Transcript Slide 1
RAKSHA TPA PVT LTD WARMLY WELCOMES FAMILY OF CONSOLIDATED CONSTRUCTION CONSORTIUM LTD WE WISH EVERYONE A VERY HEALTHY YEAR HEALTH IS WEALTH. RAKSHA ENSURES GOOD HEALTH CONCEPT OF TPA TPA STANDS FOR THIRD PARTY ADMINISTRATOR ABOUT RAKSHA TPA PVT LTD • IRDA Licensed TPA (License No.015) • Promoted by Mrs.Ritu Nanda, an Icon in insurance field, Mr.Rajan Nanda, Chairman, Escorts Group and Padma Bhusan Dr.Naresh Trehan, Chief Cardio Thoracic Surgeon • ISO 9001-2000 Certified company by TUV of Germany • Associated with All Insurance companies in India Claim Process - Cashless Network Hospital Emergency Admission Hospital/Relative of the patient calls up Raksha Planned Admission Intimate at least 72 hours prior to admission & get AL issued Intimate Raksha within 24 hours of admission. Authorization Letter (AL) issued depending on plan benefit & balance sum available . Cashless Medical Facility to the limit of available Sum provided to the hospitals Call Account Manager of Raksha TPA Fax Pre-Authorization Form stating : Name of Patient Member ID Ailment/Diagnosis Pre-existing diseases if any Approx date of admission Approx duration of ailment/stay Approx Cost of Hospitalization Influence of alcohol in accident cases Claim Process Non-Cashless Non-Network Hospital Emergency Admission Planned Admission Get the treatment done After Discharge send following in original to HR Claim form (duly filled & signed) Discharge Summary Hospital Final bill and receipt Investigation Reports if any Prescriptions & Bills for medicines, Surgical items Details of Pre & Post hospitalization expenses if any` Claim will be processed and the cheque would be sent to the Corporate HR Are all documents complete ? Deficiency letter would be mailed to Corporate HR Documents required • You must submit following documents in Original within 30 days of discharge from the hospital thro HR • Signed Claim Form of Insurance Co. • Original Final Hospital Bill along with Payment Receipt • Original Discharge Summary / Card • All Original Investigation Reports • Original Bills & Receipts for investigations done outside hospital. • Doctors Prescription, Pre – Post Hospitalisation bills (in original) • Original Bills of medicines,etc. if any purchased *kindly retain a copy of all documents for future reference Compensation Payable • Reasonable and necessarily incurred – Room Expenses in Hospital/Nursing Home – Nursing Expenses – Medical Practitioner Fee – Treatment cost • Medicines • Blood / Oxygen • Cost of Pacemaker / Artificial Limbs / Cost of Organs • Operation Theatre Charges • Surgical Appliances • Diagnostic cost • Dialysis, Chemotherapy, Radiotherapy • Pre Hospitalisation (30 days) and Post Hospitalisation expenses (60 days) • Max of Sum Insured SERVICE PARAMETERS Issuance of ID cards Issuance of pre auth SMS alert for cashless approval Settlement of reimbursement claims Issuance of deficiency letter Processing after retrieval of deficiency Repudiation of claims Data not found cases (DNF) intimation MIS reports 6 working day Within 3 hours Immediate 14 Working days 3 working days 7 working days 3 working days 2 working days Monthly basis Policy Details Insurance Co : ICICI LOMBARD INSURANCE Policy No. : 4016/0002326/01 Policy Period : 26/06/08 TO 25/06/2009 Corporate Name : CONSOLIDATED CONSTRUCTION CONSORTIUM LTD Address : 5, II LINK ROAD, CIT COLONY, CHENNAI – 600 004 POLICY COVERAGE SUM INSURED ON A FLOATER BASIS OF 3 LAKHS PER FAMILY PRE EXISTING DISEASE IS NOT COVERED MATERNITY IS NOT COVERED POLICY COVERS EMPLOYEE, HIS/HER LEGALLY WEDDED SPOUSE, 2 LIVING CHILDREN AND DEPENDENT ROOM RENT CAPPING 1 % OF SUM INSURED, ICU 1.5 % OF SI PRE 30 DAYS & POST 60 DAYS HOSPITALISATION IS COVERED Exclusions • • • • • • • • • • • War / war group Nuclear perils Plastic surgery Spectacles/contact lens/ hearing aid & other external appliances Dental treatment Intentional self injury Influence of intoxicating drugs / alcohol Treatment for AIDS Diagnostic / laboratory expenses not consistent with treatment Vitamins / tonic inconsistent with treatment Naturopathy Contact Details Raksha TPA Mr. Rajeswaran ([email protected]) Mobile No : 97909 51678 Escalations, if any Mr. R.Sethumadhavan ([email protected] or [email protected]) Mobile No. 97890 86557 OR T.R.Venkatachlam ([email protected] or [email protected]) Mobile No. 99404 55582 Chennai Office: PLN Complex, 18/4 Conran Smith Road, Gopalapuram, Chennai 600 086. Office Tel: 2835 0536 / 2835 0537 Fax: 2835 0538 Website: www.rakshatpa.com 24/7 Helpline Mumbai 022-22632727 Fax : 022 - 2263 2451/57 Faridabad 0129-2250 0000 Fax : 0129- 4100185/87 Thank you