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TPA FAQ
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600000 Medical Checkups | 500000 TPA Members | Network of 3500 DC`s & Hospitals |
1. Who should the policyholder contact in the event
of claim under Overseas Mediclaim Policy?
2.What compensation is provided under the Individual Personal Accident Policy?
3.What are the different benefits that can be claimed under the Mediclaim insurance
policy in event of hospitalisation?
4.How do you decide whether a disease was a pre-existing one or not?
5.What is the procedure to be followed to apply for cover under an Overseas
Mediclaim policy?
6.How do I become member of your TPA?
1.Who should the policyholder contact in the event of claim under Overseas Mediclaim Policy ?
TOP
In the event of claim under Overseas Mediclaim Policy the policyholder can contact
any overseas insurance company
2.What compensation is provided under the Individual Personal Accident Policy ? TOP
under the Individual Personal Accident Policy.
If the accident results in death, the full Capital Sum Insured must be paid to the Insured’s beneficiaries.
In the accident results in permanent disablement that involves the total loss of both eyes or two limbs or one eye and one
eye and one limb, the full Capital Sum Insured is payable.
In case the accident results in loss of one eye and one limb, then only 50 percent of the Capital Sum Insured will be paid
In case the accident results in partial disablement of certain parts of the insured’s body, only a specified percentage of the Capital Sum Insured will be paid.
In case there is disablement excluding injuries that are not visible or verifiable through medical tests like sprains, muscular spasms, etc ALL the benefits listed above have to be paid PLUS 1 percent of the Capital Sum Insured subject to a maximum of Rs.3000 per week over the Capital Sum Insured. However the total period of compensation will not exceed 104 weeks or 2 years approximately.
3.What are the different benefits that can be claimed under the Mediclaim insurance po3.licy in event of hospitalisation?TOP
Different heads of benefits under hospitalisation
Room boarding expenses by the hospital nursing home
Nursing expenses
Surgeon, anaesthetist, medical practitioner, consultants, specialist’s fees
Anaesthesia, blood, oxygen, operation charge, surgical appliances,
medicines and drugs, diagnostic material and x-rays,
dialysis and chemotherapy, radiotherapy, pacemaker, artificial limbs and cost of organs and similar expenses
4.How do you decide whether a disease was a pre-existing one or not?TOP
While filling up the proposal form for insurance you need to provide details of the illnesses you have suffered during your lifetime. Such disclosures are important else at a later stage if discovered you could end up losing out terribly. At the time of insurance, you should be aware whether you have any disease and whether you are undergoing any treatment. The insurers refer such health issues to their medical panel to differentiate between pre-existing and newly contracted illnesses.
5.What is the procedure to be followed to apply for cover under an Overseas Mediclaim policy?TOP
To acquire cover under an Overseas Mediclaim policy, the traveler must submit his
Visa details and its validity
Country of visit
Passport details
Name and address of the sponsor, a certificate giving details of employment / studies and its duration
Period of cover required
Medical examination certificate as per the prescribed guideline
Income certificate of the sponsor in case of student
6. How do I become member of your TPA? TOP
One can member of this tpa by taking any individual policy / Group policy from any of the R.O’s that we service.
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