Transcript Diapositive 1 - Leading Sales Manager,Insurance, Health insurance

www.coris.fr
CORIS International
A
Presentation for
Star Health and Allied Insurance Company Limited
Introduction to Coris
•
Coris International
established in 1987.
•
CORIS International quickly developed its network worldwide,
handling international claims and assistance on behalf of insurance
companies and automobile clubs to the highest professional
standards
•
Coris International owns 50 offices worldwide in 47 Countries around
the world.
•
Coris International has 34 tie up offices in 30 countries around the
world.
is
an
International
Assistance
Company
Introduction to Heritage
•
Heritage Health TPA Pvt.Ltd., established on 30th December, 1998, is
the Indian Co-ordinator of CORIS International since July 2002 and
having its offices as under :
Registered : Mcleod House, 3 Netaji Subhas Road, Kolkata – 700 001.
Tel : +91 33 22484648
Corporate : Nicco House, 5th Floor, 2 Hare Street, Kolkata – 700 001.
Tel : +91 33 22486430; 22482784
Front Office : 1102, Raheja Chambers, 11th Floor, Free Press Journal Road,
Nariman Point , Mumbai – 400 021.
Tel : +91 22 66547960/ 61
Introduction to Coris
Coris International and Heritge Health are the overseas
medical service provider (OSP) for the GIPSA (Public Sector)
Companies namely :
National Insurance Co.Ltd.
New India Assurance Co.Ltd.
Oriental Insurance Co.Ltd. And
United India Co.Ltd.
and a few private players namely :
Star Health & Allied Insurance Co.Ltd.
Universal Sompo General Insurance Co.Ltd.
CORIS Network
Own & Tie-up Offices - Europe
Europe
Albania - Tirana
Andorra – La Velle
Austria - Vienna
Belarus – Minsk
Belgium – Gent
Bulgaria - Sofia
Croatia – Zagreb
Cyprus - Limassol
Czech Rep. – Prague
Denmark - Copenhagen
Finland - Tuusula
France – Paris (2)
Germany – Munich /
Voerde
Greece- Athens
Hungary - Budapest
Italy – Milan
Latvia - Riga
Lithuania – Vilnius
Malta – Valletta
Norway – Oslo
Poland - Warsaw
Portugal - Oeiras
Romania - Bucharest
Russia - Moscow
Serbia - Belgrade
Slovakia - Bratislava
Slovenia - Ljubljana
Spain – Madrid (2)
Sweden – Stockholm
Switzerland (Tie-up Office
also)
Turkey
Ukraine - Kiev
UK – London / Farnham
CORIS Network
Own & Tie-up Offices – North & South America
North and South America
USA - Miami
Argentina - Buenos Aires
Brazil - Sao Paulo
Colombia - Bogotá
Ecuador - Quito
Mexico - Mexico D.F.
Uruguay - Montevideo
CORIS Network
Own & Tie-up Offices – Africa & Middle East
Africa and Middle East
Egypt – Cairo
Israel – Tel Aviv
Kenya – Nairobi
Morocco – Casablanca
Saudi Arabia – Riyadh
South Africa – Edenvale
Tunisia – Tunis
CORIS Network
Own & Tie-up Offices – Asia Pacific
Asia Pacific
Australia
China
India
Malaysia
Singapore
Sri Lanka
Thailand
•The Haj Experience
Introduction to Coris
• Coris has allocated 3 centres to cater to the policy
holders of Travel policies as under :
•
•
Coris USA Inc: 11900 Biscayne Blvd # 803,Miami, Florida 33181, USA
Jurisdiction : North, Central & South America
•
•
•
Coris International
& Coris Assistance : 110 Avenue de la république 75011Paris,France
Jurisdiction : Continental Europe, UK & Ireland, Africa, Pakistan
•
Heritage Health TPA Pvt.Ltd. :1102, Raheja Chambers, Free Press
Journal Road, Nariman Point, Mumbai- 400 021, India.
Jurisdiction : South & South East Asia, Middle East, Australia & New
Zealand
•
COORDINATING OFFICES
Paris
Miami
North & South America
Europe , Africa &Middle East (
Incl. Pakistan)
Mumbai
Asia Pacific Region
(Excl.Pakistan)
Details of Toll Free Numbers (America, Europe, &
India)
Europe - Toll Free Numbers - No. (800) - 4141 4444 is operative and
can simultaneously handle 25 incoming calls at a time. Toll-Free
lines are manned by employees fluent in English.
North America - Toll Free Numbers - +1-877-5367264 & +1-8003589105 can handle several incoming calls simultaneously and is
operative all over North America including Canada. Toll-Free lines
are manned by employees fluent in English.
India - Phone no. 1800 224004 (Toll Free) is operative in India. TollFree lines are manned by employees fluent in Hindi & English.
CORIS Employees dealing with Health Insurance Claims
CORIS worldwide employs more than 900
persons in their own offices dealing with Travel
Health Insurance Claims, for Example:
• France – 57 employees
• USA – 50 employees
• India – 20 employees
CORIS Management in most countries have over
25 years of Experience in the business
• 95% of the staff that are recruited are multi-lingual and are
fluent in more than one language
Coris’s Tie-up with Hospitals in US/ Canada and
Other countries
CORIS Group has Twelve Thousand Five Hundred plus tie ups with Medical
Service Providers (Hospitals) all over the world out of which in USA alone,
CORIS has over :

6,200 tie ups with Hospitals
In addition to above CORIS has also tied up with :



400,000 with Physicians in USA
40,000 with Dental Physicians in USA
80,000 with Medical Centers in USA
The list of hospitals in USA/ Canada and other countries can be viewed on the website
www.coris-heritage.com
Process-Flow of a Claim
- First Call
- Assistance
- Evaluation of Medical Records
- Determining of Admissibility of the Claim
- Issuance of Cost Guarantee to the Provider
- Processing
- Billing
- Payment - To Insured / To Provider
First Call
•
•
•
•
•
•
Calls received at the Toll-Free numbers at Coris
Operator at Coris answers the call and verifies the information
For GIPSA Cos and Star Health the policy is faxed to the number shown in the
Policy
For a valid policy the Claim Dossier is created for the Insured in the Software
which Includes:
– Type of Loss
– Type of Assistance Required
Software will generate a Reference No. which will be given to the Insured for
tracking the claim status online and for quoting the same in all future
correspondences
Even if the Call requires no Assistance, all the data of the call is recorded on
the system. The Call Centre at Coris will have all the information required to
handle the situation and will guide the Insured on:
– The claims process
– The deductible and SI
– The documentation
– The exclusions
Assistance
ASSISTANCE - CORIS
• If Assistance is required, then Coris will
arrange for the Assistance which would be
Arranging the following:
– Ambulance
– Doctor’s Visit / Appointment
– Referral to Nearest Hospital
– Legal Assistance
– Any other type of assistance required
Evaluation of Medical Records
• The different types of Medical Claims will be taken care of by the
following services as under:
– OPD
– Hospitalisation / ER (Emergency Room)
• For OPD Treatment, the following documents will be sent to Coris:
– Doctor’s Diagnosis
– Reports
• For Hospitalisation / ER, the following documents will be sent to Coris:
– Admission Diagnosis
– Reports and Discharge Summary
• Coris’ Medical Department will Evaluate the Medical Records
Determining the Admissibility of the Claim
• After Evaluation of the Medical Records by
Coris’ Medical Panel, the admissibility of the
claims will be determined based on the
following criteria:
–
–
–
–
The Claim is not ELECTIVE, but a NECESSITY
Not due to a pre-existing disease
Not the sole reason for the trip
The customer should not have availed of
treatment if not needed
Issuance of Cost Guarantee / Authorisation to the
Provider
• Coris will provide the cost guarantee / authorisation for the
procedure to the provider
• If the claim is not admissible, then Coris will inform the patient
and the provider accordingly
• All Medical Reports / Discharge Summary received by Coris
will be scanned for completing the documentation required
for claims processing
Services by Heritage
Services Provided by Heritage Health TPA Pvt.Ltd.
1.
2.
3.
4.
5.
6.
High quality 24x7 service through Indian languages
speaking operators.
Strong web enabled client server based software.
Online with Coris Network worldwide.
Helping in reconciliation & management of funds
between Coris and Star Health.
Maintaining confidentiality.
Respond to any queries raised by the Star Health.
Services by Heritage
8. Guide clients in completing claim documentation
9. Process and sanction claims upto US $ 3000
10. Maintain complete liaison between Coris and Star
Health
11. Investigate in India, if needed, any doubtful and
specific claim.
12. Provide information on claims every month to Star
Health.
13. Follow up with Coris on specific enquiries for claims.
14. Consolidate premium data received from Star Health
to Coris.
www.coris.fr
Thank you
CORIS INTERNATIONAL | 110 Avenue de la république 75011 Paris, France
Tél. 33(1) 41 61 23 07 | Fax : 33 (1) 44 51 16 93 | Email : [email protected]