December 2006

RelianceHealthWise PolicyDecember 2006

December 2006

Agenda

1. Introduction - Clinical Indian Health Industry and Health Insurance

2. Product Offering – Reliance HealthWise Policy

3. Underwriting Overview

4. Claims Overview

December 2006

Introduction

Health Risks could arise from various factors such as

Physical Condition

Psychological Conditions

Occupation

Lifestyle Related Factors

Growing concern over prevalence of chronic illnesses in India

obesity

heart-illnesses

diabetes and hypertension among others

These factors will have significant impact on the health-care cost.

December 2006

Our Life Style.. A Ticking Time Bomb

Tremendous change in our life style

More nuclear families…more responsibilities

Late working

Extreme work pressures

No time for self

Not eating on time…eating out

Eating unhealthy….junk food

High inflation….everything getting expensive

December 2006

Alarming Symptoms

Increased risk of falling sick

More and more younger people fall sick

One has to pay heavily for medical treatments

Medical costs directly affect one’s hard earned savings

Savings which were meant for important needs is drained on medical expenses

Our Life Style.. A Ticking Time Bomb

December 2006

Our Daily Solemn Promise – what we should do

Every day I promise to myself

• I will get up early and go for a walk

• I will come home early after office

• I will eat on time

• I stop drinking..Ok ..Only a little bit

• I will eat healthy, absolute NO to junk food

• Go to a gym..Take care of my health

• I will sleep early

As Promises are meant to be broken..so I break them every day!!

December 2006

The Next Best Alternative….

It’s never too

early to

plan for future…..

Health Insurance…

December 2006

Need for Health Insurance

Urban Lifestyle and Rural Infrastructure support

Inadequate Facilities in Government Hospitals

Privately run hospitals are expensive

Increased cost of medication

Diagnostic Expenses have spiraled

Specialist Doctors come expensive

Increasing Population with income disparity

More nucleus family means less savings and less disposable income

Changing disease profile and lack of Medical Information

December 2006

Current Market Scenario

Only 85m people in India are covered under Health Insurance

Among them, only 10.8m are covered by Insurance Companies

The rest are covered under government and company schemes

Contributes to 9.6% of the general insurance market

Intense competition among the public and private players Historically perceived as a loss making portfolio

• Lack of spread of risk

• Lack of adequate Underwriting guidelines

• Inadequate claims control

• High perceived fears of fraud and abuse

Very little variation in product and price among the insurance providers Inadequate distribution Coverage of Pre-existing diseased - still a question

December 2006

Healthcare spending in the next 10 years will Double

Healthcare spending will increase to 2,00,000 crores by 2012 (Rs.86,000 crores in 2000-01)

Health care insurance sector is to become a

Rs 25,000 crore industry by 2009 (Rs.1200 crores- in 2001-02)

Rs 75,000 crore by 2020

Healthcare Opportunity in India - Mckinsey report

December 2006

The Way Forward….

Increased customer awareness for more spread of insurance

Higher standards of customer service

Popularisation of Floater Concept

Reduction of Claim Ratio through efficient underwriting guidelines/ control / product offerings / spread of risk

Value Adds and Increased Features which further sweetens the product

Affordable pricing – cross subsidize across age categories

Increased Marketing Communication

Increased Cashless Coverage through TPA

Ensure Hassle-Free Policy Issuance and Claim Procedures

Inclusion of Preventive elements

December 2006

Agenda

1. Introduction - Clinical Indian Health Industry and Health Insurance

2. Product Offering – Reliance HealthWise Policy

3. Underwriting Overview

4. Claims Overview

December 2006

What is Reliance HealthWise Policy?

Reliance HealthWise Policy provides for …………….

Financial Assistance for you and your family against Hospitalisation

Expenses towards disease / illness / injury in India along with host of

value additions / options

December 2006

Reliance HealthWise Policy

1. Basic Features

2. Value Added Features

3. Policy Features

4. Exclusions

5. Plan Details

6. Our Advantage

December 2006

1. Basic Features

a. Hospitalisation Expenses

b. Daycare Treatment

c. Domiciliary Hospitalisation

d. Pre and Post Hospitalisation

e. Coverage of Pre-Existing Diseases

f. Critical Illness Cover

g. Donor Expenses

December 2006

1.a. Hospitalisation

Covers hospitalisation expenses incurred as an in-patient in a Hospital which will include

• Room, Boarding and Operation Theatre charges

• Fees of Surgeon, Anesthetist, Nurses, Specialists

• The cost of diagnostic tests, medicines, blood, oxygen, appliances like pacemaker, artificial limbs and organs etc

Hospitalisation for a minimum period of 24 hours is a must

The cover provided is to a maximum of the Sum Insured

as selected by the Customer

December 2006

1.b. Day Care Treatment

Hospitalisation less than 24 hrs

Due to advancement of technology, hospitalisation expenses for certain treatments / diseases like the following are also covered, even though the hospitalisation is for less than 24 hours

•Cardiac Catheterization

•Cataract

•Chemotherapy

•Coronary Angiography

•Coronary Angioplasty

•Dialysis

•Dilation & Curettage

•Eye Surgery

•Hernia Repair Surgery

•Hydrocele Surgery

•Lithotripsy (Kidney stone removal)

•Radiotherapy

•Tonsillectomy

December 2006

1.c. Domiciliary Hospitalisation

Medical Treatment at your Home

Medical Treatment for a period exceeding three days, which in the normal course, would require hospitalisation, but treatment is actually taken at home, under any of the following circumstances: -

the condition of the patient does not permit him/her to be removed to Hospital or

the patient cannot be admitted to Hospital for lack of accommodation therein

This benefit also covers expenses on employment of a qualified nurse, as recommended by the attending Doctor.

The cover provided is to a maximum of 10% of the Sum Insured

as selected by the customer

December 2006

1.d. Pre and Post Hospitalisation

Extended Pre and Post Hospitalisation

Policy also covers relevant medical expenses incurred during a specified period, before & after hospitalisation (for which a claim is payable)

December 2006

1.e. Coverage of Pre-Existing Diseases

Pre-Existing Diseases Coverage

Hospitalisation expenses incurred on treatment towards Pre-existing diseases / condition can be covered:

Gold Plan: after completion of 2 consecutive years of the policy period

Silver Plan: after completion of 2 consecutive years of the policy period

Standard Plan: after completion of 4 consecutive years of the policy period

December 2006

1.f. Critical Illness Cover

Double Sum Insured Benefit

If Insured contracts any of the following nine Critical Illnesses, the Sum Insured under the Policy (chosen by the Insured), is doubled towards hospitalisation expenses incurred for treatment of such Critical illness. Cancer

Coronary Artery Bypass Surgery

First Heart Attack

Kidney Failure

Multiple Sclerosis

Major Organ Transplant

Stroke

Aorta Graft Surgery

Paralysis

Primary Pulmonary Arterial Hypertension

This feature is available only in Gold Plan

December 2006

1.g. Donor Expenses

Major Organ Transplant

Covers hospitalisation expenses towards donor in case of major organ transplant.

This feature is available to customers of Gold and Silver Plans

December 2006

2. Value Added Features

a. Expenses on accompanying person at the Hospital

b. Local Road Ambulance Services

c. Recovery Benefit

d. Cost of Health Check up

e. Nursing Allowance

f. Hospital Daily Allowance

Value added benefits are payable up to the Sum Insured for the plan opted.

These features become applicable once a valid claim is admitted under the basic hospitalisation expenses cover of the Policy

December 2006

2.a. Expenses on Accompanying Person

Payment towards expenses incurred by an accompanying person at the hospital while Insured is hospitalised for a minimum period of 5 days.

Gold Plan: Rs. 300/- per day for a maximum of 5 days

Silver Plan : Rs. 250/- per day for a maximum of 5 days

Standard Plan : Rs. 200/- per day for a maximum of 5 days

This is a common feature available to all Policyholders

December 2006

2.b. Local Road Ambulance Services

Reimbursement of Expenses incurred for necessary transportation of the insured to the Hospital in an ambulance for hospital admission and requiring immediate treatment.

Maximum limit:

Gold Plan – Rs. 1000/-

Silver Plan – Rs. 750/-

Standard Plan – Rs. 500/-

This is a common feature available to all Policyholders

December 2006

2.c. Recovery Benefit

In an unfortunate event, if the Insured is hospitalised for more than 10 consecutive days, a lump sum benefit of Rs. 10,000 will be payable as Recovery Benefit.

Basic Hospitalisation claim is enough. No need to provide for bills as this is a benefit payment.

This benefit is applicable for

All the members of the floater separately

Irrespective of the number of occurrence during the policy period

This feature is available only to customers of Gold Plan

December 2006

2.d. Cost of Health Check up

This benefit provides for reimbursement of cost / charges incurred for medical check up.

Applicable once at the end of a block of 4 claim free years.

Reimbursement is limited to 1.25% of the average sum insured.

This is a common feature available to all Policyholders

December 2006

2.e. Nursing Allowance

Payment of Nursing Allowance for expenses towards employment of registered nurse at the residence of Insured or at the Hospital provided such services are:

Confirmed as being necessary by the treating Physician

Relate directly to a disease / illness / injury for which the Insured has been hospitalised.

This is applicable irrespective of the number of times of occurrence

Allowance is payable for 5 days. In case of Critical Illness under Gold Plan this is payable for 10 days.

Gold PlanRs 300/- per day

Silver Plan Rs. 250/- per day

This feature is available to customers of Gold and Silver Plans

December 2006

2.f. Hospital Daily Allowance

Daily Hospital Allowance of Rs. 250 per day up to 7 days will be paid to Insured, provided he/she is hospitalised for more than 3 days.

It is irrespective of the number of occurrences

If case two people of the same floater are hospitalised, concurrently, each one of them will be eligible for hospital daily allowance separately

This feature is available only for Gold Plan customers

December 2006

3. Policy Features

a. Income Tax Benefit

b. Family Floater

c. Sum Insured

d. Pre-insurance Health Check up

e. Option in Policy Duration

f. Renewal Discount

g. Cashless Facility (Through Third Party Administrators - TPA)

h. Age Slabs

December 2006

3.a. Income Tax Benefit

Premium paid for Reliance HealthWise Policy is eligible for tax deduction under section 80 D of the Income Tax Act, subject to the condition that the premium amount is paid by cheque/DD by the customer from his bank account.

Rs. 10,000/- for self, spouse, kids and parents

Rs. 15,000/- if the policy includes senior citizens whose ages is above 65 yrs

December 2006

3.b. Family Floater

Policy can be issued on a Floater basis covering the family members of the Insured comprising the Insured, spouse and two dependant children (upto the age limit of 21 years).

What is floater, how does it benefit?

All members of the family (Self, Spouse, 2 Kids) can be covered under one single policy

Single premium payable for the entire family

The amount of Sum Insured “floats” over the entire family

No need to insure individual members separately

No hassles of tracking renewals for different members

December 2006

Family: Mr. Ashish Sethi, Mrs. Sethi & their kid Nikki

Scenario 1:

They take an insurance policy with a SI of Rs.1 Lakh each

Mr. Sethi unfortunately needs to undergo angioplasty

The total bill amount Rs. 1.4 lakhs

Insurance company pays only Rs. 1 Lakh as he is covered for only 1 Lakh. He cannot adjust the rest in the unused coverage amount of his wife and daughter

Mr. Sethi needs to bear the reminder of the cost – i.e. Rs, 40,000!!

3.b. Family Floater - Illustration

December 2006

Family: Mr. Ashish Sethi, Mrs. Sethi & their kid Nikki

Scenario 2:

They take a Reliance Healthwise Policy with a SI of Rs. 3 Lakh for the family

Mr. Sethi unfortunately needs to undergo angioplasty

The total bill amount Rs. 1.4 lakhs

The entire amount is paid for by Reliance HealthWise Policy

Mr. Sethi does not need shell out any money out of his own picket

3.b. Family Floater - Illustration

December 2006

3.b. Your Choice!

OR

December 2006

Chance of all in the Sethi family falling ill in one year is low as compared to one member falling severely ill – Theory of probability

3.b. Advantage Floater!

Individual Floater

Single cover for each member Common cover for all members

No flexibility to transfer the unutilized limit for other members

The limit can be used by any member of the family & for any number of times

Separate policy (separate document) for family members

Single document, single premium, single date to track

Premium payment annual in nature For the 2 year option, premium payment once in 2 years (at the beginning)

Currently, all plans annual in nature Floater plan available for one/two years..so assured zero hassle renewal next year

December 2006

3.b. Fits all in the Family

Family covered under floater policy

Choice to cover

Individual

Couple

Couple & One kid

Couple & Two kids

Choice of cover amount

Rs. 1 to 5 Lakh per family depending on the plan selected

December 2006

3.c. Sum Insured

Wide range of Sum Insured option depending upon his medical requirement:

Gold Plan: 1 lac, 2 lac, 3 lac, 4 lac, 5 lac

Silver Plan: 1 lac, 2 lac, 3 lac, 4 lac, 5 lac

Standard Plan: 1 lac, 2 lac, 3 lac, 4 lac, 5 lac

December 2006

3.d. Two Year Policy Option

The Reliance HealthWise Policy offers to the Insured an option of

1 year Policy

2 years Policy

If two year policy option is taken……………….

No worries for the insured members regarding:

Any price increase

Remembering to renewing the policy again next year

Premium to be paid for 2 years at the beginning itself

December 2006

3.e. Pre-insurance health Check up

No medical tests required at enrollment stage for family members under the

age of 45 and the Policy is issued immediately based on proposal form and

declaration

Applicants above 45 yrs will be covered only after completion of medical

tests, submission of reports and the approval of Underwriting team

December 2006

3.f. Renewal Discounts

A renewal discount of 5 % on the renewal premium will be allowed, in case

no claim is made during the expiring policy period

This renewal discount can be accumulated upto a maximum of 50%

December 2006

3.g. Cashless Facility (Through TPA)

Each Policy holder will get a Health Card

Using Health Card the Insured can avail of Cashless Hospitalisation facility through contacting the TPA

Cashless facility is available in over 3000 networked hospitals across the country

TPA provides assistance in

Cashless hospitalisation

Information on Claims status

Information on Hospitals

24 hour helpline

(TPA - Third Party Administrators)

December 2006

3.h. Age Slabs – Applicability

Anyone between the age of 3 months to 65 yrs can be covered under the

various plans

No fresh policy to be issued after 55 yrs in case of Gold Plan; 60 yrs incase

of Silver Plan; 65 yrs incase of Standard Plan

3 months - 45 yrs can be covered without Pre-insurance medical tests

46 yrs & above Mandatory medical test & necessary approval from the UW

Age band Coverage

3 months to 5 yrsCovered only along with either of the parents without any medical examination

6 years to 45 yrs Covered without any medical examination.

46-65 yrs Covered subject to satisfactory medical examination

December 2006

4. Exclusions

First year Exclusions

There are certain ailments which are not covered for the First year of inception of health insurance cover, but are covered subsequently –

Cataract

Benign Prostatic Hypertrophy

Myomectomy, Hysterectomy or menorrhagia or fibromyoma unless because of malignancy

Dilation and curettage

Hernia, hydrocele, congenital internal disease, fistula in anus, sinusitis

Skin and all internal tumors/ cysts/nodules/ polyps of any kind including breast lumps unless malignant /adenoids and hemorrhoids

Dialysis required for chronic renal failure

Gastric and Duodenal ulcers

This exclusion will not apply for roll over cases

December 2006

Permanent Exclusion

Disease/ Injury existing before inception of health insurance policy being pre-existing disease (however, these will be covered after 2nd year, depending on the choice of plan)

Any disease contacted during the first 30 days of inception of policy – accidents excluded and roll over cases excluded

Naturopathy or other forms of local medication

Pregnancy & childbirth related diseases

Intentional self-injury / injury under influence of alcohol, drugs

Diseases such as HIV or AIDS

Diseases existing from the time of birth (Congenital diseases)

4. Exclusions

December 2006

Cost of spectacles, contact lenses and hearing aids

Dental treatment or surgery of any kind unless requiring hospitalization

Charges incurred at Hospital or Nursing Home primarily for diagnostic without any treatment

Expenses on vitamins and tonics unless forming part of treatment for disease or injury as certified by the medical practitioner

Cosmetic, aesthetic, treatment unless arising out of accident

Treatment related to obesity

War, riot, strike, terrorism, nuclear weapons induced hospitalisation

Routine medical, eye and ear examinations

Treatment of mental illness

4. Exclusions contd……..

December 2006

Plan Comparison – Basic Features

5. Plan Details

December 2006

Plan Comparison – Value added Benefits

5. Plan Details

December 2006

Plan Comparison – Policy Features

5. Plan Details

December 2006

6. Our 17 points Advantage!

1. Family Floater Option

2. Coverage of Pre-Existing Diseases after 2nd year of renewal

3. Automatic Double Sum Insured under Critical Illness cover

4. Policy duration for 2 years

5. Extended Pre and Post-hospitalisation

6. Wider Sum Insured options

7. Hospital Daily Allowance

8. Nursing Allowance

9. Recovery Benefit

10. Reimbursement of Cost of Health Check up after 4 years

11. Local Road Ambulance Services

12. Expenses on Accompanying Person

13. Cashless Facility

14. Policy without Medical test till 45 yrs

15. Renewal Reward - No Claim Bonus

16. Income Tax Benefits

And you tell me the Last Advantage…. The 17 advantage

December 2006

17. Instant Policy Issuance

6. Our 17 points Advantage!

December 2006

6. Reliance Healthwise Vs. Other Cos.

December 2006

6. Reliance Healthwise Vs. Other Cos.

December 2006

6. Reliance Healthwise Vs. Other Cos.

December 2006

Agenda

1. Introduction - Clinical Indian Health Industry and Health Insurance

2. Product Offering – Reliance HealthWise Policy

3. Underwriting Overview

4. Claims Overview

December 2006

Product Code

Reliance HealthWise Policy

Product Code - 28-25

December 2006

Proposal acceptance authority – fresh proposal

Type of Proposal Age Band

Acceptance Authority

Medical TestBranch Office Regional Office

Corporate Office

Fresh

Pro

po

sals

3 Mths - 45

Front Line Office can accept business based on clear proposal form where there is no pre-existing disease. Where proposal form states pre-existing disease, proposal form as to be referred to Regional Office

Proposal referred to by the Front line office with pre-existing disease may be considered for acceptance based on underwriting.

N ANo Medical Required

46 -55 RO can accept the proposal subject to medical examination. Only such medically cleared proposals are to be underwritten by the RO for this age group . Any deviation refer to CO

CO may consider acceptance depending on merits of each case

Medical Required

56-65 (Applicable to Standard & Silver Plans Only

Medical Required

December 2006

Type of Proposal Age Band

Acceptance Authority

Medical TestBranch Office Regional Office Corporate Office

Ren

ewals o

r Ro

llovers

3 Mths - 45Proposal/Renewal with “No Claim” maybe accepted

Proposal/Renewal with claim history may be consider based on underwriting

No Medical Required

46yrs -55 yrs

Proposal/Renewal maybe accepted where there is "No Claim"

Proposal/Renewal with claim history may be consider based on underwriting

No Medical Required

56 yrs – 65yrs

(Applicable to Standard & Silver Plans Only

Proposal/Renewal maybe accepted where there is "No Claim"

No Medical Required

Proposal acceptance authority – renewal / rollover proposals

December 2006

Endorsements - Non premium bearing endorsements

Change in the following;

• Correction in Name of the Insured and/or dependants (only spelling)

• Correction in Gender

• Correction/Change in Address

• Correction on Date of Birth provided no impact on the premium

• Correction in Relationship of the dependants

• Change in Nominee

Cancellation of Policy due to dishonor of Cheque

December 2006

Endorsements resulting in Refund

1) Cancellation

at the request of the Insured (short period rate) subject to no claim policy.

at the instance of the Insurance Company (pro rata basis)

2) Deletion of Insured Members

only in case of legal separation and/or demise of Spouse or demise of child

premium to be refunded subject to no claim paid

3) Change in Date of Birth of the oldest member of the family

resulting in charging a lower premium due to reduction in age shall be done on receipt of written request from the Insured and proof of Date of Birth. (Proof of DOB can be Birth certificate, copy of Passport, Pan Card, driving license and the like)

premium will be refunded pro rata basis

Endorsements - Premium bearing endorsements

All the above are subject to UW approval

December 2006

4) Reduction in Period of Insurance

No reduction on Period of Insurance is allowed

5) Degradation of Plan

No mid term degradation of plan to be allowed

6) Decrease in Sum Insured

No mid term decrease in Sum Insured to be allowed

All the above are subject to UW approval

Endorsements - Premium bearing endorsements

December 2006

Endorsements resulting in collection of additional premium

1) Inclusion of dependants

Mid term addition is allowed only in the following cases

• New Born Child ( to be intimated within 4 months of birth)

• Newly married Spouse, ( to be intimated within 2 months of marriage)

Premium in case of the above scenario to be collected on pro rata basis

Under no other circumstances addition of family members is allowed

2) Change in Date of Birth of the oldest member of the family

Resulting in charging a higher premium due to increase in age shall be done on receipt of written request from the Insured and proof of Date of Birth. (Proof of DOB can be Birth certificate, copy of Passport, Pan Card, driving license and the like)

Premium will be colleted on pro rata basis

Endorsements - Premium bearing endorsements

December 2006

3) Increase in Period of Insurance

No mid term increase in Period of Insurance is allowed

4) Upgradation of Plan

No mid term upgradation of plan to be allowed

5) Increase in Sum Insured

No mid term increase in Sum Insured to be allowed

All the above are subject to UW approval

Endorsements - Premium bearing endorsements

December 2006

Agenda

1. Introduction - Clinical Indian Health Industry and Health Insurance

2. Product Offering – Reliance HealthWise Policy

3. Underwriting Overview

4. Claims Overview

December 2006

Types of claims - Hospitalisation

Claims can be broadly of two types:

Reimbursement claims

Cashless claims

This further can be broken into:

Planned - Where the customer is aware of the hospitalisation atleast 72 hours in advance

Emergency - Where the customer meets with an accident or suffers from bout of illness that requires immediate admission to the hospital

Claims are serviced at both network as well as non-network hospitals

Network hospitals – Hospitals which are on the tied up list (more than 3000 hospitals covered) - Where our service provider has a relationship

Non-network hospitals – which do not form part of the list

December 2006

A) Emergency hospitalisation Step 1. Take admission into the hospital. Step 2. As soon as possible, inform TPA about the hospitalisation. Step 3. At the time of discharge, to settle the hospital bills in full and

collect all the original bills, documents and reports. Step 4. Lodge the claim with TPA for processing and

reimbursement by duly filling in the claim form & enclosing all original bills/vouchers/receipts

B) Planned hospitalisation Step 1. Inform TPA about the planned hospitalisation. Step 2. Get admitted into the hospital as planned. Step 3. At the time of discharge, to settle the hospital bills in full and

collect all the bills, documents and reports. Step 4. Lodge the claim with TPA for processing and

reimbursement by duly filling in the claim form & enclosing all original bills/vouchers/receipts

Reimbursement - Steps to follow during hospitalisation

December 2006

Reimbursement Claims - Claim procedure

As soon as hospitalised, to intimate the TPA (Help line/Toll free number mentioned in the Health Card)

Following information needs to be furnished while intimating a claim:

• Contact Numbers

• Policy Number (as reflecting on the Health Card)

• Name of Insured person who is Sick or Injured

• Nature of Sickness/Accident

• Date & Time in case of accident, commencement date of symptom of disease in case of sickness

• Location of accident

December 2006

Cashless Claims – Procedure (Approval)

Cashless Service is the service wherein the Insured need not pay any money at the time of admission or discharge.

• This facility is available only at our Network Hospitals

To avail the “Cashless Service”

• “Cashless Request Form” available in network hospital (and in the H Kit) is to be filled up and sent to TPA for getting authorisation from TPA. The Hospital will coordinate for this.

• This authorisation along with a copy of the Health Card has to be given to the Network Provider at the time of admission

• Please also keep a copy of any photo ID card, it may be required by the Hospital.

TPA will authorize “Cashless Service” at the Network Hospitals for all cases which are covered under the policy.

December 2006

“Cashless Service” may be denied in following situations:

In case of any doubt in the coverage of treatment of present ailment under the Policy

If the information sent to TPA is insufficient to confirm coverage

The ailment/condition etc. not being covered under the policy

If the request for pre-authorisation is not received by TPA in time

Denial of “Cashless Service” is not denial of treatment. The Insured can continue with the treatment, pay for the treatment to the hospital and after discharge send the claim to TPA for processing.

Cashless Claims - Procedures (Denial)

December 2006

Rush to hospital and get admitted.

Obtain the Pre-Authorisation Form from the hospital (if it network).

Get the same filled in & signed by the attending doctor with required details.

Fax the pre-authorization form along with necessary medical details to TPA at the number mentioned in health card. The Hospital will coordinate for this.

Cashless Claims - Procedures for emergency hospitalisation

December 2006

If pre-authorisation is received from the TPA for “Cashless Service”

At the time of discharge………….

• Verify the bills and sign on all the bills at the Hospital.

• Pay only for those items that are not reimbursable under the Policy (Hospital / TPA will guide in this).

• Leave the original discharge summary & other investigations reports with the hospital. Retain a Xerox copy for records.

Cashless Claims - Procedures for emergency hospitalisation

December 2006

Coordinate with hospital & send in all the details along with the Pre-Authorisation Form at least 2 days prior to the hospitalisation including the plan of treatment, cost estimates etc. to TPA.

If “Cashless Service” is authorised by TPA

• At the time of admission, handover in the authorisation letter of TPA for cashless service & a photocopy of ID card to the hospital.

• At the time of discharge

a. Verify the bills and sign on all the bills.

b. Pay only for those items that are not reimbursable under the Policy.

c. Leave the original discharge summary, other reports with the hospital. Retain a Xerox copy for records.

Cashless Claims - Procedures for Planned hospitalisation

December 2006

fast forward better living

December 2006

Thank youDecember 2006