing / Medical Practitioner Fees.
• Consultation Fees.
• Anesthesia / Anesthetist Fees.
• Treatment fees including medicines, blood,
  oxygen, artificial limbs / organs, operation
  theatre charges, surgical appliances.
• Diagnostic costs related to a hospitalization up
  to the limit of the Sum Insured.

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Hospitalisation..

• Minimum period of 24 hrs.
• Time Limit Not Applicable For Specific
  Treatments Like
• Dialysis
• Chemotherapy
• Tonsillectomy
• Eye surgery
• Dental surgery
• D C and others

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Minimum Criteria for Hospital..

• Min 15 In-Patient Beds.
• Fully Equipped Functional Operation Theatre.
• Round the Clock Availability of Nursing Staff/
  Doctor.

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Additional Covers opted by OSI Consulting Pvt
Ltd.

• 30 Days Exclusion Waiver
• Any disease/illness that occurs during first 30
  days of commencement of insurance is not covered
  under an ordinary mediclaim policy. However, OSI
  has opted for the waiver of this exclusion.
• First TwoYears Exclusion Waiver
• A Standard Group Mediclaim Policy does not cover
  certain diseases (Eg cataract, hernia,
  hysterectomy, hypertrophy etc.) in the first two
  years succeeding the inception of the policy.
• Since this exclusion has been waived, the
  employees of OSI can avail these benefits in the
  first year itself.

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Additional Covers opted by OSI Consulting Pvt
Ltd.

• Maternity Expenses Benefit
• Treatment taken in hospital/Nursing Home arising
  from pregnancy.
• The Maximum benefit that can be availed is Rs.
  25,000/- for normal and Rs. 40,000/- for C -
  Section.
• Pre Hospitalisation and Post Hospitalisation is
  not covered under Maternity Expenses.
• Voluntary abortions excluded from the scope of
  policy

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Additional Covers opted by OSI Consulting Pvt
Ltd.

• Child Day One Cover
• With the inclusion of this cover a New born baby
  is covered from the day of birth ( Provided
  intimation has to be given for this to HR).
• Coverage of Pre-Existing Diseases
• Any injury/disease that was in existence prior to
  the inception of the current policy is a
  pre-existing disease.
• OSI has opted for the coverage of these diseases
  for employees and their dependants.

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Benefits of GMC for OSI Consulting Pvt Ltd

• Maternity Coverage
• 9 months waiting period waiver
• Child Day one cover within Maternity limit
• Preexisting Diseases Cover
• First two years exclusion waiver
• 30 days waiting period waiver
• All the above with no medicals
• Employees covered from Date of Joining subject to
  availability of adequate CD balance with
  Insurance company

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General Exclusions..
Diseases In-Patient Treatment Others
Plastic Surgery (Cosmetic) Diagnostic Expenses not consistent with treatment. Spectacles,Contact Lens, Hearing Aid
Dental Treatment Vitamins/ Tonics (unless prescribed by the Doctor) Use of intoxicating drugs/ alcohol
Sterility/Venereal Disease/Circumcision Telephone,Fax,Barber,Photocopy, Vaccinations,Toiletries and TV charges Naturopathy/Homeopathy
Intentional Self Injury AIDS Special diet and extra diet for patients (unless prescribed by the Doctor) Transport to Hospitalisation (except in case of emergency)
Congenital Diseases (External) e.g. An operation to remove a 6th finger, Skin Graphting External Implants e.g. An operation to remove a 6th finger, Skin Graphting Transport to Home
Convalescence / General Debility. Supports and Accessories, e.g. Crutches
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General Exclusions..
Diseases In-Patient Treatment Others
HIV / AIDS Service,Maintenance and Surcharges
Dental Treatment Special Nursing, Attendant Pass
Health Drinks e.g. Horlicks, Complan etc
Abortion done for voluntary reasons
Food and Beverage for Relatives
Damage done by the patient (accidentally). Damage charges not covered.
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Claims Process..

• All claims are processed through the TPA
• Treatment can be taken either at a Network
  Hospital or a Non Network Hospital
• Cashless facility can be availed at Network
  Hospital
• Treatment at Non Network Hospital is reimbursed

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Claims Process Cashless..

• Member approaches Network Hospital with ID Card.
• Caution Deposit may be asked at some hospitals,
  which has to be paid by the member. Once the
  member gets an approval for cashless treatment,
  the deposit is reimbursed to the member.
• Network hospital intimates TPA.
• TPA issues authorization within 4 Hours.

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Claim Process Cashless..

• Network Hospital extends Cashless facility to
  member
• Member is discharged
• Network Hospital forwards claim documents to TPA
  for settlement

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Claims Process Reimbursement..

• Member avails treatment at any Non Network
  Hospital
• In case of reimbursement claims, claim shall be
  intimated to Mediassit TPA at their website
  (Registration/ Claims intimation) and HR at
  kkurra_at_osius.com.
• Makes the payment upfront to the Hospital
• All reimbursement claims would be processed
  through Visista.
• Hence the claim documents should be handed over
  to Visista by the respective member / HR.
• The claim documents would be processed by Visista
  and sent to the TPA for finalizing the claim.
• TPA verifies the documents submitted.

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Claims Process Reimbursement..

• Incase of further requirements the TPA intimates
  Visista/ client within 4 working days
• Upon receipt of the complete documents with the
  claim form TPA settles the claim within 21
  working days
• Once the claim is finalized the cheque would be
  handed over to Visista which in turn would be
  passed to the respective member /HR
• Reimbursement claims to be submitted to Visista
  within 14 working days from date of discharge
  from hospital

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Checklist for Reimbursement Claims..

• Claim form duly filled
• Original Discharge Summary
• Medical Bills Respective Prescriptions
• Test Reports, Prescriptions Respective Bills in
  Originals
• Hospitalization Bills Originals
• All Receipts in Original
• Cash Receipt or Original Credit Card Charge Slip
  in case of credit card payment

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Details of Network Hospitals..

• All India 4000 Hospitals
• Soft copy of the Network Hospitals available at
  https//www.mediassistindia.com/Index.html
• All other hospitals which do not feature in the
  list are Non Network Hospitals

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Employee Login Procedure

• Please follow the below process to access the
  Employee Login 
• Step 1 log on to https//www.mediassistindia.com
  /index.html
• Step 2 Click on the Login/Corporate Employee
  Tag.
• Step 3 Emp Login empcode_at_OSICP (Eg.
  NS0477_at_OSICP)
• Step 4  Emp Password OSICP
• Step 5 Click Login 
• Step 6 Reset new password (one time process)
• Step 7 Click on the policy no (highlighted) to
  view Benefit Chart
• Step 8 You may choose tabs on the top as per the
  requirement-
• For e.g. Click  the E card
  print the same

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For any queries contact Visista ..

• Mr. D. Srikanth 9052855676
  dsrikanth_at_visistarisk.com
• Mr. Shramik Kumar 9989037737
• shramik_at_visistarisk.com