Guidelines for Mediclaim :
financialsolutions.in welcomes you into the fold of MEDICLAIM health insurance policyholders. Family Health Plan Ltd, the TPA of National Insurance Company Ltd, is here to provide you with services in a hassle free manner within the terms and conditions of your MEDICLAIM policy. As a Third Party Administrator for your Insurance Company, FHPL will provide you the following services
As soon as you receive your booklet and card, please go through;
a) Your card for any discrepancies. If you find any discrepancies, please bring it to the notice of our office nearest to you or return the card for rectification. Please keep a xerox copy of the card before returning it to FHPL.
b) Please go through the guidebook in detail to familiarize yourself with the proper procedures to be followed while availing the various services offered by FHPL.
c) Please go through your MEDICLAIM policy, especially the clause 4 pertaining to the exclusions under the policy, in detail to be aware of, what ailments are covered under the policy and what ailments/conditions are excluded.
For any doubts or clarifications and/or information, contact our nearest office or call our Toll free line at 1600-425-4033. or log-on to our website http://www.financialsolutions.in
The MEDICLAIM policy, your FHPL card and the guidebook are important documents. Please keep them in safe custody and carry them with you whenever you go to a hospital for admission.
Please quote your UHID number, policy number and the name of your insurance company in all your correspondence with FHPL.
Health insurance is considered to be a part of the larger business set-up. One of the primary reasons why Health Insurance is becoming popular in India is the escalating cost of medical treatment today, which is beyond the reach of the common man in India . In the case that a medical emergency arises, the cost of a hospital room rent, the doctor's fees, medicines and related health services usually work out to be a huge sum. It is in such time that having a health insurance policy ensures that you are provided with the much-needed financial relief.
Network Hospitals and “Cashless Service”: Network providers are Hospitals and Nursing Homes who have contracted with FHPL to provide cashless service for Inpatient treatment, for ailments, diseases and medical conditions covered under the MEDICLAIM policy, to all those who are insured and enrolled with FHPL.
Cashless Service is the service wherein you need not pay any amounts either as a deposit at the time of admission or for the hospital bills at the end of treatment / discharge. This facility is available only at the Network Providers. To avail the “Cashless Service” you need to get an authorization from FHPL. This authorization along with a copy of the card issued by FHPL has to be given to the Network Provider at the time of admission.
Pl Note: FHPL will authorize “Cashless Service” at the Network Providers in all cases eligible under the insurance policy. “Cashless Service” may be denied in some of the situations as listed below.
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In case of any doubt in the policy terms with respect to the present ailment.
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The ailment/condition etc. not being covered under the policy.
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The insured amount not being sufficient to cover the hospitalization expenses.
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If the request for preauthorization is not received by FHPL in time.
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If the information sent to FHPL is insufficient to confirm coverage.
Denial of “Cashless Service” is not denial of treatment. You can continue with the treatment, pay for the services to the hospital, and later send the claim to FHPL for processing and reimbursement.
AVALING OF INPATIENT HOSPITALIZAION SERVICES
In case you need to avail inpatient hospitalization services, you can go to any hospital of your choice, either a hospital on our network or a hospital outside the network. The difference between the two being that FHPL can authorize for “Cashless Service” in the hospital on its network whereas you will have to settle all the bills in the hospital which is outside its network.
However you have to follow the procedures listed below to get the services in different situations.
A) Emergency hospitalization in Non Network Hospitals
Step 1. Get admitted into the hospital.
Step 2. As soon as possible, inform FHPL about the hospitalization.
Step 3. At the time of discharge, settle the hospital bills in full and collect all the bills, documents and reports.
Step 4. Lodge your claim with FHPL for processing and reimbursement.
B) Planned hospitalization in Non Network Hospitals
Step 1. Inform FHPL about the planned hospitalization.
Step 2. Get admitted into the hospital.
Step 3. At the time of discharge, settle the hospital bills in full and collect all the bills, documents and reports.
Step 4. Lodge your claim with FHPL for processing and reimbursement.
C) Emergency hospitalization in Network Hospitals
Step 1. Get admitted into the hospital.
Step 2. As soon as possible inform FHPL and coordinate with the hospital to have the details sent to FHPL for authorization for cashless service.
Step 3. A) In case of very short stay at the hospital or if the authorization for “Cashless Service” was not received from FHPL or if “Cashless Service” was denied by FHPL
i) At the time of discharge settle the hospital bills in full and collect all the bills documents and reports.
ii) Lodge your claim with FHPL for processing and reimbursement
OR
Step 3. B) If authorization for “Cashless Service” from FHPL has been received
i) At the time of discharge
a) Pay for those items that are not reimbursable under the MEDICLAIM policy.
b) Verify the bills and sign on all the bills.
c) Leave the original discharge summary and other investigations reports with the hospital. Retain a Xerox copy for your records.
d) Planned hospitalization in Network Hospitals
Step 1. Please co ordinate with your doctor and the hospital and send in all the details of your planned hospitalization including the plan of treatment, cost estimates etc. to FHPL. Also indicate the address or fax number to where the authorization is to be sent. This should be sent to FHPL at least 3 days prior to the admission.
Step 2. A) If authorization for “Cashless Service” from FHPL has been received
i) At the time of admission, hand in the authorization letter and a photocopy of your ID card to the hospital.
ii) At the time of discharge
a) Pay for those items that are not reimbursable under the MEDICLAIM policy.
c) Verify the bills and sign on all the bills.
d) Leave the original discharge summary and other investigations reports with the hospital. Retain a Xerox copy for your records.
OR
Step 2. B) In case “Cashless Service” was denied by FHPL
i) At the time of discharge settle the hospital bills in full and collect all the bills documents and reports.
ii) Lodge your claim with FHPL for processing and reimbursement
How to lodge your claim with FHPL for processing and reimbursement.
Within 7 days after discharge, please lodge your claim with FHPL for processing. When lodging your claim with FHPL, please make sure that all the documents listed below are sent.
1. Claim form duly signed by the insured.
2. Photocopy of your ID card.
3. Photocopy of your policy.
4. Hospital bills in original. For all consolidated amounts, the detailed breakup of the billed amount is required from the hospital.
5. For medicines purchased outside, the bills should be accompanied by a prescription from the doctor.
6. Discharge summary or card in original.
7. All investigation reports in original.
FREQUENTLY ASKED QUESTIONS
1. Are there any charges by the hospital, which are not reimbursable and hence have to be paid by me even after “Cashless Service” has been authorized for treatment in the network hospitals?
Yes. There are quite a few charges, which are not reimbursable and have to be paid by you even though you have been authorized for “Cashless Service” at the Network Hospitals. Some of those charges are enumerated below:
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Registration/Admission Charges.
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Attendant/Visitor pass charges.
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Ambulance charges.
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Special nursing charges not authorized by the attending doctor.
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Service charges not forming a part of the room rent.
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Charges for extra bed for attendant etc.
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Bed retaining charges.
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Charges for TV, Laundry etc.
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Telephone/Fax charges.
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Food and Beverages for attendants and visitors.
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Toiletries etc.
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Purchase of Medicines not related to the treatment
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Stationery, Xerox or certifying charges
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