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Health Benefit Plan 2011 - 2012

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Agenda

 Group Health Insurance

 UnitedHealthcare Parekh TPA Service Offerings

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Group Health Insurance Current Insurer The Oriental Insurance Company Ltd

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Policy Benefits

         

Benefit commences on April 01, 2011 and ends on March 31, 2012 Sum insured : 200000 Beneficiaries: The family includes the employee, spouse, 2 children Benefits: Maternity benefit up to Rs.30000 for C-section and Rs.25000 for Normal delivery with no 9 months waiting period Baby s coverage : From Date of Birth Pre-existing diseases covered 1st-4 years exclusion waived off 30 days waiting waived off Room Rent including nursing and boarding charges 1% of sum insured and 1.5% of sum insured for ICU

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Scope of Insurance Cover

 Includes:
 Only in-patient hospitalization expenses.  Active treatment with minimum 24 hours hospitalization.

 Excludes:
 Non - Medical Expenses - Registration/Admission fees, hospital surcharge, food bills for attendants, telephone charges, pharmacy charges for nonmedical items etc.  Out Patient (OPD) treatment  Other standard exclusions

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Standard exclusions to the Insurance Cover

 Injury or disease directly or indirectly caused by or arising from or attributable to war or war like

situations and by nuclear weapons.

Terrorism  Circumcision unless necessary for treatment of diseases  Dental treatment of any kind unless requiring hospitalization  Congenital external diseases or defects/anomalies  Hospitalization for convalescence, general debility, intentional self-injury, use of intoxicating

drugs/ alcohol.
 Venereal diseases, HIV and AIDS, Infertility treatment and Naturopathy  Cost of spectacles, contact lenses, hearing aids  Any cosmetic or plastic surgery except for correction of injury  Hospitalization for diagnostic tests only even if prescribed by a medical practitioner  Voluntary termination of pregnancy during first 12 weeks (MTP)  Lasik Surgery (correction of refractive error of the eyes)  Unproven or experimental treatment not approved by Indian Medical Council
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group. 6

UnitedHealthcare Parekh TPA Pvt. Ltd. - Service Offerings

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UnitedHealthcare Services

e cards. Cashless Hospitalization through HealthConnect. SMS facilities for Pre-authorizations. 24 hour telephonic Nurseline. Claims Administration.

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Procedure for Online enrollment

Please follow the below steps to Login  Go to https//:www.uhcindia.com via the Internet.  Select e-Enroll Login (bottom left)  Log on with the help of the username and password which will be sent to you directly from UHC Parekh TPA.  You can now view your details. To Print e-Cards  Go to https//:www.uhcindia.com via the Internet.  To print e-cards, click on the ID-card status link  Click on the `Print ID card` for each member and print the card. You are allowed to print each ID card only 3 times. Please ensure that you save the ID cards.  Log off once the e-Card is printed.

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Cashless Hospitalization - HealthConnect

 Our Network consists of approximately 3373 hospitals in 419 cities.


To locate a network hospital  Login to www.uhcindia.com  Select HealthConnect Provider Network  then click on Hospital List Username uhcindia Password uhc586

 

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How does the plan work ?

Hospitalization event can be:  Planned or Emergency

 In a Network hospital or Out of Network

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Network Hospitalization (Planned)

Call up Nurseline (022-3065 7331) 48hrs prior to Admission date Nurseline Sends Pre-Auth (Available on www.uhcindia.com)

Fill it up by the help of the treating Doctor and fax it back to the Nurseline (022-2852 8222) Medical Management Team assesses the Pre-auth and after it is approved, Nurseline sends Credit letter to Network Hospital

All Medical Expenses including Room Rent would be covered

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Network Hospitalization (Emergency)

Call up Nurseline if possible

Or else, get hospitalized into the nearest Network Hospital with the E- card

Get the Patient treated and after the patient has Stabilized, complete the Pre-auth process

You can also identify yourself as a member of UHCP so that they can assist you with the Pre-auth formality.

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Procedure of discharge at Network Hospital

 All the original documents and bills will be sent to us directly by the hospital.
Please sign the main hospital bill and ask the hospital for photocopies, if required

 Submit a claim form signed by the claimant/employee to the hospital else the
claim is not reimbursable

 If you have any reports/documents or you have incurred any other expenses for
medicines purchased pertaining to the hospitalization, submit these as well

 Kindly settle the bill for non medical expenses / co-pay if applicable at the
hospital.
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Non-Network Hospitalization (Planned & Emergency)

Complete the Pre-auth so that we can intimate you on your claim eligibility. Kindly make the arrangements for the admission and pay for all expenses at the hospital

Claim needs to be sent to us within 7 days from the Date of Discharge

Collect all original documents from the Hospital including the Hosp. & Dr. Reg No.

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Procedure of discharge & claim at Non Network Hospital

PRE AUTHORIZATION is necessary- else the claim is liable to get rejected. The employee is requested to arrange for the admission and all other payments
required by the hospital.

Collect and submit the following documents (in original) after discharge


Discharge Card. Main Hospital Bill. Signed Claim Form. Prescriptions, reports and bills for all investigations done. Prescriptions and bills for medicines consumed during hospitalization. Break-up of the medicines bills amount to Rs.200/- or more.

Hospital s registration number is required. NOTE: A claim will not be assessed if the documents mentioned in red are not
submitted.
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Claim Intimation Timelines - Important

Claim Submission Timeline - All claims to be submitted to the TPA within 7 days from date of discharge. Claim Intimation For all non-cashless claims, members would need to send an intimation mail to claimsintimation@uhcpindia.com with the following details, intimation for all planned hospitalization should happen two days prior to admission (or within 24 hours of hospitalization in case of emergency) Name of Employee Name of Corporate Name of Dependent Patient ( if applicable) Employee ID Name of Hospital / Provider Date of Admission Probable Cost of Hospitalisation Probable Diagnosis Any other Information as felt necessary Any delayed intimation or submission beyond the timeline mentioned above will be rejected.
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.

Claims Administration
Claims Administration Team

Document handling Registration of claim with insurer Liaison with insurer for payment Explanation of paid amounts and rejection Sends reminders for the missing/required document(s). In case of non-receipt of the same, may send the entire claim back to the employee or deduct the appropriate amount and send the balance claim for QC

Document Recovery Team (DR Team)

Quality Check Team (QC Team)

Re-assesses the claim to ensure that the claim is complete in all respect before sending it for payment to the insurance company.

Claim settlement
Approximate time to settle claim is 15 working days from completion of documentation
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Help Line Numbers

Customer Service line Mon- Fri (9.00 am - 5.00 pm) All general queries relating to Id-card, claims status etc.

( 1800-22-4646 (Nationwide toll free) ( or 022- 3065 7351

Email: customerservice@uhcindia.com Nurseline (24 hours): Hospitalization queries only

( 1800-22- 4545 (Nationwide toll free) ( or 022- 3065 7331

Email: nurseline@uhcindia.com

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Thank You

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