FAQs. (8). What is the helpline number for FHPL? The toll free helpline number for FHPL is

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1 FAQs (1). New -Mobile Sparrow? Application which helps employee to check details on smart phone. Member can download the Mobile App Software online on to the smart phone using the link available on the E-card page. Please log onto the E-card page and click the link to download and user name and password will be same which is been used for E-cards. (2). Who all are covered under the insurance policy and what is the total coverage amount? The policy provides coverage for a family of 1+3 Members only Employee + Dependents (Any =Spouse, 2 dependent Children or Parents). New member can be added only subject to availability of the slot. (3). What are the services offered by FHPL to its beneficiaries? FHPL is the service provider for required Health care service to corporate through its activities like - Cashless services at over 3100 Network Hospitals, Member Reimbursement facility for Non-Network hospitals, Personalized client servicing, Enrollment and Claims administration. (4). How different is FHPL from Health Insurance Company? FHPL is a Third Party Administrator (TPA) in health Insurance Sector servicing all subsidiaries of all Insurance Companies. Group Mediclaim Policy of Insurance Companies is the basic product on which FHPL adds its value-addition like network of hospitals, medical care standardization, claims management, client servicing expert opinion etc. Thus FHPL administers a `healthcare package' for its clients with customized healthcare delivery. (5). What does an Insurance Policy cover? Is maternity covered under Insurance Policy? The policy is with through Oriental Insurance Company Limited (OIC) and coverage is for In-patient hospitalization with both network and out of network hospitals for various diseases. Maternity is covered under the corporate policy up to INR 50,000/- per delivery restricted to 2 children. (6). Are emergencies / ailments that happen on overseas trips covered by FHPL? No. FHPL has arrangement only with the Indian insurance companies. These companies do not extend cover outside India; Separate Policy needs to be taken. (7). Whether day care treatments covered under the insurance policy? There are a few day care treatments covered under the policy where 24 hours hospitalization is not mandatory. These are Dialysis, Chemotherapy, Radiotherapy, Cataract, Lithotripsy, D & C, Tonsillectomy, Hysterectomy, Coronary Angioplasty, Coronary Angiography, Surgery of Gall Bladder, Surgery of Hernia etc. for more details contact HelpDesk personnel of FHPL. (8). What is the helpline number for FHPL? The toll free helpline number for FHPL is (9). What are the timings for the FHPL Helpline? The dedicated FHPL helpline is accessible 24/7

2 (10). Is there a mail id where the associates can write to FHPL? Yes, associates can write to info@fhpl.net (11). Whom to contact for any queries regarding E-Card access? What if I forget my user id and Password? Please write to info@fhpl.net (10). How do I access and print my E-Card? Please follow below mentioned steps to access your E-Card and other information regarding your mediclaim policy: E-Card Access: E-Cards will be available online for all the covered associates and their dependents. Please follow these simple steps to download / print the same: Step 1: Log on to FHPL website Step 2: Click on Ecard Login. Step 3: Key in the Corporate ID, User ID and the Password. Step 4: Click on the name of the member to view e-card. Corporate ID: User Name: EMP ID NO Password: «As shared via mail» For Printing of E-Card Select 'Tools' on the Internet Browser Go to 'Internet Options' Go to 'Advanced' Check printing with back ground and Colors The Card can be printed in B/W or Color (11). How do I check my Claim status. Details of all claims, which are submitted to FHPL for the current policy period can be accessed through employee ecard login ( an associate can check the claim status and also other essential details which is send to you via mail. (12).Where can the member avail the required services? Member can avail Cashless facility at the Network Hospitals. In case member gets admitted in any Non - Network hospitals within India then the member has to make the payment to the hospital and have to submit the original bills along with complete documents at FHPL help desk for reimbursement. (13).What is a Network Hospital? A Network Hospital includes all hospitals, nursing homes, clinics and other healthcare providers accredited and intimated to the Member Organization by FHPL from time to time, to deliver hospitalization facility. (14). How does claim process work for a network hospital?

3 When you are admitted to the network hospital you need to show the FHPL Card to the treating doctor. The Network Hospital would contact the responsible TPA (Third Part Administrator, mentioned on the card i.e., FHPL) and fill up the preauthorization form. Then it would send the same to TPA with estimation of expenses. The TPA checks the policy conditions and sum-insured and approves the estimate. Associate has to pay only non admissible expenses as stated, to the hospital, once the hospitalization is authorized by FHPL. FHPL settles the claim directly with the hospital. (15).Which is the list of network hospitals? FHPL network hospitals list is available in the FHPL website home page ( (16).What is a Non-Network Hospital? What are the basic criteria of a hospital for reimbursement in a Non-Network Hospital? It includes all hospitals that are not on the FHPL Network. Hospital should have a registration number, which should be mention on final bill and Discharge summary failing which claim cannot be processed. Note: Doctor s registration no will not work. We should get the hospital registration no. It s mandatory. Hospital means any institution in India (including nursing homes) established for Medical Treatment which: (i) Is under the constant supervision of a Medical Practitioner, and (ii) Has fully qualified nursing staff (that hold a certificate issued by a recognized nursing council) under its employment in constant attendance, and (iii) Maintains daily records of each of its patients, and (iv) Has at least 15 Inpatient beds, and (v) has a fully equipped and functioning operation theatre. (vi) Has valid hospital / nursing home registration number. (17). How does the claim process work for Non Network hospitals for both planned and emergency hospitalization? Associate has to intimate to FHPL within 48 hrs of admission and take the unique intimation ID at that time. Associate has to make upfront payment at the hospital and submit all bills within 30 days from the date of discharge. The documents that need to be submitted are: - Claim Form of Oriental Insurance Company Limited duly filled and signed by claimant. FHPL ecard copy of the patient Any Govt. ID proof of the patient A crossed cheque of the employee (If name is not mention on the cheque, Please write your name and sign it ) Original detailed discharge summary with hospital seal and doctor signature. Original investigation reports along with bills Original Hospital Bill-consolidated and with detail breakup with hospital seal and signature of hospital authority. (Advance paid receipt needed if any) Original printed Payment receipt of hospital bill In case of surgical packages detail breakup of the package. Original Medicine bills with prescriptions Letter stating the bed capacity and registration no of the hospital.

4 FHPL will scrutinize the documents for completeness. Once the documents are complete, payment will be made directly to the associate within 25 working days. Note: Please do retain the photocopy of entire documents for your future reference. In case we (FHPL) require any further documents to process the claim, a mail communication (IR Pending) would be sent to the associate with the list of documents required. The claim would be processed up on receipt of such documents. (18).Is cashless facility available at all the hospitals? The cashless facilities are available only at the hospitals which are on FHPL network. (19).Are all the major corporate hospitals on network? Most corporate hospitals are part of our network. (20).Will I get cashless at government institutions like AIIMS/TMH/ARMY Referral hospitals? No, this facility does not extend to government hospitals. (21). How can I add my newly married spouse or new born child under the insurance policy and what is the total coverage amount? The addition can be possible if the employee has any slot empty for a dependent to be added. For example as the coverage is for 1+3, the member won t be able to add the members if the entire slot are full. He would need to keep the slot empty to add the dependent. New member can be added only subject to availability of the slot. The coverage will be given up to the sum insured. Example: If employees already have his wife and parents (father & mother) covered then he cannot add his new born baby as the slot is full for addition and new born baby will not be covered. If incase if he has enrolled only wife and father only or mother only then he can add the child (22).What is Pre existing disease? Pre Existing ailments such as diabetes, hypertension, etc or related ailments for which care, treatment or advice was recommended by or received from a Doctor or which was first manifested prior to the commencement date of the Insured Person s first Health Insurance policy with the Insurer. (23).What is 1 st Year Exclusion? During the first year of the operation of the policy the expenses on treatment of diseases such as Cataract, Benign Prostatic, Hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital Internal diseases, Fistula in anus, Piles, Sinsutitis and related disorders are not payable. If these diseases are pre-existing at the time of proposal they will not be covered even during subsequent subsequent period or renewal too. (24).What is Pre-Post Hospitalization Expenses? Pre and Post hospitalization expenses - covered for all relevant medical expenses incurred 30 days prior to hospitalization and expenses incurred during 60 days after hospitalization. By RELEVANT EXPENSES we mean all expenses pertaining to the disease for which he/she is hospitalized, prior to hospitalization or after discharge. For Example: A person maybe required to undergo certain tests to confirm the disease for which he is eventually hospitalized. The Doctor's consultation fees for this, the expenses on tests and medicines 30

5 days prior to hospitalization for that particular disease are covered. RELEVANT EXPENSES for post hospitalization 60 days after being discharged from the hospital, e.g. the subsequent follow up consultations with specialists, medicines and test expenses are covered. (25).What are the pre hospitalization formalities that an associate needs to complete to avail of cashless transactions for a planned hospitalisation in a network hospital? Associate needs to approach a network hospital at least 7 days in advance of the admission to the hospital with the FHPL Ecard. The advance notice may be reduced depending on the criticality of the situation and on case to case basis. The network hospital approaches FHPL for authorisation. FHPL authorises the treatment and employee gets to know about it through the hospital / FHPL helpline/fhpl representative. (26).What is Maternity benefits coverage? The maximum benefit allowable will be Rs.50,000/- for both normal delivery as well as C-section within the Sum Insured limit, max up to 2 children. The new born baby is covered only if additional slot is employee under the Insurance. There are special conditions applicable to the Maternity Expenses Benefits as below: These benefits are admissible only if the expenses are incurred in as in-patients. Hospital/Nursing Home Claim in respect of delivery for only first two children and/or operations associated therewith will be considered in respect of any one Insured Person covered under the Policy or any renewal thereof. Those Insured Persons who already have two or more living children will not be eligible for this benefit. (27).What are the list of diseases covered in the policy? As the lists of diseases covered in the policy are exhaustive, in case of any specific query, please write to info@fhpl.net with the details of diagnosis and treatment for confirmation, subject to policy terms and conditions. (28).List of Standard exclusions of the policy. 1. War or any act of war, invasion, act of foreign enemy, war like operations (whether war be declared or not or caused during service in the armed forces of any country), civil war, public defence, rebellion, revolution, insurrection, military or usurped acts, nuclear weapons/materials, chemical and biological Weapons, radiation of any kind. 2. Any Insured Person committing or attempting to commit a breach of law with criminal intent, or intentional self injury or attempted suicide while sane or insane. 3. Any Insured Person s participation or involvement in naval, military or air force operation, racing, diving, aviation, scuba diving, parachuting, hang-gliding, rock or mountain climbing. 4. The abuse or the consequences of the abuse of intoxicants or hallucinogenic substances such as intoxicating drugs and alcohol, including smoking cessation programs and the treatment of nicotine addiction or any other substance abuse treatment or services, or supplies. 5. Treatment of Obesity and any weight control program.

6 6. Psychiatric, mental disorders (including mental health treatments); Parkinson and Alzheimer s disease; general debility or exhaustion ( run-down condition ); congenital internal or external diseases, defects or anomalies; genetic disorders; stem cell implantation or surgery; or growth hormone therapy; sleep-apnoea. 7. Venereal disease, sexually transmitted disease or illness; AIDS (Acquired Immune Deficiency Syndrome) and/or infection with HIV (Human immunodeficiency virus) including but not limited to conditions related to or arising out of HIV/AIDS such as ARC (AIDS related complex), Lymphomas in Brain, Kaposi s sarcoma, tuberculosis. 8. Pregnancy (including voluntary termination), miscarriage (except as a result of an Accident or Illness) 9. Sterility, treatment whether to effect or to treat infertility; any fertility, sub-fertility or assisted conception procedure; surrogate or vicarious pregnancy; birth control, contraceptive supplies or services including complications arising due to supplying services. 10. Dental treatment and surgery of any kind, unless requiring Hospitalization. 11. Expenses for donor screening, or the treatment of the donor (including surgery to remove organs from a donor in the case of transplant surgery). 12. Treatment and supplies for analysis and adjustments of spinal subluxation; diagnosis and treatment by manipulation of the skeletal structure; muscle stimulation by any means except for treatment of fractures (excluding hairline fractures) and dislocations of the mandible and extremities. 13. Treatment of nasal concha resection; circumcisions (unless necessitated by illness or injury and forming part of treatment); laser treatment for correction of eye due to refractive error; aesthetic or change-of-life treatments of any description such as sex transformation operations, treatments to do or undo changes in appearance or carried out in childhood or at any other times driven by cultural habits, fashion or the like or any procedures which improve physical appearance. 14. Plastic surgery or cosmetic surgery unless necessary as a part of medically necessary treatment certified by the attending Medical Practitioner for reconstruction following an Accident, Cancer or Burns. 15. Experimental, investigational or unproven treatment, devices and pharmacological regimens; measures primarily for diagnostic, X-ray or laboratory examinations or other diagnostic studies which are not consistent with or incidental to the diagnosis and treatment of the positive existence or presence of any Illness for which confinement is required at a Hospital. 16. Convalescence, cure, rest cure, sanatorium treatment, rehabilitation measures, private duty nursing, respite care, long-term nursing care or custodial care. 17. Any non allopathic treatment. 18. All preventive care, vaccination including inoculation and immunisations (except in case of post- bite treatment); any physical, psychiatric or psychological examinations or testing; enteral feedings (infusion formulae via a tube into the upper gastrointestinal tract) and other nutritional andelectrolyte supplements, unless certified to be required by the attending Medical Practitioner as a direct consequence of an otherwise covered claim.

7 19. Charges related to a Hospital stay not expressly mentioned as being covered, including but not limited to charges for admission, discharge, administration, registration, documentation and filing. 20. Items of personal comfort and convenience including but not limited to television (wherever specifically charged for), charges for access to telephone and telephone calls, internet, foodstuffs (except patient s diet), cosmetics, hygiene articles, body care products and bath additive, barber or beauty service, guest service as well as similar incidental services and supplies, and vitamins and tonics unless vitamins and tonics are certified to be required by the attending Medical Practitioner as a direct consequence of an otherwise covered claim. 21. Treatment rendered by a Medical Practitioner which is outside his discipline or the discipline for which he is licensed; treatments rendered by a Medical Practitioner who shares the same residence as an Insured Person or who is a member of an Insured Person s family, however proven material costs are eligible for reimbursement in accordance with the applicable cover. 22. The costs of any procedure or treatment by any person or institution that We have told You (in writing) is not to be used at the time of renewal or at any specific time during the policy period. 23. The provision or fitting of hearing aids, spectacles or contact lenses including optometric therapy, any treatment and associated expenses for alopecia, baldness, wigs, or toupees, medical supplies including elastic stockings, diabetic test strips, and similar products. 24. Any treatment or part of a treatment that is not of a reasonable charge, not medically necessary; drugs or treatments which are not supported by a prescription. 25. Artificial limbs, crutches or any other external appliance and/or device used for diagnosis or treatment (except when used intra-operatively). 26. If Admission is only for medical test with oral medicines, it will not be covered, even if hospitalization is for 24hrs. (29).List of critical illness covered in the policy. The critical illness like Cancer, Coronary Artery (Bypass) surgery, Heart Attack, Kidney failure (End Stage renal Disease), Major Organ Transplantation, Multiple Sclerosis, Paralysis, and Stroke would be covered subject to policy terms and conditions. (30).Does a member needs a FHPL Card for cashless transactions? Yes, the member needs to have a FHPL E-Card for cashless transaction, also any government ID proof of the patient (31).When will the associate know if his/her request for cashless has been approved by the FHPL for coverage in a routine case? Associate can get a status on the same within 3 working hours of putting forward the request, also an alert would be sent on the employee's mobile number provided in the preauthorization form. (32).Do we need authorization from FHPL for cashless treatment? Yes, Authorization is required from FHPL for cashless treatment. (33).The Insurance Company is not giving cashless approval for treating an illness, why? And how can the same be resolved. The Insurance Company goes by the information furnished in the preauthorization form filled by the treating doctor or the doctor of the hospital, if the information provided by them does not qualify for a cashless facility as per the policy terms and conditions the preauthorization request will be rejected.

8 If some additional information is sought by the Insurance company or TPA kindly work with your treating doctor to furnish the additional information that may be required so that the Doctors at the Insurance Company / TPA may evaluate and take a necessary decisions and communicate as per the policy terms and conditions. (34).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: Registration/Admission charges Attendant/Visitor passes charges Special nursing charges not authorized by the attending doctor Service charges not forming a part of the room rent Charges for extra bed for attendant etc. Bed retaining charges Charges for TV, Laundry etc. Telephone/Fax charges Food and Beverages Toiletries etc. Purchase of Medicines not related to the treatment Medical records fees, Stationery, Xerox or certifying charges. Service Tax / Luxury Tax Medicines not related to treatment Medical kits not part of treatment Administration Charges The above list is only indicative. (35).Will I get cashless treatment for any kind of ailment in the hospital by showing FHPL Card? Presenting the ID card can facilitate treatment in the hospital, but does not guarantee cashless facility / reimbursement. It depends on the nature of illness and plan of the treatment. (36).Will all ailments be covered by the policy? Each corporate policy is different and the TPA medical panel would go through the details and approve accordingly. There are certain norms laid down by Govt. of India and those have to be adhered by the hospital and by FHPL. For more call our toll free no. (37).Are vaccinations covered under the policy? Vaccinations are not covered. (38).Are accidents related to drink and drive cases covered under the policy Accident related to Drink & Drive cases are not covered. (39).I got some Ayurvedic/ Naturopathy treatment done; will it be covered under the Policy? Ayurvedic/ Naturopathy treatment will not be covered under the Policy (40).I bought some tonics which were advised to me by the doctor, for my stomach. Will it be covered under the policy? Expenses on Vitamins and tonics unless forming part of hospitalization treatment will not be covered under the policy. (41).Will there be any payments or out of pocket expenses to be made to hospitals and how are they adjusted? Some hospitals ask for advance to be deposited at the time of admission, but

9 Before the cashless are approved by us. It is generally refunded back by the hospital once cashless is approved. Special expenses like telephone bills, extra bed, food and beverages for visitors, tests or medicines which are not part of line of treatment are to be borne by the insured and will be part of out of pocket expenses. (42).In how many days does FHPL process the claim? FHPL processes the claims within 25 working days from putting forward the claim. (43).If my documents are incomplete would FHPL still process my claim in 15 working days? FHPL will not be able to process the claim unless and until all the required documents are submitted. (44).What are the documents that an associate needs to submit for the 30 Days pre & 60 Days Post hospitalization expenses claims? Associate needs to submit in original: 1.Claim Form of OIC. 2. Original investigation reports along with bills & prescriptions. 3. Consultation bill/receipt along with the consultation letter. (Need to know what the advice was given by the doctor during the visit to the doctor. If consultation letter is not enclosed then the consultation bill is not payable) 4. Medicine bills with prescriptions. 5. A crossed cheque of the employee (If name is not mention on the cheque, Please write your name and sign it ) (45).Are any external Implants covered under the policy? Cost of Spectacles, crutches or any external implants are not covered. (46). Are dental treatment costs a part of the policy? There is no Dental Coverage except in case of a Road traffic accident, which warrants hospitalization & requires surgeries under general anesthesia with MLC & FIR needed. (47). Will cosmetic surgeries be covered under the policy? Any kind of Cosmetic Surgery will not be covered. (48).Although I was well after my treatment in a hospital, the doctor advised me to stay in the hospital for observation for 1 day. Will it be covered under the policy? Investigation, evaluation & observation will not be admissible, even if hospitalization is for more than 24 hrs or for extra day stay. (49). How long does an associate/dependant need to be hospitalized for in order to claim for hospitalization benefit? An associate / dependant needs to be in the hospital or hospitalized for a minimum for 24hrs and active line of treatment to be given by doctor in order to claim for hospitalization benefit. (50).In case of associate transfer to another location is there any procedure involved to continue the scheme? Change of location with in India does not affect the operation of our Policy scheme, as our Network is countrywide. However, if there is a change in the employment, this may affect the continuity. FHPL's contract is primarily with the corporate employer and not with any individual associate or his/her family. Hence on termination of employment, an associate ceases to be a member of the FHPL; Enrollment is a continuous function all through the year. Hence the employers are expected to provide us with the list of additions (recruitments) and deletions (resignations/ terminations) periodically. (51).Will location of dependent Family member affect in availing services under FHPL?

10 No, location does not affect the operational activities, main member or the dependant member can avail equal benefits irrespective of their location. FHPL's Network hospitals are across the country. FHPL has accredited over 4000 healthcare providers so far and these accredited healthcare providers would assure qualitative healthcare delivery to FHPL members and FHPL proactively monitors and reviews the outcomes of its network. (52). Will the change in names/age/gender in between policy period matters? Yes, according to the Insurance Company the claim will not be settled (unless prior intimation to FHPL and Insurance company) if there is any alterations in the name on bills / reports (documents) submitted by member / hospital. In case of any correction in name / age / gender, a mail request has to be sent to FHPL by the associate. (53).Within how many days the claim documents needs to submit to FHPL? Claim documents should be submitted FHPL within 20 days from the date of discharge from the hospital. More than 30 days the claim will not be payable. (54).In case of partial settlement of claims, can the member claim for the balance by producing the required documents? Yes, but only eligible amount as per the terms and condition of the policy shall be paid. The member has to quote the claim id & UHID (Each insured member is allocated Unique Health ID, which will help FHPL in identifying the member details) for such resettlement. (55).What is the mode of payment for my reimbursment claim? Payment is done through NEFT. (56).Are there chances of 'claim rejection'? Claims can be rejected under the following conditions: 1. Less than 24 Hrs hospitalization. 2. Admission only for investigations & evaluations. Imp Note: If the patient is unwell, taken to the hospital for checkup and the doctor advice to get hospitalized, please be careful. Some hospital are making patient hospitalized for 24hrs and during the stay in hospital only medical test are done with oral medication given to patient. For this treatment hospitalization is not needed and these cases will be rejected. Kindly please check the need of hospitalization and do not get carried away. If admissions / treatment don t fall under the policy terms & conditions the claim gets rejected. (57).If I have not utilized my permissible eligibility amount in a particular policy period will I get any benefits like carry forward for the next period if I renew the policy? The Health insurance policy is valid for a period of one year. This amount cannot be carried forward to subsequent period. (58)In the event of an emergency what should a FHPL member do? The member should immediately approach one of the Network hospitals or can go to the nearest hospital/clinics/nursing home for immediate medical attention. Later the patient can be shifted to nearest network hospital for cashless treatment or can continue at the same hospital and can submit the documents for reimbursement. Please check FHPL website: for the Network Provider List.

11 (59).What all information can be obtained from the FHPL representative? Following Information can be obtained from the FHPL representatives 1) Information on Network Hospitals. 2) Protocols of admission to Network Hospitals. 3) Claim Eligibility and Status of claims / enrollment. 4) Claim Documentation support and query handling. (60). Do we need to intimate about the hospitazation? Yes when ever any dependent that is covered under Insurance get hospitalized, he or she should intimate the TPA on the same. FHPL will intake give you can intimation no which needs to be written on the claim form while coming for reimbursement. In cases of reimbursement claim (PLANNED or Emergency Hospitalization), the employe should intimate 48 hours before the admission of the patient to FHPL TPA via writing mail to intimation@fhpl.net or by calling FHPL TPA would be providing an Intimation ID/number, which needs to be written on the claim at the time of Submission. --Thank You--