This document provides information about a group mediclaim policy issued by The New India Assurance Co. Ltd. and administered by Raksha Health Insurance TPA Pvt. Ltd. It summarizes the key policy details, including the policy number, period of coverage, benefits provided, exclusions, claim processes for cashless and reimbursement claims, and requirements for network hospitals. It also provides an overview of Raksha TPA, its promoters and services.

1. NR SWITCH N RADIO SERVICES PVT. LTD.
Group Mediclaim Policy
Raksha TPA Private Limited 1
Raksha TPA

2. Raksha TPA Private Limited 2
Raksha TPA
RAKSHA TPA Pvt Ltd

3. IRDA Licensed Company (License No.15)
Promoted By :
Mr.Rajan Nanda
(Chairman Escorts Group of Companies)
Mrs. Ritu Nanda
( Chairman- RNIS )
Dr.Naresh Trehan
(Chairman- Medanta Medicline)
Raksha TPA
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Raksha TPA Private Limited

4. PAN INDIA PRESENCE
Mumbai
Faridabad
Bangalore
Vadodara
Chandigarh
Ludhiana
Chennai
Guwahati
Hyderabad
Indore
Jaipur
DECENTRALISED
OPERATIONS IN 22
MAJOR CITIES
Kolkata
Patna
Lucknow
Dehradun
Pune
Raipur
Raigarh
Ahmedabad
Bhopal
Kochi
Bhuvneshwar
83 Service
Locations

5. Footage
PRESENCE…
83 Service
Locations

6. POLICY FEATURES
Raksha TPA Private Limited 6
Raksha TPA
Tailor Made Floater Group Mediclaim Policy
Policy No: 35020534200500000004
30-Sep-2020 to 29-Sep-2021
Insurance Co :
THE NEW INDIA ASSURANCE CO. LTD.
TPA : RAKSHA HEALTH INSURANCE TPA PVT. LTD.

7. Policy Features
Benefits/Extensions Coverage
Family Cover and size Employee
Room Rent Capping
ICU / CCU Capping
1 % of the Sum Insured
2 % of the Sum Insured
Pre existing diseases Covered
1st Year exclusion Waived Off
2nd Year exclusion Waived Off
Pre & Post Expenses 30 & 60 Days Respectively Covered
Treatment Anywhere In India
First 30 days exclusion Waived Off
Room Rent Condition Incase an employee opts for the higher room rent then his
eligibility, proportionate deduction will be applicable. Please
note proportionate deduction will not be applicable for
medicines.
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Raksha TPA

8. Raksha TPA Private Limited 8
Day Care Treatments covered under Policy
Expenses on Hospitalisation for minimum period of 24 hours are admissible. However, this time
limit is not applied to specific treatments, such as:
 Appendectomy
 Haemo dialysis
 Coronary angiography
 Hydrocele
 Coronary angioplasty
 Hysterectomy
 Inguinal/ventral/ umbilical/femoral hernia
 D&C
 Parenteral chemotherapy
 Eye surgery
 Piles/ fistula
 Fracture/ dislocation excluding hairline fracture
 Sinusitis
 Lithotripsy
 Tonsillectomy
 Incision and drainage of abcess
 Liver aspiration
 Colonoscopy
 Sclerotherapy
 Prostrate
 Radiotherapy
 Or any other surgeries / procedures agreed by the
TPA/ Company which require less than 24 hours
hospitalisation and for which prior approval from
TPA is mandatory.
Note: Procedures/treatments usually done in out patient department
are not payable under the policy even if converted as an in-patient in
the hospital for more than 24 hours
Raksha TPA

9. Raksha TPA Private Limited 9
Eligibility for Hospital / Nursing Home
 Minimum 15 in-patient beds (in major cities) & 10 in Remote
areas.
 Fully equipped OT
 Fully qualified nursing staff round the clock
 Fully qualified & registered doctor(s) round the clock
Raksha TPA

10. Raksha TPA Private Limited 10
General Exclusions Under the Policy
 Domiciliary Hospitalization
 OPD treatment
 Treatment related to infertility, Voluntary Termination of
Pregnancy
 External Accessories (e.g.) Walking Stick, Crepe bandage,
Spectacles, contact lens, hearing Aids etc.
 Non Medical Expenses (e.g.) Telephone Charges, Food Charges,
Registration Charges, Accommodation Charges for Relatives.
 Naturopathy Treatment , Homeopathic & Ayurvedic Treatment
 War Like operations whether declared or not
 Circumcision unless necessary for treatment of disease
 Cosmetic treatment
 Plastic Surgery
Raksha TPA

11. Raksha TPA Private Limited 11
General Exclusions Under the Policy
 Intentional Self Injury, Intoxicating Drugs, Alcohol, Congenital External
Disease, sterility etc
 Hospitalization meant for Oral Medication, primary Investigation is
non Payable
 Vitamins And Tonics unless part of treatment
 Hospitalization Less than 24 hrs other than day care treatments
 All Expenses related to the treatment of AIDS is not covered.
 Pre & Post Hospitalization charges for Maternity is Non Payable
Raksha TPA

12. PROCESS FLOW
Raksha TPA Private Limited 12
Raksha TPA

13. Cashless Services
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Emergency
Identification via UHID Cards
Approach Network Hospital
Planned
Pre-authorization request to
Raksha TPA from Provider
Raksha TPA Pvt Ltd
VERIFIED BY
DOCTOR
Authorization Issued Pre – Authorization Request Denied
Queries Raised for
further Clarification
 
Raksha TPA

14. Communication Support…
 Providing information directly from servers (www.rakshatpa.com):
- Claim Status
- Cashless Status
- ID Card Status
- Information on Network Hospitals
- Claim intimation
- Customer Care
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Raksha TPA Private Limited

15. EMERGENCY
APPROACH TO NON - NETWORK HOSPITAL
PLANNED
INTIMATE 3-4 DAYS
BEFORE ADMISSION
INTIMATE WITHIN 24 Hours from
ADMISSION
Hospitalization through Non-Network Provider
(Reimbursement Claims)
Raksha TPA Private Limited 15
Raksha TPA Pvt Ltd
 
SUBMIT DOCUMENTS IN 7 DAYS
FROM D.O.D
Raksha TPA

16. PROCESS FLOW
CLAIMS
Raksha TPA Private Limited 16
Raksha TPA

17. PROCESSING OF NON-NETWORKING CLAIMS
INSURED (REIMBURSEMENT with
intimation in 24 Hours
CLAIM RECEIVED BY RAKSHA
TPA PVT. LTD (within 7 days
from D.O.D.)
AUDITING
ENTRY ON LOCAL
WEBSITE
DOCTOR’S OPINION
PASSED
QUERY
NON PAYABLE
FINANCE
DEPARTMERNT
Raksha TPA
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18. WEB ENABLED SERVICES…
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Raksha TPA Private Limited

19. www.rakshatpa.com
Click here
Raksha TPA
Raksha TPA
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Raksha TPA Private Limited

20. Click here when you have entered your
member id
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Raksha TPA Private Limited

21. Either enter policy no. (incase you don’t know your
Raksha member id) or enter Raksha member id.
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Raksha TPA Private Limited

22. Than click here
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Raksha TPA Private Limited

23. Than click here
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Raksha TPA Private Limited

24. Now you can take the printout of this e-card.
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Raksha TPA Private Limited

25. MUST KNOW
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Raksha TPA

26. DO’S (Cashless Services)
 Pre-auth form should be sent along with insured/attendant cell no. duly signed
by treating doctor/hospital.
 Avail cashless treatment at Network hospitals for the covered ailments within
eligible amount under the policy.
 Leave back all the original documents and signed claim form with the network
hospitals at the time of discharge.
 Contact local Raksha office in case of any query.
 Make payment to the network hospital for the expenditure over and above sum
insured/ specified limit for any disease, and for the expenses/treatment not
covered under the package
 For current status of empanelment/de-empanelment of networking hospital,
please refer our website: www.rakshatpa.com
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Raksha TPA

27. DONT’S (Cashless Services)
 Don’t insist upon admission for investigations or evaluation or health
check-ups.
 Don’t carry back any original document at the time of discharge from the
hospital.
 Don’t forget to sign on claim form.
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Raksha TPA

28. After discharge policy holder has to submit the following
documents to Raksha TPA within 7 days.
Original detailed discharge summary
Payment receipt in original
Copy of ID card
Original hospital bill with breakup
Package break-up (if applicable)
Original investigation reports
Pharmacy bills with prescription
Claim form duly signed
Scan copy of Cancelled Cheque
Hospital registration certificate cont……
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Raksha TPA

29. Copy of MLC and FIR in Accidental Claims.
Obstetric History in Maternity Claims.
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Raksha TPA

30. Raksha TPA Private Limited 30
Raksha TPA