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Contents
Introduction Mediclaim Policy.3 Policy Terms & Conditions.3 Exclusion in the Mediclaim policy..4 Accommodation or Room Tariff & charges...5 Procedure for printing ID card6 Procedure for availing Cashless facilities...11 Procedure for Reimbursement of Hospitalization Claim14 Submission of Reimbursement Mediclaim form in SSC Website......16 Contact Details...30
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MEDICLAIM POLICY Mediclaim is a health insurance to cover medical costs incurred by an employee. Our health insurance policy is a contract between an Oriental Insurance Co. Ltd. and L&T in which the insurance company agrees to provide health insurance cover to its employees at a premium fixed by the insurance company. The policy is for a period of one year and can be renewed every year after paying the premium. The Insurance Company offers cashless as well reimbursement facilities through a Third Party Administrator (TPA) & for current policy period (1ST OCT 2012 30TH SEPT 2013) TPA is Dedicated Healthcare Systems (India) Pvt. Ltd. (DHS)
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Accommodation or Room Tariff & charges for Hospitalization: Employees are required to adhere to the Type of Room as applicable to their cadre, Subject to the Maximum Limit of Room Tariff, since reimbursements will be made as per eligibility. Limits have been revised w.e.f 1st Oct 2010
Cadre & Grade S & E, A-5-0 to B-3-4 M1 A to C M2 A to C, 31, 32 M3 A to C, 33,20,21,22,23 M4 A & Above, 11, 12, 13
FOR L & T EMPLOYEES & L&T INFOTECH EMPLOYEES Tier II Cities Tier I Cities Pune, Bangalore, Delhi, Mumbai, Hyderabad, Surat, Kolkata, Baroda, Kochi, Type of Room Chennai Ahmedabad Economy class Room Twin sharing Room Twin sharing Room Single Room Deluxe Room 2500/2500/- to 3000/2500/- to 3000/5000/At actuals 2000/2250/- to 2500/2250/- to 2500/4000/At actuals
Tier III Cities Ahmednagar, Jamshedpur, Mysore, Vizag, Coimbatore 1500/2000/2000/3500/At actuals
FOR L & T FIANANCE EMPLOYEES Tier II Cities Pune, Bangalore, Hyderabad, Surat, Baroda, Kochi, Ahmedabad 2000/2250/- to 2500/2250/- to 2500/2250/- to 2500/4000/At actuals Tier III Cities Ahmednagar, Jamshedpur, Mysore, Vizag, Coimbatore 1500/2000/2000/2000/3500/At actuals
Cadre & Grade S&E M6 A & B M5 A & B M4 A & B M3 A & B M2 A, M1 B & Above
Type of Room Economy class Room Twin sharing Room Twin sharing Room Twin sharing Room Single Room Deluxe Room
Tier I Cities Delhi, Mumbai, Kolkata, Chennai 2500/2500/- to 3000/2500/- to 3000/2500/- to 3000/5000/At actuals
Cadre & Grade 4C 4A&B 3A&B 2C 2A&B 1 C & B & Above [Type text]
FOR L & T GENERAL INSURANCE CO. EMPLOYEES Tier II Cities Pune, Bangalore, Tier I Cities Delhi, Hyderabad, Surat, Mumbai, Kolkata, Baroda, Kochi, Type of Room Chennai Ahmedabad Economy class Room Twin sharing Room Twin sharing Room Twin sharing Room Single Room Deluxe Room 2500/2500/- to 3000/2500/- to 3000/2500/- to 3000/5000/At actuals 2000/2250/- to 2500/2250/- to 2500/2250/- to 2500/4000/At actuals
Tier III Cities Ahmednagar, Jamshedpur, Mysore, Vizag, Coimbatore 1500/2000/2000/2000/3500/At actuals Page 5
Cadre & Grade JB1C JB1 A & B JB2 A & B & C JB3 A & B & C JB4 A & B & C
FOR L & T INFRASTRUCTURE EMPLOYEES Tier II Cities Pune, Bangalore, Tier I Cities Delhi, Hyderabad, Surat, Mumbai, Kolkata, Baroda, Kochi, Type of Room Chennai Ahmedabad Economy class Room Twin sharing Room Twin sharing Room Single Room Deluxe Room 2500/2500/- to 3000/2500/- to 3000/5000/At actuals 2000/2250/- to 2500/2250/- to 2500/4000/At actuals
Tier III Cities Ahmednagar, Jamshedpur, Mysore, Vizag, Coimbatore 1500/2000/2000/3500/At actuals
Procedure for printing ID card is as under: STEP 1: First visit DHS site by internet address www.dhs-india.com
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STEP 2:
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STEP 3: Go to Log in Employee Number Enter your Employee number as LT with your P. S. No. without any gap in both the fields. For example if your Employee number is 20000954 then Your Login ID - LT20000954 Password - LT20000954
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STEP 4:
For very First login Screen for Change Password will appear. Change your password to proceed further. However please remember it forever.
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STEP 5:
Go to Members Home Screen will show your personal details. Click on ready to print (right hand bottom corner)
Your card will be displayed and you can take a print of the same. Cards will not be printed for dependants. Therefore in case of dependents claims please tell the hospital that DHS will honor the cashless arrangement on the basis of your card. Ecards for current year with new DHS I.D. No. are been already updated on DHS website. Note that your last year DHS cards & the Password stands deleted w.e.f. 1st Oct 2011.
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Cashless Hospitalization can be availed only at DHS network hospitals. To check whether the hospital is in network or not, please refer the guide book provided along with cards. Alternatively the list can also be viewed in website www.dhsindia.com as follows
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Once the city is selected the list of that city appears. If further bifurcation is required on the basis of area in the city then the same can also be selected.
Alternatively if a particular hospital required is to be located , then press CNTRL+F and enter part or full name of the hospital as shown below
Write the name of the hospital you want in the particular city.
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In case of planned Hospitalization 1) DHS Identity card should be presented at the hospital while approaching for the cashless facility. 2) Please approach the hospital well in advance for getting the approval from DHS before the admission of the patient. 3) The Hospital will submit a Cashless request form duly filled in to DHS. This Cashless request form will have to be signed by the treating doctor and must be stamped by the hospital 4) DHS will issue a Letter of Guarantee directly to the hospital, specifying the amount that can be expended by the hospital. 5) The employee can make an enquiry with the hospital as to whether the sanction is received before the patient gets admitted himself into the hospital. 6) The entire procedure will take a minimum of 6 8 hours. 7) In case the total Hospitalization expenditure is more than the amount authorized, the hospital will ask for further authorization from DHS, giving reasons for the increase, at least one hour before the patient is to be discharged. 8) Kindly note that the letter of guarantee is valid for a period of fifteen days from the date of its issue. An application will have to be made to DHS for renewal of letter of guarantee, if admission is postponed beyond fifteen days. Hospitals may take some deposits for non-payable expenses.
In case of Emergency Hospitalization DHS Identity card is E-Card print out should be presented at the hospital while approaching for the cashless facility. The Hospital will submit a Pre-certification request duly filled in to DHS. This pre- certification will have to be signed by the treating doctor and must be stamped by the hospital. DHS will issue a Letter of Guarantee directly to the hospital, specifying the amount that can be expended by the hospital. The entire procedure will take a minimum of 3 4 hours. In case the total Hospitalization expenditure is more than the amount authorized, the hospital will ask for further authorization from DHS, giving reasons for the increase, at least one hour before the patient is to be discharged.
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Although Cashless Hospitalization facility is available at the DHS network of hospitals, you may sometimes need to use hospitals that are not on the DHS network. In case you choose to or are required to avail of Hospitalization facilities at a non-network hospital, your medical expenses can still be claimed through DHS. This is called Reimbursement. Reimbursement claims may be filed in the following circumstances 1. Hospitalization at a non-network hospital 2. Post-Hospitalization and pre-Hospitalization expenses 3. Denial of preauthorization on application for cashless facility at a network hospital
Employees have to submit main Hospitalization claim within 7 days from the date of discharge & the claims for reimbursement of post Hospitalization expenses has to submit within 70 days from the date of discharge otherwise due to late submission claim will be rejected by the Insurance Company. Claim form is to be sent along with covering letter stating all the details of employee like OD name, Phone number, and email ID.
Claim Form has to be properly filled in and signed by the Claimant. Claim form is available in SSC website. Original Discharge Card / Summary from the hospital /nursing home with the details such as time in and time out, date of admission/operation/discharge date, diagnosis, previous history of the patient complaints / symptoms at the time of admission, noting of investigations done in-house, treatment given during Hospitalization and advice after Hospitalization. Doctor's consultation reports/history. Numbered and signed Hospital and other medical Bills, Receipts in original.(Bills/Receipts on letterhead are not acceptable) Cash Memos from hospital/ pharmacies supported by proper detailed break-up of hospital bills with original prescriptions. Item wise and cost wise breakup for charges shown in the bill for all the amounts, which includes more than one item.
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Diagnostic test reports in original supported by a note from the attending medical practitioner / surgeon justifying such diagnostics. Surgeon's certificate stating the nature of the operation performed and surgeon's bill and receipt. Attending doctor's / Consultant's / specialists / anesthetist's bill and receipt, and certificate regarding diagnosis. Certificate from the attending medical practitioner / surgeon that the patient is fully cured. Bills of surgical appliances, if purchased. In case of Accidental/fracture case, the Medico Legal Case (MLC) paper and letter from hospital / treating Doctor stating details of accident, alcohol or any intoxicating drugs history. Complete obstetric history in case of pregnancy / delivery. Intra Ocular lens (IOL) sticker showing serial number in case of Cataract Operation, If lens are expensive then invoice of lens from hospital. All Bills and prescriptions must have the name of patient and Doctor. All documents are to be attached date wise along with the Claim form.
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Submission of Reimbursement Mediclaim form in SSC Website: On Home page as shown in the given below screen shot we are having Employee Benefits icon, kindly click on same for lodging Employee reimbursement claims
Quick Links
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On Home page as shown in the given below screen shot we are having Employee Benefits icon, kindly click on same for lodging Employee reimbursement claims.
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Select Claim Type as MEDICLIAM & then click on New Claim to submit the claim intimation followed by the Oriental Hospitalization claim form for reimbursement.
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After saving the Mediclaim Intimation form, click on the check box of declaration & then click on Submit Intimation
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As soon as you click on Submit Intimation the below mentioned pop up will be displayed which states that now the Hospitalsation claim form need to be submitted. Click on OK
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As soon as you will click on OK then the Claim History page will appear. & then to fill the Hospitalsation claim form click on the link available on Claim number
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On this Mediclaim Submission you need to fill the Hospitalsation details. Some details will be directly picked up from the Claim Intimation form. On this page you need to fill the mandatory field marked by * Date of Detection, Expenses Incurred etc. Kindly fill the amount in the Expenses Incurred field only & let the Claim Amount field as blank. Then Click on SAVE
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After click on Save, the 2nd part of the claim form will appear which include - Schedule of Expenses : Click to update Expenses Incurred Once you click on this link the small window will appear as shown in 2nd snap shot. Make sure that the Total Amount & expenses incurred both has to be same. Note that any medicinal bill amounts you can put in point no. 2 Then click on Save & close
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Now click on Document check list Click for Check List Once you click on this link the small window will appear as shown in 2nd snap shot. Click on the check box Then click on Save & close
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Once the Claim forms entirely filled then click on the check box Then click on Submit Claim
under Declaration.
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As soon as you click on Submit Claim the below shown pop will appear stating that you need to click on the print icon
to take a print of claim form & then dually signed claim form with other original claim document need to be send to SSC Mediclaim dept. Address of SSC-Pune is available in Dialogue box,
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Click on Settlement History to check the payment details which shown in 2nd snap shot.
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You are requested to make use of the above procedure & help us to process your Hospitalization claim faster through DHS. We request you to avail Cashless facility to the maximum extent possible. For any queries & follow up you can lodge Query through SSC Helpdesk. For cashless claims & to get the Status of the claims under reimbursement you may contact DHS Helpdesk - Mr. Narayan on Mob. No. 9987008927 or Tel No.020-67344444 & on Email id insurance-ssc@larsentoubro.com
For cashless claims, to send the Preauthorization Admission request Form from hospital to DHS, the Fax no. 022-22874235, 022-2795999 & to confirm whether Fax has been received By DHS or not you can contact DHS on
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Toll Free No. 18002090201, DHS Mumbai Office No. 022-67354300, 022-66275900 / 914 / 932.
Larsen & Toubro Limited Shared Services center EBC Mediclaim Hospitalization ICC Devi Gaurav Tech Park, 2nd Floor, Old Mumbai Pune Highway, Pimpari, Pune: 411018
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