Mediclaim Insurance & Hospitalisation Scheme ( 11 Sep 2013 to 10 Sep 2014 )

1. Mediclaim Insurance & Hospitalisation Scheme (11 Sep 2013 to 10 Sep 2014)

2. Entities Involved

3. Mediclaim pays for treating an ailment and not for diagnosing an ailment

4. Sum Insured PDPMIIITDM College has opted cover of Sum Insured Rs. 50,000/-

5. Policy Terms & Conditions 1). Pre-Existing:-Covered. 2). 30 Days waiting: -Applicable. 3). 1, 2 years Exclusions: -1 Year Exclusions are Applicable. 4). Co Payments: -No Copayment. 5). Pre & Post Hospitalization: -30 / 60 Days. 6). Domiciliary Hospitalization Charges: -Not Covered. 7). Dental & Spectacles & Hearing aids: -Not Covered. 8). Health Check-up: -Not Covered. 9). Special Conditions 1: -Claim Submission for MRC should be within 60 Days from the DOD from Hospital, Post 60 Days TPA should raise the deficiency for the submission delay reason from the insured. Claim submission for Hospitals (PP Claims) should be within 30 Days from DOD from Hospital, Post 30 Days TPA can reject the claim with concurrence of USGI Claims Team. 10). Special Conditions 2:- All other terms & conditions shall be as per Standard GMP. 11). Room Notes: -As per GMP conditions..

6. Definition of Hospital : • Any hospital which is tied up by FHPL and any Nursing home or hospital which is Registered and has more than 15 Beds. • Definition of Hospitalization: • Minimum period of 24 hrs of admission in a hospital for a proper medical management. • Time Limit Not Applicable For Specific Treatments Like • Dialysis • Chemotherapy • Eye surgery

7. What is not covered under this policy

8. What is not covered under this policy

9. Do’s • Carry your ID card (IDEA)/ E Card (FHPL) at the time of admission at network hospitals • Incase of emergency admission kindly contact FHPL within 24 hrs of Hospitalisation • Incase of emergency kindly refer your companies name and your Emp No at the time of admission • Take a pre approval from FHPL for all the elective cases • Sign on the final bill at the time of discharge from the hospital • For any other assistance call the account manager

10. How to avail benefits under your policy Member approaches with Network Hospitals with ID Hospital sends Intimation to FHPL Eligibility Member approaches Any other Hospital Out of Pocket payment Not Covered Avails treatment, makes upfront payment Submits bills to FHPL for reimbursement Covered TAT : less than 2 hr for routine cases Emergency : No authorization required Regularization within 24 Hrs Authorization as per eligibility Cashless treatment at NWH

11. Documents required for reimbursement • Original detailed discharge summary • Original investigation reports along with bill • Original Hospital Bill-consolidated and with detail breakup of every component of the bill with the patients signature on it. • Incase of surgical packages – detail breakup of the package • Medicine bills with prescriptions. • Claim Form – ( available on FHPL website ) • MLC Certificate from the hospital in the case of Road traffic accident. Or a certificate from the treating doctor mentioning that the patient was not under the influence of alcohol at the time of Accident. • Payment receipt for the payment done to the hospital. • *30 Days pre & 60 Days Post hospitalization • Original investigation reports along with bills & receipts • Consultation receipts. • Medicine bills with prescriptions

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