Safeway TPA Services (P) Ltd.A

PresentationFor

IIT, DELHI 27 FEBRUARY 2012

POLICY COVERAGE

STANDARD “VIDYARTHI MEDICLAIM POLICY”

POLICY DETAIL_ IIT

INSURER : NATIONAL INSURANCE

POLICY START DATE : 17 SEP 2011

POLICY EXP DATE : 16 SEP 2012

FAMILY SIZE : 1 (STUDENT)

SUM INSURED : 1,00,000/-

POLICY TYPE : STANDARD(VIDHYARTHI)

APPLICABLE MEMBERS

Total No of people Insured 1 (STUDENT ONLY)

SELF NO

Spouse NO

Children NO

Parents NO

Parents-in-Law NO

Siblings NO

Others NO

SCOPE OF COVER1) Room, Boarding expenses as provided by the Hospital/Nursing Home.

2) Nursing expenses ( Within Room Rent Limit).

3) Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees.

4)Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical appliances any disposable consumables subject to upper limit of 10% of Sum Insured), Medicines & Drugs, Diagnostic Materials and X-Ray, Dialysis, Chemotherapy, Radiotherapy, Cost of pacemaker, Artificial Limbs and cost of Stents and implants

Major Exclusions of policy( 4.1 , 4.2 and 4.3)

NONONOCOVERAGE

EXCLUSION OF

SPECIFIC DISEASES

WAITING OF 30DAYS

PRE-EXISTING DISEASE

REMARKS

4.34.24.1CLAUSE NO

Detail of Clauses

Clause No 4.1 (Pre-Existing Disease)

All disease/injuries/ailment which are pre-existing when the cover incept for the first time.

Detail of Clauses

Clause No 4.2

Any Disease other than those stated in clause 4.3, contracted by the insured person during the first 30 days from the commencement date of the policy.

Detail of Clauses

Clause No 4.3

During the first 2 years of the operation of the policy the expenses incurred on treatment of diseases such as Cataract, Benign ProstaticHypertrophy, Hysterectomy, Hernia, Hydrocele, Congenital Internal Disease, Fistula in anus, Chronic fissure in anus, Piles, Pilonidal Sinus, Sinusitis, Stone disease of any site, Benign Lumps/growths in any part of the body, CSOM(Chronic Suppurative Otitis Media), joints replacements of any kind unless arising out of accident, surgical treatment of Tonsils, Adenoids and deviated nasal septums and related disorders are not payable.

COVERAGE OF PRE – POST HOSPITALIZATION

PRE - HOSPITALIZATION :-Relevant Medial Expenses incurred during period up to 30days prior to hospitalization on disease/illness/injury sustained will be admissible

POST – HOSPITALIZAION :- Relevant Medical Expenses incurred up to 60days after hospitalization will be admissible.

What is Not Covered *

Injury or disease directly or indirectly caused by or arising from or attributable to War or War-like situationsWorking Student in Vidhyarthi PolicyCircumcision unless necessary for treatment of diseaseDental treatment of any kind unless requiring hospitalizationCongenital external diseases or defects/anomalies HIV and AIDSHospitalization for convalescence, general debility, intentional self-injury, use of intoxicating drugs/ alcohol.Venereal diseasesInjury or disease caused directly or indirectly by nuclear weaponsNaturopathyAny non-medical expenses like registration fees, admission fees, charges for medical records, cafeteria charges, telephone charges, etcCost of spectacles, contact lenses, hearing aidsAny cosmetic or plastic surgery except for correction of injuryHospitalization for diagnostic tests onlyVitamins and tonics unless used for treatment of injury or diseaseInfertility treatmentVoluntary termination of pregnancy during first 12 weeks (MTP)

* These are only major Clauses

Claim Process

Cashless ClaimsTo avail cashless hospitalization treatment at network hospitals –

Step 1: SAFEWAY will provide the list of network hospitals offering cashless facility for treatment.

Step 2: The claimant needs to produce the SAFEWAY Health card at the hospital.

Step 3: Hospital sends Pre-authorization Request with the treatment details; past history and clinical notes along with estimate of hospitalization expense to SAFEWAY local office.

Step 4: SAFEWAY issues a letter authorizing treatment to the Hospital the approved amount up to the Sum Insured limits.

Cont………

Cashless

• Step 5: In case the treatment is taken at other non network centers, the Insured is reimbursed the cost of treatment, subject to the provisions of the Policy on the basis of Admit

Card/Discharge Card, Diagnostic Reports and Bills/Prescriptions.

Step 1: Please immediately intimate SAFEWAY TPA Services about the claim. Claim intimation can be done by the following methods.

Inform the Call Centre at Toll Free No: 1800-102-5671 / 41425671 And intimate the claim to support@safewaymediclaim.com, info@safewaymediclaim.com, & query@safewaymediclaim.com

Step 2: At the time of intimation, the customer should provide the following a. SAFEWAY ID card No/ copy of ID Card (Student) with Mobile No & E-Mailb. Date of Hospitalization c. Ailmentd. Approximate Date of Dischargee. Approximate Date of Claim submission.

Step 3: Download the Claim Form & Medical Certificate Form from our website and fill all columns. The Medical Certificate Form will be filled by the treating doctor.

Step 4: Submit filled and signed Claim and Medical Certificate Forms to your “Student Affair Section”

Cont……..

Re-imbursement Process

Re-imbursementStep 5: SAFEWAY will assess the validity of the claim based on the documents submitted, validate the policy, validate the treatmentundergone and settle the claim within the claim settlement parameters. In case of claim is not adhering with parameters, the case would be rejected.

Step 6: SAFEWAY will correspond with you within 7 days of Claim receipt -

Step 7:Event of Settlement: Please sign the Discharge Voucher and send it back to local SAFEWAY officeEvent of Shortfall: Please forward the requested documents for settlement of claim to local SAFEWAY office.Event of Disallowance: Please forward the necessary documentation not submitted before to process disallowance and for addendum settlement

E- Cards

E- CardsSTEP 1- LOGIN to our Web SITE

www.safewaymediclaim.com

E- CardsSTEP 2- click on below “Know Your Card Status” ( Right Side)

CLICK HERE

E- CardsSTEP 3- Fill the details

IIT

YOUR ROLL NO

E- CardsSTEP 4- PRINT LINK & COVERAGE DETAIL

CLICK HERE FOR PRINT YOUR CARD

E- CardsSTEP 5- PRINT YOUR CARD

NOW YOUR E-CARDIS READY FOR PRINT

NOTE : IT IS VALID ONLY WITH COPY OF YOUR STUDENT ID CARD

Contact us…..

SAFEWAY TPA SERVICES (P) LTD Mr Rahul Vij : 092122319826/2, 1ST FLOOR, KIRTI NAGAR INDL AREA Mr Gurpreet Singh: 09990079269NEW DELHI - 11 00 15PH - 011-41425671 TOLL FREE - 1800 -102-5671TOLL FREE FAX – 1800-102-5672E-MAIL ID : support@safewaymediclaim.comurl : www.safewaymediclaim.com