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Corporate health plan by manish

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Corporate health plan by manish

  1. 1. Strictly Confidential Group Health Insurance By: Manish Agarwal Senior Risk Manager
  2. 2. We are independent intermediaries who represent the client and not the insurance company, unlike an insurance agent who normally represents the company  
  3. 3. What do we do… <ul><li>We market Insurance Solutions for </li></ul><ul><li>“ ALL INSURANCE COMPANIES ” </li></ul><ul><li> Life & General </li></ul><ul><li> Public & Private </li></ul><ul><li>“ Product Range ” </li></ul><ul><li> ALL TYPES OF INSURANCE </li></ul><ul><li>And advice the best to our Valuable Client </li></ul>
  4. 4. <ul><li>Identify and evaluate your needs </li></ul><ul><li>Design your Insurance Portfolio </li></ul><ul><li>Choose the Right Product </li></ul><ul><li>Negotiate with the Companies for the most competitive rates </li></ul><ul><li>Assist in documentation </li></ul><ul><li>Claims Management- After all money matters </li></ul><ul><li>Claims Handling </li></ul><ul><li>Legal Representation </li></ul>And what do we do for you…
  5. 5. <ul><li>Advantages of Group Health </li></ul><ul><li>Floater cover for Entire Family so higher cover at lower cost </li></ul><ul><li>Lower Premiums than Individual Plans </li></ul><ul><li>Easy Claims Settlement </li></ul><ul><li>Pro Rate Premium if people leave </li></ul><ul><li>Maternity Benefit </li></ul><ul><li>Pre Existing Diseases Covered so all disease covered from day one* </li></ul><ul><li>Parents can be covered too without any Medical Tests upto age 80 </li></ul><ul><li>some exclusions are there </li></ul>
  6. 6. <ul><li>We take complete responsibility of any service/claims/other issues during the policy period. </li></ul><ul><li>Your employee needs to give us intimation during an unfortunate event of a claim and we take over from there managing all documentation, liasioning with the TPA and Insurer for speedy cashless/recovery and other necessary work. </li></ul><ul><li>We will train all your employees about the procedure of claims so that the claim process becomes hassle free for them. </li></ul><ul><li>We will provide a 24 hr. Helpline number for any Assistance </li></ul><ul><li>We will give you One dedicated Service Manager for day-to-day requirements </li></ul><ul><li>We will also provide assistance related to any other type of insurance that your employees might need </li></ul>
  7. 7. <ul><li>Some of Our Group Health Insurance Clientele </li></ul><ul><li>Keventer Agro </li></ul><ul><li>Tilaknagar Industries </li></ul><ul><li>Zentech Pharma </li></ul><ul><li>Prachar Communications </li></ul><ul><li>Bengal Ambuja Group </li></ul><ul><li>South City Projects </li></ul><ul><li>Hotel Golden Park </li></ul><ul><li>Hotel Taj Bengal </li></ul><ul><li>Machino Polymers Ltd </li></ul><ul><li>Aircon India (Unit of Voltas) </li></ul><ul><li>Infinity InfoTech Parks Ltd </li></ul><ul><li>S.P.Jain Institute of Management and Research </li></ul><ul><li>Purbanchal Cements </li></ul><ul><li>Maithan Group </li></ul><ul><li>Orion Edutech </li></ul><ul><li>N K Realtors </li></ul><ul><li>Raj Bhavna & Associates </li></ul><ul><li>Rebecca Technologies </li></ul><ul><li>JMD Telefilms </li></ul><ul><li>T B Marketing </li></ul>
  8. 8. <ul><li>CREDENTIAL’S </li></ul><ul><li>We are currently managing more than 20000 lives under Health Insurance </li></ul><ul><li>We settle more than one claim every day </li></ul><ul><li>We maintain a 100% claims settlement ratio!! </li></ul><ul><li>In case of rejection on false grounds, we file the claims with ombudsman and get the claim </li></ul><ul><li>We have a strong Claims & Customer Service team which is there 24 hours to support your people </li></ul>
  9. 10. <ul><li>About Your Policy </li></ul>
  10. 11. Enrolment
  11. 12. Guidelines for Hassle-Free Claims <ul><li>In case of Emergency </li></ul><ul><li>Approach Network Hospital on recommendation of Physician & Show Cashless Card at the Hospital </li></ul><ul><li>Obtain a Pre-Authorization form and get it filled and signed by the treating doctor and submit to Hospital which will then fax it to the TPA along with other necessary reports </li></ul><ul><li>After investigation, TPA will fax the approval for Cashless to Hospital </li></ul><ul><li>Cashless can be rejected </li></ul><ul><ul><li>If the Disease is not covered </li></ul></ul><ul><ul><li>Information sent is insufficient </li></ul></ul><ul><ul><li>Request for Cashless is not sent in time </li></ul></ul><ul><ul><li>However, you need to pay the bills which can be reimbursed later </li></ul></ul><ul><li>In case of Planned Hospitalization </li></ul><ul><ul><li>Go to the Hospital at least 72 Hours before admission and </li></ul></ul><ul><ul><li>Submit the Pre-Authorization Form available with the Hospital </li></ul></ul><ul><ul><li>Show your Cashless Card, Doctor’s Advice Letter, Probable Date of Admission so that </li></ul></ul><ul><ul><li>You will get the Cashless approval even before admission to the Hospital if cashless is </li></ul></ul><ul><ul><li>approved by the TPA </li></ul></ul>
  12. 13. Claims Reimbursement <ul><li>If Cashless is not approved or if you visit a Non-Network Hospital </li></ul><ul><ul><li>At the time of Discharge, settle the Hospital Bills in full and collect all the original BILLS, DOCUMENTS, REPORTS and DISCHARGE SUMMARY </li></ul></ul><ul><ul><li>Lodge your claim with the TPA by filling the CLAIM form and attaching Necessary Documents within 7 Days of Discharge </li></ul></ul><ul><li>Documents to be Submitted: </li></ul><ul><ul><li>Claims Notification - Within 3 Days of Admission via Letter/Fax/Email </li></ul></ul><ul><ul><li>Discharge Summary in Original with all Necessary Details </li></ul></ul><ul><ul><li>Detailed Bill – </li></ul></ul><ul><ul><ul><li>Proper Bills with Break-up of all the items/medicines/tests </li></ul></ul></ul><ul><ul><ul><li>Doctor’s Bills must be stamped, with Doctor’s Reg. No. </li></ul></ul></ul><ul><ul><li>All Supporting Prescriptions and Reports </li></ul></ul><ul><ul><li>Payment Receipt – Must be stamped and signed by Hospital Authorities </li></ul></ul><ul><ul><li>Any expenses not pertaining to the Medical Treatment are not covered </li></ul></ul>
  13. 14. Do’s and Don'ts <ul><li>Store our Helpline No’s and Also give it to other Family Members </li></ul><ul><li>Find out whether the disease is covered in the policy or not </li></ul><ul><li>Always carry Cashless Card while going to the Hospital </li></ul><ul><li>Maintain All Bills inc. pre and post Hospitalization </li></ul><ul><li>Take the bill also from the family/consulting doctor </li></ul><ul><li>Never Disclose the amount of coverage to the Hospital </li></ul><ul><li>Do not go for very expensive treatment </li></ul><ul><li>Enquire about the Approx. cost of Treatment beforehand </li></ul><ul><li>Do not panic. Procedures and Rules have to be followed </li></ul><ul><li>No Need to call at Weird Hours </li></ul><ul><li>Push the Hospital Authorities to send all papers to TPA and follow up continuously </li></ul>
  14. 15. Reminders
  15. 17. Your Risk We at IDEAL would like to assure you a Seamless Service Experience with a focus on building a Long Term Relationship. NEEDLESS TO SAY WE TAKE COMPLETE RESPONSIBILITY OF YOUR CLAIMS SETTLEMENT We will surely create a Difference both in terms of “ Cost & Quality” With IDEAL

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