FAQ ON GROUP MEDICLAIM POLICY CAVINKARE PRIVATE LIMITED

FAQ ON GROUP MEDICLAIM POLICY CAVINKARE PRIVATE LIMITED

FAQ ON GROUP MEDICLAIM POLICY CAVINKARE PRIVATE LIMITED What is Group Mediclaim Policy ? GMC Policy is taken for mediclaim coverage for employees and their families in the event of hospitalisation. Following points are essential for coverage : Minimum Coverage of 24 hours hospitalization. Treatment should be availed only in registered hospital / nursing home under the supervision of a registered & qualified medical practitioner Hospital should have the following: - Minimum 20 in-patient beds (in metros) 15 in nonmetros

- Fully equipped OT - Fully qualified nursing staff round the clock - Fully qualified & registered doctors round the clock Who is our Insurer & TPA? We have our policy with National Insurance Company Limited, Chennai TTK Healthcare Services, Chennai is our TPA. Contact Details of TTK in-charge Ms. Anitha - ani [email protected] / 98840 94544 TOLL FREE NOS. OF TTK TOLL FREE FAX NOS. OF TTK TTK HO CALL CENTER 1800 425 8885 TTK HO CALL CENTER

1800 425 7878 TTK HO FAX NO. 1800 425 2626 TTK CHENNAI CALL CENTER 1800 425 7575 MUMBAI FAX NO. 1800 22 1919 COCHIN FAX NO.

1800 425 6262 TTK MUM CALL CENTER 1800 22 1717 CHENNAI FAX.NO. 1800 425 7474 TTK COCHIN CALL CENTER 1800 425 6264 TTK HYD CALL CENTER

1800 345 4051 TPA stands1800 for345 Third Party What is Policy period & Who are all covered under the policy? CavinKare Group Mediclaim Policy period commences on 22nd August of every year, and closes by 21st August of next year. Employees and their dependents are covered under the policy. Dependents includes Self, Spouse, Parents & Children, subject to max. of 6 members in a family including employee. ( 1 + 5 coverage )

of CK Mediclaim policy ? Pre-existing diseases covered Waiver of 1st year exclusion Waiver of 30 days waiting period Coverage till 80 years Inclusion of maternity benefit ( Pre & post maternity charges not covered ) Baby coverage from Day 1

Floater made policy Coverage for 1 + 5 dependents Cashless scheme - network with 3500 hospitals through out India What is my claim eligibility ? We have a graded coverage for our employees MN3 & Above Rs.85,000 pa MN4 & MN 5 Rs.50,000 pa O1 & O2 Rs.40,000 pa O3 & O4 Rs.30,000 pa Eligibility amount is per member in a family.

What is floater made policy ? Under floater scheme the sum insured for the individual family members will be added and the total insured amount will be treated as sum insured for family members. If an employee in MN4 grade has 4 members in his family, total SI for his family is Rs. 2.0 lacs 50000/- * 4 = 200000 /- Sum Insured Sum Insured amount can be used within the family, and there is no restriction on the same. What is cashless facility ? ID cards are provided to employees & their dependants. With the use of id card, they may get admitted in any of the network hospitals through out India and need

not pay any cash during hospitalisation. How does Cashless access for Hospitalization works ? Cashless access for Hospitalization Hospital faxes Pre Authorisation to TTK on Toll Free Number Patient approaches Network hospital Based on recommendation of physician Request received at TTK Pre Auth dept thru Dedicated Fax Machines

CYCLE TIME SAME DAY. Claims Dept checks for coverage and eligibility Authorisation faxed to Hospital Medical Dept checks for Treatment & Applies Negotiated Tariffs Use Toll Free Nos. Online HelpDesk at Select Hospitals :Authorisation & Billing Will my claim be covered

under reimbursement scheme ? Yes. If the hospital is not covered under cashless scheme, employee may get admitted to any nearest hospital. The amount incurred by the member towards hospitalization shall be reimbursed. What are the documents to be submitted for reimbursement claim ? Original Discharge Summary Medical investigation / diagnostic test Bills must be accompanied by photocopies of the Reports Medical bills and prescriptions Lab reports, x-ray / scan reports etc. Claim to be submitted to HRD.

In case of reimbursement claim submitted by me, why full amount doesnt get reimbursed from TPA ? Following charges / expenses incurred by member is disallowed as per Mediclaim conditions : Admission fee Registration Charges

Diet & Canteen charges Telephone calls Service charges Miscellaneous Expenses Purchase of diapers, napkins, child food like Nestum This is applicable for both cashless & reimbursement claims. Will maternity claim for 3rd child be covered ? Only 2 live births are covered. i.e, if the claimant has 2 children, then the 3rd baby delivery charges are not payable even if he/she has not claimed for the 1st and 2nd children

Similarly, Medical/voluntary termination of pregnancy unless necessitated by medical advice where fetal/maternal life is endangered is not covered under Mediclaim What are the other coverage excluded from policy ? Domiciliary Hospitalization Treatment for sterility / infertility. Family planning operations Naturopathy treatment Admissions for evaluation / purely for

investigation Congenital external disease or defects AIDS OTHER FREQUENTLY RAISED QUERIES QUERIES REPLIE S REMARKS Will Cataract be covered? Yes However, cost towards

lens shall not be reimbursed Will Dental treatment be covered? No Dental treatment arising out of accident shall be covered Will Cosmetic surgery be covered? No --

Will Outpatient treatment be covered? No -- ADDITIONS & DELETIONS Employees presume that by sending their wedding invitation to HR, their spouse shall be covered automatically. Nomination form should be filled in by employee, giving details of their nominee, DOB and duly signed form should reach HR for adding their dependents. Similarly, any deletion in the family to be informed by giving a nomination form to HR. Otherwise, Company will continue to pay the

premium for that member unncessarily. Where do I get mediclaim related forms ? For your convenience, forms ( claim reimbursement & nomination form ) are made online available in http://my.cavinkare.com All you need to do is, login with your emp id, click the DOWNLOAD FORMS link, and can take the print out of the forms. Whom should I contact in HR for further information on Mediclaim ? You may contact Mr. Kalaiselvan, [email protected] ( 044 24317749 ) or

Ms. Kayal, [email protected] ( 044 24317751 ) for further details on Mediclaim policy. THANK YOU !

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