Mediclaim and Corporate Department
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Mediclaim department of Shalby
Mediclaim Policy is a hospitalization benefit policy,
which takes care of medical expenses incurred during
Hospitalization / Domiciliary Hospitalization of the
Insured for treatment of illness / disease / injury
contracted during the policy period.
Location & Staff: Ground floor, Head, manager, assistant manager, Senior executive, executive, Medical officer.
This department is in the panel of PPN (preferable provider network)
Functions:
Manager & Assistant manager: administrative queries (packages, break-ups,) International patients
Executives: Discharge file preparation, Documents to TPA, Settlement summary, billing summary , corporate patients etc..
Medical officer: for cashless procedure- pre-authorization form,
On discharge- claim form, Medical queries
Corporate
Hospitals focuses on creating strong customers from the cream of society through Corporate Marketing. Hospitals focuses in marketing of its premium and priority services to its corporate clients.
Hospital directly deals with the corporates regarding employee facilities in the hospital.
Gives credit or discount basis of tie-up with the corporate.
TPA ( Third Party Administration)
IRDA(Insurance Regulatory Development Authority ) has defined TPA's as "An insurance intermediary licensed by the Authority who, either directly or indirectly, solicits or effects coverage of, underwrites, charges premium from an insured, or adjusts or settle claims in connection with health insurance, except as an agent or broker or an insurer.“
NETWORK HOSPITAL means hospital that has agreed with the TPA to participate for providing cashless health services to the insured persons. The list is maintained by and available with the TPA and the same is subject to amendment from time to time.
CASHLESS FACILITY:
Means the TPA may authorise upon the Insured's request for direct settlement of admissible claim as per agreed charges between Network Hospitals & the TPA. In such cases the TPA will directly settle all eligible amounts with the Net work Hospitals and the Insured Person may not have to pay any bills after the end of the treatment at Hospital to the extent the claim is covered under the policy
What are the salient Features of this policy
Reimbursement for hospitalization or domiciliary hospitalization due to disease/surgery.
Pre Hospitalization expenses up to 30 days.
Post Hospitalization expenses up to 60 days.
Age Limit: 5 years to 80 years. Children between the age of 3 months to 5 years can be covered provided one or both parents are covered concurrently.