मेडीक्लेम धारक ध्यान दें

SAIL MEDICLAIM SCHEME 2018-19

POLICY START DATE : - 11 APRIL, 2018

POLICY END DATE      : - 10 APRIL, 2019

POLICY COVERAGE

OPD BENEFIT

• RS. 4000/- Per member below 70 yrs of age as on 31.03.2017Persons completing 70 yrs of age as on 31.03.2017 will also be considered for enhanced OPD
• 
  
• The OPD facility cannot be clubbed between the Ex-employee and his/her spouse

• IPD BENEFITS
• Rs. 2 Lac per member per policy Period with clubbing facility under hospitalization with his/her spouse. (Maximum clubbed limit Rs. 4 lac per policy period)
• CLAIM SUBMISSION - OPD Claims to be submitted by the policy member to the IC/ TPA when the expenses is equal to or above Rs. 2000/- or after 90 days whichever is earlier.


CLAIM SUBMISSION FOR HOSPITALIZATION

The Reimbursement claims with respect to  IPD/ Hospitalization to be submitted to the TPA within 30 days from the date of Discharge from the hospital.
• The reimbursement claims pertaining to Post hospitalization (IPD treatment) to be submitted to the TPA withing 30 days after the completion of permissible post Hospitalization treatment period of 60 days.




MANDATORY CLAIM INTIMATION/ SUBMISSION


• The Mediclaim member shall be required to inform/ intimate, in writing, the Insurance Agency/ TPA at least 48 hrs prior to any elective/ planned Hospitalization/ Admission
In case of emergency Admission/ Hospitalization, the Insurance Company/ TPA, to be informed by the Mediclaim member, in writing within 24 hrs of such hospitalization.
The claim Intimation by the Mediclaim member is mandatory for both Cashless and Reimbursement claims.
Claim Intimation can be sent via Toll Free No./Letter/ Email/ Fax/Phone to any MD India Branch/ Personally Delivered at TPA offices.
• OPD Treatment should be from the Govt. Hospital or from the listed OPD hospital.
• IPD Claims:
  • Cashless – Would be done at the Network Hospitals.
  • Non-Cashless – Other than Network Hospitals