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E-MEDITEK (TPA) SERVICES LIMITED AS A THIRD PARTY ADMINISTRATOR ( IRDA LICENSE NO.

007) TAKES PLEASURE IN WELCOMING YOU TO THE HEALTH INSURANCE FAMILY. OUR WEB
INTERFACE ENSURES THAT ALL IMPORTANT INFORMATION IS AVAILABLE TO YOU WITHIN NO
TIME AT WWW.EMEDITEK.COM

WHILE REPRESENTING YOUR INSURER WE PROMISE TO OFFER QUALITY SERVICE, AND SHOULD
YOU REQUIRE ANY SUPPORT CALL OUR 24 HR. HELPLINE AT: 0124 - 2562994,95,96 & 97.

THE TOLL FREE LINE MAY BE USED FOR ALL EMERGENCIES.

IDENTITY CARD

CASH LESS HOSPITALIZATION PROCEDURE

PLANNED HOSPITALIZATION

EMERGENCY HOSPITALIZATION

EXPENSES NOT COVERED UNDER STANDARD MEDICAL POLICY

NON-CASHLESS/NON-NETWORK CLAIMS

IDENTITY CARD: ON THE BASIS OF DETAILS PROVIDED BY THE INSURER, EMSL ISSUES AN
IDENTITY CARD TO OF THE BENEFICIARY UNDER THE POLICY. THE CARD IS ISSUED FOR
IDENTIFICATION PURPOSE ONLY AND SHOULD NOT BE CONSTRUED AS AN AUTHORIZATION TO
THE HOSPITAL TO PROCEED WITH THE TREATMENT.

CASH LESS HOSPITALIZATION PROCEDURE: CASHLESS HOSPITALIZATION FACILITY IS


AVAILABLE ONLY AT NETWORK HOSPITALS. CASHLESS HOSPITALIZATION FACILITY ENABLES
THE INSURED TO OBTAIN ADMISSION AT DESIGNATED HOSPITALS AFTER OBTAINING AN
AUTHORITY LETTER FROM EMSL

IN SUCH CASES, EMSL SETTLES THE HOSPITAL BILLS DIRECTLY ON YOUR BEHALF. TO AVAIL
CASHLESS FACILITY THE INSURED NEEDS TO OBTAIN AN AUTHORITY LETTER FROM EMSL BY
PROVIDING ALL RELEVANT INFORMATION. THIS CERTIFICATE WILL AUTHORIZE THE HOSPITAL
TO DELIVER TREATMENT UP TO THE LIMITS.

PLANNED HOSPITALIZATION: FOLLOWING ARE THE STEPS THAT NEED TO BE COMPLETED FOR A
PLANNED CASHLESS HOSPITILIZATION:

STEP 1: AUTHORITY LETTER FROM EMSL, THE INSURED SHOULD FILL UP A REQUEST FOR
CASHLESS HOSPITALIZATION AND SEND IT BY COURIER/FAX TO EMSL. THE REQUEST SHOULD
REACH EMSL AT LEAST 72 HOURS BEFORE THE PLANNED ADMISSION. COPIES OF THE REQUEST
FOR CASHLESS HOSPITALIZATION CAN BE DOWNLOADED FROM OUR WEB SITE:
WWW.EMEDITEK.COM KINDLY ENSURE THAT "PART B" TO BE FILLED IN BY THE TREATING
DOCTOR AT THE HOSPITAL AND "PART C" TO BE FILLED IN BY THE HOSPITAL / NURSING HOME
AND ENSURE IT IS CORRECT. THE REQUEST FOR CASHLESS HOSPITALIZATION CAN EITHER BE
FAXED (FAX NO. 0124 - 4062071) OR MAILED TO EMSL AT CONTACTUS@EMEDITEK.COM

STEP 2: EMSL WILL SUBSEQUENTLY SCRUTINIZE THE ADMISSIBILITY OF THE REQUEST AND
EITHER APPROVE OR DENY THE REQUEST. AUTHORITY LETTER / REJECTION LETTER WILL BE
FAXED TO THE HOSPITAL WITH INTIMATION TO THE INSURED.
IMPORTANT PLEASE NOTE THAT REJECTION OF A REQUEST FOR CASHLESS HOSPITALIZATION
IS ONLY DENIAL OF CASHLESS SERVICE AND IS IN NO WAY TO BE TREATED AS DENIAL OF
TREATMENT. THE INSURED RETAINS THE RIGHT TO GET TREATED AND SUBMIT BILLS TO EMSL
FOR SUBSEQUENT REIMBURSEMENT (IF ANY) AS PER POLICY TERMS & CONDITION.
STEP 3: THE PATIENT WILL CONTACT THE ADMISSION DESK OF THE NETWORK HOSPITAL ON
THE PLANNED ADMISSION DATE WITH THE EMSL IDENTITY CARD. THE IDENTITY OF THE PATIENT
WILL BE VALIDATED BEFORE ADMISSION.

EMERGENCY HOSPITALIZATION:
1. THE POLICY HOLDER IS ADVISED TO GET ADMITTED.
2. IN CASE OF ADMISSION TO A NETWORK HOSPITAL, THE HOSPITAL WILL ADMIT THE
PATIENT AS PER THE HOSPITAL PROCEDURE.
3. POLICY HOLDER / RELATIVE WILL THEN CONTACT EMSL AND SEND THE REQUEST FOR
CASHLESS HOSPITALIZATION DULY COMPLETED.
4. EMSL WILL CONFIRM OR DENY THE REQUEST FOR CASHLESS HOSPITALIZATION ON
GOING THOUGH THE REQUEST. IN THE EVENT OF DENIAL REQUEST FOR CASHLESS
HOSPITALIZATION BY EMSL THE HOSPITAL SHALL TREAT THE INSURED AS ANY OTHER PATIENT
FOR THE PURPOSE OF PAYMENT OF SERVICES RENDERED, AND EMSL WILL NOT BE LIABLE FOR
PAYMENT.

IF THE AUTHORITY LETTER FOR PROCEEDING WITH THE CASHLESS HOSPITALIZATION IS NOT
ISSUED BY EMSL, CASHLESS FACILITY CANNOT BE AVAILED BY THE INSURED. HOWEVER, NON-
ISSUE OF AUTHORITY LETTER DUE TO NON-AVAILABILITY OF ANY SPECIFIC INFORMATION DOES
NOT MEAN DENIAL OF TREATMENT OR DENIAL OF CLAIMS SETTLEMENT. IN SUCH CASES,
CLAIMS CAN BE SUBMITTED TO EMSL AFTER DISCHARGE, AND THE SAME, SHALL BE DEALT ON
ITS MERIT FOR REIMBURSEMENT.

EMSL SHALL NOT BE RESPONSIBLE FOR AVAILABILITY, QUALITY AND CLINICAL OUTCOME OF
THE TREATMENT AND SELECTION OF NETWORK OR OUTSIDE NETWORK HOSPITAL IS A
PREROGATIVE OF THE INSURED.
THE CASHLESS FACILITY MAY BE DENIED IN THE FOLLOWING CIRCUMSTANCES:
(A) WHERE SUFFICIENT MEDICAL/PAST INSURANCE INFORMATION IS NOT AVAILABLE TO
US.
(B) WHERE THE REPORTED SYMPTOMS/AVAILABLE INPUTS ARE INADEQUATE IN THE
OPINION OF EMSL MEDICAL TEAM AS REGARD TO DETERMINE THE LIABILITY UNDER THE
POLICY.
(C) WHERE THE INTIMATION OF CLAIM HAS NOT BEEN GIVEN IN TIME.
(D) WHERE ANY INFORMATION HAS BEEN CONCEALED OR MISREPRESENTED IN THE
PROPOSAL FORM AVAILABLE ON RECORD.
(E) WHERE THE REPORTED AILMENT/TREATMENT IS EXCLUDED UNDER THE POLICY.

EXPENSES NOT COVERED UNDER STANDARD MEDICAL POLICY:


(A) ADMISSION CHARGES,
(B) EXTRA BED CHARGES FOR ATTENDANT,
(C) EXPENSES ON LUXURY ITEMS UNLESS WITHIN THE ROOM PACKAGE,
(D) TELEPHONE EXPENSES,
(E) EXPENSES ON VITAMINS, TONICS IF NOT DIRECTLY RELATED WITH THE TREATMENT,
(F) FOOD & BEVERAGES FOR ATTENDANT,
(G) XEROX/CERTIFYING CHARGES IF ANY,
(H) SANITARY ITEMS
(I) VACCINATION, DIETICIAN FEE ETC.
(J) EXPENSES OF EXTERNAL AID E.G. SPECTACLES, HEARING AIDS, CLUTCHES ETC.
(K) OR ANY OTHER EXPENSES AS SPECIFIED UNDER THE POLICY.

NON-CASHLESS/NON-NETWORK CLAIMS:

IF CASHLESS FACILITY IS NOT AVAILED/OR PRE-AUTHORIZATION IS DENIED OR TREATMENT IS


AVAILED AT A NON-NETWORK HOSPITAL, THE INSURED WILL HAVE TO SETTLE THE BILLS
DIRECTLY WITH THE HOSPITAL AND SUBSEQUENTLY CLAIM REIMBURSEMENT FORM EMSL BY
SUBMITTING THE FOLLOWING DOCUMENTS IN ORIGINAL:
1. ALL DOCTORS PRESCRIPTIONS.
2. ALL TEST/INVESTIGATION REPORTS ALONG WITH THE PRESCRIPTION OF DOCTOR.
3. ALL CASH MEMOS AND BILLS FOR MEDICINES.
4. DISCHARGE SUMMARY OF THE HOSPITAL.
5. A DULY FILLED CLAIM FORM ALONG WITH A SIGNED DISCHARGE VOUCHER.
6. PACKAGE BREAK-UP (IF APPLICABLE).
7. COPY OF ID CARD.
8. HOSPITAL REGISTRATION CERTIFICATE.

PLEASE ENSURE THAT THE HOSPITAL/NURSING HOME WHERE YOU ARE CONTEMPLATING
TREATMENT FULFILLS THE CRITERIA FOR HOSPITAL/NURSING HOME AS PER THE POLICY
WORDING FOR DEFINITION OF THE HOSPITAL/NURSING HOME.

NOTE: KINDLY REFER TO THE TERM AND CONDITIONS OF THE INSURANCE POLICY ISSUED TO
YOU FOR ANY AMBIGUITY REGARDING THE EXPENSES ADMISSIBLE AND/OR NON-ADMISSIBLE
UNDER THE POLICY.