22-Jun-16 12:40 PM. Kind Attn: All Faculty and Staff Members. Dear Sir/Madam,
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1 Process Flow Chart, Timeline for cashless and reimbursement details fr... of Jun-16 12:40 PM From: "circular" <circular@iitd.ac.in> Subject: Process Flow Chart, Timeline for cashless and reimbursement details from Vipul, TPA Date: Tue, June 21, :18 pm To: "Allfaculty" <allfaculty@circular.iitd.ac.in>,"allstaff" <allstaff@circular.iitd.ac.in> Cc: "Ar Cdn" <arcdn@admin.iitd.ac.in> Kind Attn: All Faculty and Staff Members Dear Sir/Madam, The committee constituted under the Chairmanship of Prof.V.K.Agarwal with Head, Hospital Services, AR I/C (Accounts) and AR(SS), Health Unit as Members had a meeting with M/s Vipul, TPA regarding the process flow chart, timeline for various transactions/settlements etc. As advised by the Committee, M/s Vipul has submitted a PPT File containing the Process Flow Chart, Timeline for Cashless processing and reimbursements etc. in connection with the medical insurance policy of the Institute with National Insurance Company. The document received from M/s Vipul, TPA is provided in the following link for the kind information and knowledge of all the beneficiaries. Link: For any further information/details, the following representatives of M/s Vipul may kindly be contacted. Mr. Ashwani : Mr. Omkar Gupta : Thanking you Yours sincerely, N. Bhaskar Assistant Registrar (SS) Coordination Section & Health Unit IIT Delhi.
2 IIT DELHI CLAIM PROCESS
3 CASHLESS PROCESS IN CASE (SINGLE CLAIM)cashless is more than 2 Lac and less then 3 lasc (How to avail cashless) Employee/ attendant need to contact the hospital prior to His/ Her Admission and provides Pre-authorization request form to VIPUL MED COPR through Hospital TPA help centre with Vipul ID, photo ID and past treatment record. Employee approaches the nearest network hospital and follow the same process as per planned hospitalization Cashless is extended in two portions - Initial Approval at the time of admission which shall be between % of the requested amount and balance at the time of discharge as per T&C of the policy. At the time of Discharge from Vipul shall approve the final discharge /Bill within 2-3hours after the receipt of the final bill and discharge summary from the hospital. In case there is bill amount more than 2 lac s the rest amount will be processed within 1more additional hour from Buffer (2+1) The hospital may ask for a security deposit at the time of admission that would be adjusted at the time of discharge. In case any delay contact Mr. Omkar /Ashwani
4 CASHLESS PROCESS IN CASE (SINGLE CLAIM) cashless is more than 3 Lac and less then 5Lacs (How to avail cashless) Employee/ attendant need to contact the hospital prior to His/ Her Admission and provides Pre-authorization request form to VIPUL MED COPR through Hospital TPA help centre with Vipul ID, photo ID and past treatment record. Employee approaches the nearest network hospital and follow the same process as per planned hospitalization Cashless is extended in two portions - Initial Approval at the time of admission which shall be between % of the requested amount and balance at the time of discharge as per T&C of the policy. At the time of discharge In case total bill is more than 3 lacs and credit approval is required then we require a confirmation from Mr. Bhaskar IIT about the credit approval and after confirmation from IIT final approval will be done in 2-3hours. THE CRADIT APPROVAL IS ONLY APPLICABLE IF IT IS A SINGLE CLAIM AND CLAIM AMOUNT IS HIGH
5 CASHLESS PROCESS IN CASE SINGLE CLAIM AND AMOUNT IS MORE THAN 5 LAC THE EMPLOYEE HAS TO SUBMIT THE REST OF BILLS TO IIT WITH THE COPY OF APPOVAL LETTER FROM VIPUL
6 CASHLESS PROCESS IN CASE (Multiple Claims) cashless is more than 2 Lac and less then 3Lacs (How to avail cashless) Employee/ attendant need to contact the hospital prior to His/ Her Admission and provides Pre-authorization request form to VIPUL MED COPR through Hospital TPA help centre with Vipul ID, photo ID and past treatment record. Employee approaches the nearest network hospital and follow the same process as per planned hospitalization Cashless is extended in two portions - Initial Approval at the time of admission which shall be between % of the requested amount and balance at the time of discharge as per T&C of the policy. At the time of Discharge from Vipul shall approve the final discharge /Bill within 2-3hours every time after the receipt of the final bill and discharge summary from the hospital. I The hospital may ask for a security deposit at the time of admission that would be adjusted at the time of discharge.
7 CASHLESS CLAIM MORE THAN 3 LACS AND THERE ARE MULTIPLE CLAIMS THE EMPLOYEE WILL SUBMIT THE CLAIMS TO IIT WITH A LETTER FROM VIPUL CONFIRMING ABOUT THE SUM INSURED+BUFFER EXHAUSTE (The settlement letter will be issued within 15 days after settlement of all bills up to 3lacs).
8 CASHLESS PROCESS IN CASE MULTIPLE CLAIMS AND AMOUNT IS MORE THAN 3 LACS THE EMPLOYEE HAS TO SUBMIT THE REST OF BILLS TO IIT WITH THE COPY OF LETTER FROM VIPUL CONFIRMING ABOUT THE SUM INSURED+BUFFER EXHAUSTE (The settlement letter will be issued within 10 days after settlement of all bills up to 3lacs)
9 REIMBURSEMENT CLAIMS (SINGLE)PROCESS MORE THAN 3 LACS IN CASE THE CLAIM IS MORE THEN 3 LACS THEN VIPUL WILL SETTLE THE CLAIM UPTO 3LAC WITHIN 20 DAYS AND ON THE REQUEST OF INSURED VIPUL WILL ISSUE A SETTLEMENT LETTER WITH COPY OF DOCUMENT WITH IN 10 DAYS.
10 REIMBURSEMENT CLAIMS (MULTIPLE)PROCESS UPTO 3 LACS Process will remain same as per singe claim up to 3 lacs but in case more that 3 lacs employee will submit the claims directly to IIT with a letter of SI+ Buffer exhaust.
11 PRE& POST HOSPITALIZATION THE PROCESS WILL REMAIN SAME AS PER REMBURSMNET PROCESS. THE PRE& POST WILL BE ONLY SETTELED AFTER SETTLEMET OF MAIIN CALIM.
12 DOCUMENTS CHECK LIST FOR REIMBURSEMENT CLAIM Hospitalization :- Type of document Pre-/Post hospitalization:- Type of document Claim Form Duly Signed with ID poof(voter ID, Pan, driving license, Addhar card passport. Bank detail of salary account/ pension account only. Duly signed & filled claim form Bank detail of salary account/ pension account only. Dr. Prescription/ Note- letter Original Discharge Summary Original final bill Photocopy of discharge summary All relevant investigation reports in original [along with film All relevant original prescription supported by bills incurred for medicine, investigation & consultation (As applicable) Original break-up of final Bill All the bills/receipts should be in original with advising. All relevant investigation reports in original along with film (if applicable) Others specific document Original payment receipts against the final bill In case of Cataract (IOL) sticker/price of IOL/ In case of maternity (Antenatal card) In case of accident ( MLC/FIR) copy/ Sticker in case any implants Others specific document
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