FOR

SIDDAGANGA INSTITUTE OF
TECHNOLOGY
Year 2012 - 2013

POLICY OVERVIEW
INSURED

SIDDAGANGA INSTITUTE OF TECHNOLOGY

INSURER

THE NATIONAL INSURANCE COMPANY LTD

POLICY NUMBER

604203/48/12/8500000613
604203/48/12/8500000609
604203/46/12/8500000058

THIRD PARTY
ADMINISTOR

MEDI ASSIST INDIA TPA PVT LTD

PERIOD OF
INSURANCE

FROM

TO

19/10/2012
18/10/2013

Please Note:
Policy features detailed in the following slides are only important highlights
which are subject otherwise to the Terms, Conditions and Limitations of the
Policy. Please refer to the Policy Schedule/Wordings issued by the Insurer for
more details of the same.

PAN India Presence

Corporate
Office
Bangalore

Mohal
i

Regional
Offices
Delhi

Jaipur

Ahmedabad
Surat

Luckno
w
Bhop
al
Indor

Nagpu
r
Mumb
ai
Pune

Guwahati

Patna

Jamshedp
ur
Kolkata

e Bhubaneswa
r

Year

Vishakhapatn
am
Hyderabad

Our Offices
Mangalor
e
Cochin
Trivandru
m

Bangal
oreChenna
i
Coimbator
e

Corporate
office
offices
offices

Regional
Branch

Mumbai
Bangalore
Chennai
Kolkata
Branch
New Delhi
Offices 19
Manpower

2007

Strength
400

2008

525

2009

750

2010

830

2011

1010

2012

1350

Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not for Circulation

POLICY COVERAGE
The Mediclaim Policy Reimburses Hospitalisation
Expenses incurred due to:Disease
Illness or
any bodily injury sustained through Accident
Treatment done in a Hospital /Nursing Home / Day
Care Centre on the advice of a qualified Physician
/ Medical Specialist / Surgeon
As an Inpatient in the Hospital (fulfilling the
definition of Hospital)
For a minimum of duration of 24 hours

DEFINITION OF HOSPITAL
An institution established in India for indoor care & treatment of
sickness and injuries
Registered as Hospital or Nursing Home with local authorities
Under supervision of registered & qualified medical practitioner
Has minimum of 10 inpatient beds (In towns having less than 10
Lakhs population OR
15 inpatient beds if located in other towns
Has fully equipped operation theatre of its own
Has fully qualified Nursing Staff and Doctors and Maintains Daily
Record for each Patient
The Term Hospital or Nursing Home shall not include an
establishment which is a place of rest, a place for the aged, a
place for drug-addicts or place for alcoholics a hotel or a similar
place

POLICY COVERAGE
Day Care Procedures where 24 hours
hospitalization is not applicable
Anti Rabies Vaccination

Hysterectomy

Appendectomy

Inguinal/ventral/Umbilical/ Femoral
Hernia
Parenteral chemotherapy
Piles/ fistula
Prostrate
Lithotripsy (Kidney Stone Removal)
Radiotherapy
Sinusitis

Coronary angiography
Coronary angioplasty
D&C of cervix
Dental surgery following accident
Eye surgery
Fracture/dislocation excluding hairline
fracture
Gastro Intestinal Tract System
Haemo Dialysis
Hydrocele

Stone in Gall Bladder, Pancreas and Bile

Duct
Tonsillectomy
Urinary Tract System

Note: All ailment mentioned above will not be payable for the first two years of
operation of the policy.

admissible provided the treatment is taken in a registered Government

EXPENSES COVERED
2.1

Room, Boarding and Nursing Expenses as provided by the Hospital / nursing home not exceeding
1% of Sum Insured Per Day for Normal Room or actual amount whichever is less.

2.2

Hospital Unit (ICU) Expenses not exceeding 2% of sum Insred Per Day or actual amount
Intensive Care
whichever is less

2.3

Surgeon, Anaesthetist, Medical Practitioner, Consultants Specialist fees.

2.4

Anesthesia, Blood, Oxygen, Operation Theatre Charges, surgical appliances, Medicines & Drugs,
Dialysis, Chemotherapy, Radiotherapy, cost of Artificial limbs, Cost of Prosthetic devices
implanted during surgical procedure like Pacemaker and relevant laboratory/Diagnostic tests, Xray and other medical expenses related to the treatment.

2.5

Pre-Hospitalization medical charges up to 30 days period immediately before insureds admission

to hospital for that treatment of illness or injury

2.6

Post-Hospitalization medical charges up to 60 days period immediately after insureds admission

to hospital for that treatment of illness or injury

Expenses incurred on Ayurvedic / Homeopathic / Unani Treatment are admissible provided the treatment is taken in a registered Government

IMPORTANT NOTE
The amounts payable
under 2.3 and 2.4 shall be at the rate applicable to the entitled room category. In case
Expenses incurred on Ayurvedic / Homeopathic / Unani Treatment are admissible provided the treatment is taken in a registered Government
Hospital with rent higher than the entitled category as under 2.1,the charges payable under
Insured opts for a room
2.3 and 2.4 shall be limited to the charges applicable to the entitled category.
No payment shall be made under 2.3 other than part of the hospitalization bill.

Expenses incurred on Ayurvedic / Homeopathic / Unani Treatment are admissible provided

the treatment is taken in a registered Government Hospital

FEW NON MEDICAL EXPENSES NOT PAYABLE

Following are few Non Medical Expenses which are not reimbursable
under the Policy:
Telephone charges
Attendant's charges
Home Visit/Nursing charges - at residence after discharge
Assistant fee/Follow up charges in advance
Sundry/Medico Legal Charges/Diabetic chart charges
Thermometer Charges
Container for Specimen/Disposable Bag charges
Admission Kit
External Surgical Aids: Lumbo-sacral/Collar belt /Knee cap/Knee brace/
walker/hot water bag/baby kit/urine pot / traction kit/ folding commode etc
Inhaler/ Nebulizer /Glucometer or any other equipments
Diet charges
Special/protein diet/health drinks unless prescribed by the doctor
Documentation/Folder/Stationery/In Patient chart charges
Expenses on vitamins and tonics unless forming part of treatment
Naturopathy Treatment, Acupressure, Acupuncture, Experimental and unproven
treatment/therapies.
(ABOVE LIST IS NOT EXHAUSTIVE. TO SEE THE COMPLETE LIST OF NON MEDICAL EXPENSES
PLEASE VISIT OUT WEBSITE WWW.MEDIASSISTINDIA.COM)

FEW MAJOR EXCLUSIONS

Circumcision, Cosmetic or Aesthetic Treatment, Plastic Surgery unless required
to treat any injury or illness
Vaccinations and Inoculations, Vitamins and Tonics unrelated to treatment
Cost of braces, equipment or external prosthetic devices, non-durable implants,
eye glasses, cost of spectacles and contact lenses, hearing aids including
cochlear implants and durable medical equipment
All types of Dental treatments except arising out an accident
Obesity treatment and its complications, congenital external disease/defects or
anomalies, Treatment related to all psychiatric and psychosomatic disorders,
Infertility, sterility, use of intoxicating drugs/alcohol, use of tobacco leading to
cancer
Intentional self inflicted injury, attempted suicide and arising out of non
adherence to any medical advice
Participation in hazardous sports of any kind, or any criminal act
STD, AIDS and other related conditions
Diagnostic, X-Ray or Lab expenses not consistent with or incidental to the
diagnosis of positive existence of ailment
Voluntary Termination of Pregnancy
Naturopathy treatment, Experimental/Unproven treatment
Service Charges and All Non Medical Expenses
Domiciliary Hospitalization, Treatment taken outside India
Note : Please refer to policy condition for full list of exclusions

CASHLESS CLAIMS PROCESS

This service enables the customer to avail treatment at the Network Hospital
without being required to pay for the treatment.
All expenses incurred will be paid to the Hospital after deducting non medical
expenses subject to maximum limit of sum insured
Please produce your Medi Assist ID Card to the Network Hospital where you
wish to avail treatment. Additionally you will be required to provide a valid
Photo ID proof such as Voter ID, PAN Card, Driving License etc to the hospital
Kindly fill in the Medi Assist Card Number, Name of the Patient, Age & Contact
Number in the Cashless Request Form
The treating doctor/ hospital will fill in the remaining part of the Request Form
& Fax it to Medi Assist for approval.
Pre Authorisation approval for Cashless will be sent through Fax / Email to the
Hospital
Please Check & Sign the hospital bill before Discharge
Avoid informing the hospital your total coverage details to prevent inflated
billing

Claims Processing Pre-Authorization/

Cashless

Medi Assist India TPA Pvt. Ltd | Private &

Confidential

11

Network of Hospitals Pan-India

State

140
0

135
1

65
7

128
2

No. of
Hospitals

Andhra Pradesh
582
Assam
30
Bihar
29
Chandigarh
27
Chattisgarh
13
Dadra & Nagar
1
Haveli
Delhi
214
Goa
7
Gujarat
495
Haryana
204
Himachal
13
Pradesh
Jammu &
15
Kashmir
Jharkand
26
Karnataka
645
Kerala
200
Madhya
82
Pradesh
Maharashtra
771
Nagaland
2
Hospital
Orissa
49
Zones Network
Pondicherry
10
West
1351
Punjab
190
Bangalor
Rajasthan
130
e
657
Tamil Nadu
499
South
1282
Tripura
2
North
Uttar Pradesh
234
East
1400
Uttaranchal
23
Medi Assist
India TPA4690
Pvt. Ltd | Private & Confidential | Not
Total
West Bengal
197

192
-
2
14
3

Hospitals
with
Discounts
418
11
18
17
7

153
1
60
103

158
4
243
160

1
188
22

9
399
91

40

Number of
Packages

331
11
85
33
243
-
85
8
75

402
11
2
122
103
197
2
166
1912
92

PROCEDURE FOR REIMBURSEMENT CLAIMS

Please submit the following documents in original
Discharge Summary. (Original ) .
Final Hospital Bill (with detailed break-up) &Cash paid Receipts (Original)
Medicine Bills along with Doctor Prescriptions.
Investigations & Test Reports. (Original)
Duly Filled Claim Form with Signature. (can be downloaded from website:
www.mediassistindia.com
Bank Account Details of the Employee to be provided containing following
details
Name of Account Holder (Employee) as per Bank Records
Bank Account Number
Bank Name and Address
IFSC Code
Copy of cancelled cheque with all the above details
Note: In case of non-availability of prescriptions, kindly ask your
Physician to countersign on the reverse of pharmacy bills.

Claims Processing - Reimbursement Claims

Medi Assist India TPA Pvt. Ltd | Private &

Confidential

14

PROCESS TO DOWNLOAD ID CARDS FROM MEDI ASSIST

WEBSITE
HR can access Medi Assist Website by following the steps below: Log in to Medi Assist website www.mediassistindia.com
Select Corporate Login from the Log in Title
Log in Name shall be Employee Number followed by short name of
Corporate
Password will be shared separately by a welcome mail
Employee can view the names of enrolled.

Medi Assist India TPA Pvt. Ltd

Turn Around Time (TAT)

Process

Turn Around Time (TAT)

PRE-AUTHORIZATION

Approvals processed within 1 Hour to 3 Hours

maximum
Planned hospitalization can be availed 2 days prior to
admission

REIMBURSEMENT
CLAIMS

Settlement: 15 working days by Electronic Fund Transfer

(EFT)
(after receipt of complete claim documents)
Mandatory
Bank Account Details to be shared containing the
Requirements for EFT
following details in addition to all claims documents
Transfer
Full Name of Account Holder (Employee) as per Bank
Records
Name and Address of Bank
IFSC Code
Copy of Cancelled cheque containing all above
details

Medi Assist India TPA Pvt. Ltd | Private & Confidential | Not

16

SOME COMMON ERRORS THAT DELAYS SETTLEMENT OF

REIMBURSEMENT CLAIMS
Submitting document without claim form
Quoting wrong claim amount on claim form
Enclosing certificate from doctor instead of detailed
discharge summary
Not attaching original cash paid receipts and submitting
details on prescription / hospital letter head instead of
proper numbered receipt
Incomplete documents: non submission of Lab reports,
breakup for bills and medicine prescriptions
Not providing Bank Account Details for effecting settlement
of claims through EFT mode
Providing Bank Account Details of a beneficiary instead of
Employee Bank Account
Claim Documents submitted after 30 days of
Discharge for Main Hospitalization and beyond 7
days for Post Hospitalization Expenses.
(Waiver of this condition is considered by Insurer in extreme cases
of hardship where it is proved to the satisfaction of the Company
that under the circumstances in which the insured was placed it

CUSTOMER SERVICE CONTACTS

Name

Bhavya A L

Email

Bhavya.l@mediassistindia.com

Mobile

9342529734(Temp)

Corporate Response

08032942863 (9-30 am to 6 pm)

Call Centre

Toll Free Number 1800 425 9449

Accessible from any location in India. Multi lingual support

available in English, Kannada, Hindi)
ESCALATION MATRIX
FIRST LEVEL

Rajesh s
Email-rajeshs@mediassistindia.com
Mobile- 9379761657

SECOND LEVEL

Shashikala ( Manager )
Email
shashikalag@mediassistindia.com
Mobile 9379427268

ADDRESS FOR CORRESPONDENCE

Medi Assist India TPA

Private Limited

Bangalore Branch
No 45/A, Green Arch", B Block, II Floor
1st Main Road, J P Nagar Phase III,
Sarakki Industrial Layout,
Bangalore 560078
Website: www.mediassistindia.com

MediAssist Online!
We are pleased to introduce to you MediAssist Online!
This is a web-based self-service platform provided. With this selfservice application, you will be able to download soft copies of the
Medi Assist cards for you and also check the reimbursement claim
status.
Steps to be followed for:
Coporate HR Login
Features:
Beneficiary details
Claims details
E-card
Change password option

Logon to
www.mediassistindia.com
Click- on the tab
login in the
home page

Online
Access

Online
Access

Click here- to enter

your login details

Click the Tab

Corporate
employee

Username
empcode@cegedim

Online
Access

Password

Please enter your

user name and
password

For
Beneficiary
Details
Click this
Tab

For
E Cards
Click this
Tab

E Cards
Can
Be
Printed

E CARDS
CAN
BE
PRINTED

CLAIMS
INFORMATION

BY
CLICKING
THIS
HYPERLINK
GET MORE
INFORMATION

CLAIM
BREAK
UP
DETAILS

YOU
CAN
GET
YOUR
CLAIM
DEDUCTIO

CHEQ
DET

Online Issues
If you have forgotten your password, or have problems logging into the
system, please contact MediAssist directly by emailing
quoting employee code and corporate name

contact
Ms. Bhavya A L
Bhavya.l@mediassistindia.com
The same will be ratified within 3 working days from the receipt of the mail.

Wish you a healthy life

and
happy future !

Thank you !!!