GMC Policy (2017)
Policy Parameters Insurer TPA Policy Coverage Family Floater: Sum Insured UNITED INDIA INSURANCE COMPANY LIMITED Vipul MedCorp Insurance TPA Pvt. Ltd. Policy covering Employee (Self) + Spouse + 2 Children + Parents The Sum Insured per family is on 'Floater' basis INR 3Lacs, INR 3.5 Lacs, INR 4.5 Lacs Claim Intimation 48 hrs. before admission and 24 hrs before discharge, for both cashless and reimbursement Claim Submission Within 30 days from the date of discharge
What All is Covered The Policy provides financial assistance to your family against Hospitalization Expenses towards disease/illness/injury in India along with host of value additions/options. The Hospitalization claim will be passed, when it fulfils the following conditions: Claim Arising during the policy period (01/01/2017 to 31/12/2017) Treatment taken in a registered HOSPITAL or NURSING HOME The admission in a hospital is medically justified Duration of hospitalization and justified treatment is more than * 24 Hrs. (*Except for a few listed Day Care procedures wherein 24 hr. hospitalization is not required)
Policy Coverage Standard Hospitalization Maternity Pre-post Natal Covered Covered as INR 50000 for Normal & C-sec Covered for Hospitalization cases only Day care Treatment Covered Pre 30 Days & Post 60 Days Hospitalization Covered Baby Cover Baby Day 1 : Covered within Family SI Baby Expenses : Up to Discharge within Maternity Limit
DAY CARE PROCEDURES Expenses on Hospitalizations for minimum period of 24 hours are admissible. However this time limit will not applicable for specific treatments i.e. 1. Adenoidectomy 19. FESS 2. Appendectomy 20. Haemo dialysis 3. Ascitic/Pleural tapping 21. Fissurectomy/Fistulectomy 4. Auroplasty 22. Mastoidectomy 5. Coronary angiography 23. Hydrocele 6. Coronary angioplasty 24. Hysterectomy 7. Dental surgery 25. Inguinal/ventral/umbilical/ Femoral hernia 8. Dilatation & Curettage 26. Parenteral chemotherapy 9. Endoscopies 27. Polypectomy 10. Excision of Cyst/Granuloma/lump 28. Septoplasty 11. Eye surgery 29. Piles/fistula 12. Fracture/dislocation excluding hairline fracture 30. Prostate 13. Radiotherapy 31. Sinusitis 14. Lithotripsy 32. Tonsilectomy 15. Incision and drainage of abcess 33. Liver aspiration 16. Colonoscopy 34. Sclerotherapy 17. Varicocelectomy 35. Varicose Vein Ligation 18. Wound suturing
Policy Coverage Room Rent Limit (Per day) INR 4000 for sum insured of INR 3 lac and INR 3.5 lacs INR 5000 for sum insured of INR 4.5 lacs Not applicable for ICU cases Ambulance charges INR 2000 per claim Pre existing disease Covered Waiver First 30 Days exclusions, first 1 and 2 year exclusion Other Coverages Terrorism and epidemic coverage Infertility Coverage (for IVF only) upto INR 50,000
Reimbursement of expenses related to Room and boarding Doctors fees Intensive Care Unit Nursing expenses Surgical fees, operating theatre, anaesthesia and oxygen and their administration Physical therapy Drugs and medicines consumed on the premises Hospital miscellaneous services (such as laboratory, x-ray, diagnostic tests) Dressing, ordinary splints and plaster casts Costs of prosthetic devices if implanted during a surgical procedure Radiotherapy and chemotherapy Organ transplantation charges
LIST OF NON PAYABLE ITEMS Toiletries/cosmetics/ personal comfort or convenience items Elements of room charge Administrative or non-medical charges Administrative expenses
STANDARD EXCLUSIONS (NOT COVERED) OPD Expenses Physiotherapy treatment on OPD basis Dental expenses unless Hospitalization under the influence of drugs/alcohol External Congenital disorder, convalescence, general debility Any hospitalization for observation/investigation Plastic Surgery or any treatment/surgery related to beautification All expenses arising out of any condition caused/ associated with HIV/AIDS / LAV or HTLV-III. Intentional self injury and use of intoxication drugs / alcohol Expenses on Vitamins and Tonics, Vaccination or inoculation Cost of spectacles, contact lenses and hearing aids. Referral fee to the doctor, outstation expenses Registration charge /Personal Comfort charge Obesity treatment and its complications including morbid obesity treatment relating to all psychiatric and psychosomatic disorders Circumcision expenses unless necessary for treatment of any disease. Medical termination of pregnancy will not be paid unless a case of emergency.
Cashless Process IN CASE OF PLANNED HOSPITALISATION IN CASE OF EMERGENCY HOSPITALISATION Intimate TPA prior to Admission and provide Preauthorization request form through Hospital Approach nearest network hospital and submit ID card and send pre-auth request form within 24 hours of admission TPA extends cashless if all information provided, else raises relevant document / medical query and on receipt of relevant query reply extends cashless subject to T&C of policy within 1-2 hours after the receipt of the requisite papers. Validity is 10 days. Cashless extended in two portions - Initial Approval at the time of discharge sent in the range of 50-70 % of requested amount. Balance at the time of discharge At the time of Discharge from the hospital Insured/attendant to the patient signs the Discharge Summary Final Bill and also pays for the non payable items as per the policy and leaves the all the originals at the hospital. Vipul shall approve the final discharge /Bill within 2 hours after the receipt of the final bill and discharge summary from the hospital. The hospital may ask for a security deposit at the time of admission that would be adjusted at the time of discharge after deducting for the non-payable items
Reimbursement Process Claim Submission: Within 30 days after discharge Claim verified by TPA Doctor within 7 working days after the receipt of the claim documents. Query sent to the insured and after the receipt of the query reply again sent for Doctor processing Yes Query No Financial settlement of the Claim within 5 working days after doctors processing If the query reply is not submitted even after 3 reminders (every reminder sent after 15 days) the claim shall be closed and shall opened only after it is condoned by the insurer AUDIT Verification NEFT Issuance within 2 days after the receipt of claim
Claim Intimation Online : http://www.vipulmedcorp.com/ > Claim intimation (left side menu options) Email : gi@vipulmedcorp.com SMS/Call : Vipul SPOC In email/sms, please share the patient name, Vipul ID no., Hospital name, date of admission
Other Client Assistant Service: IVR Service 24/7 IVR based call center : The call center can be accessed for assistance and real time query resolution. We also back this up with 24/7 mobile helpline at all locations.
Vipul MedCorp Interactive Voice Response (IVR) Insured can dial Vipul MedCorp Toll free No (1800-102-7477) or 27x7 call Centre (0124-4833900 (100 lines ),which is on Interactive Voice response (IVR) System & they can Punch their Numeric card number. For Corporate clients, the system will give a welcome message with corporate name & employee can access following details : Claims ( Intimation / Settlement ) Cashless (Approval) Enrollment (Re-print / dispatch) Retail Insured can directly access the above on IVR
Relationship Matrix Primary Contact for All Services: Mr. Abhishake Bahl Escalations Level 1 : Name Designation Mobile No. Email ID Relationship Manager- Corporate 9311986332 abhishakebahl@vipulmedcorp.com Name Designation Mobile No Email ID Mr. Mukesh Kapoor AGM- Corporate 9599598885 mukeshkapoor@vipulmedcorp.com Escalations Level 2 : Name Designation Direct No Mobile No Email ID Mr. Anil K.G Escalations Level 3 : AGM - Operations 0124-4629805 9311986346 anilkg@vipulmedcorp.com Name Designation Direct No Email ID Mr. Pawan Choube Dy. CEO 0124-4629802 pawanchoube@vipulmedcorp.com
Branch Contacts Branch No. Primary Contact Designation Mobile No. Email ID Hyderabad Mr. Sai Prasad Branch Manager 9849667956 saiprasad@vipulmedcorp.com Kolkata Mr. Abu S Salim Operation Manager 9378178896 abusalim@vipulmedcorp.com Mumbai Mr. S. Swain Branch Manager 9323446630 swain@vipulmedcorp.com Pune Mr. Sabbyasachi Asst. Manager 7757041659 nsppune@vipulmedcorp.com Chennai Dr Hari Dy Manager 9566777297 headnwchennai@vipulmedcorp.c om Bangalore Harish Asst. Manager 9342569214 blrservice3@vipulmedcorp.com
Marsh Contact Details Levels Name Mobile No. Email ID 1st level Mr Manish pundhir 8377907994 manish.pundhir@marsh.com 2nd Level Mr Sumeet Pallav 0124 4149259 Sumeet.Pallav@marsh.com