Group Mediclaim Policy

Employee & Parent’s Policies.

2024-2025
 Contents
Group Medical Insurance – Policy Features

Claim Procedure- Cashless & Reimbursement

General Exclusions

Contact Points

FAQ’s
 Policy Details
Insurer Name The Oriental Insurance Company Limited

Policy Number 431300/48/2025/136

 Employee Policy Family Definition 1+3 (Self, Spouse & children)
Sum Insured Rs. 2,00,000/-
Policy Number 431300/48/2025/135
 Parents Policy Family Definition Only Parents
Sum Insured Rs. 2,00,000/-
Third Party Administrator Medi Assist TPA

Policy Start Date 14th April 2024

Policy End Date 13th April 2025 / Date of leaving

Coverage Type Family Floater

Claim Type Cashless and Reimbursement
Medical Benefit – Coverage Details

Benefit Details
 Yes, Minimum 24 hours hospitalization required with
 Standard Hospitalization
active line of treatment
 Covered, Pre-hospitalization expense for 30 days &
 Pre-Post Hospitalization Expenses
post hospitalization expense for 60 days
 Pre-existing diseases  Covered from Day one
 Waiver on 1,2,3 & 4th year waiting period  Waived off
 Waiver on 30 days waiting period  Waived off
 Maternity benefits  Not Covered
 Baby coverage  Covered from day one within Family Sum Insured
 Day Care procedures  Covered as per Insurer’s List
 Covered in case of Accidental hospitalization for 24
 Dental Benefit
hours
 Room Rent Eligibility  2 % Room Rent & 3 % ICU of Sum Insured.
 Ambulance Services  Covered up to 2 % of the sum insured.
 Co-Payments  No Co-Payment
Medical Benefit – Coverage Details

Benefit Details

 Conventional cancer to be covered

 Additional Coverage (Including regular chemo excluding any adjuvant or oral
chemotherapy claims)

 Covered in case of Hospitalization not on Home Isolation

 Covid 19
basis treatment

Cataract Capping  Rs 32000/- per eye

Terrorism Related Hospitalization  Covered

Internal Congenital disease  Covered

External Congenital disease  Not Covered

Claim Intimation  Not Required

Claim Submission  30 days from date of discharge from the hospital

Claim Submission for post hospitalization  Within 7 days after completion of 60 days from date of
expenses Discharge
 Do’s & Don’t

√ Midterm addition of existing dependents are not allowed except natural additions.
√ Addition of Natural dependents (newly married spouse & newborn baby) allowed subject to
intimation received by the Insurance company within 30 day of the event i.e. marriage or childbirth.
√ 24 Hrs hospitalization is compulsory with active line of treatment to avail insurance benefit except
day care procedures.
√ Any hospitalization for observation purpose is not payable.
√ OPD Benefit (doctor consultation, diagnostic procedures etc.) is not covered in this policy.
√ Reimbursement claims should be submitted within 30 days from the date of discharge.
√ Pre-hospitalization reimbursement claims should be submitted within 30 days from the date of
discharge.
√ Post hospitalization reimbursement claims should be submitted within 7 days after completing 60
days from the discharge date.
√ If there is any planned hospitalization, cashless needs to be initiated from hospital prior 24-48
hours for hassle free approval.
Medical Benefit – Standard Coverage

Reimbursement expenses related to

• Room, Boarding expenses as provided by the Hospital / nursing home.

• Nursing Expenses.
• Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees
• Anesthesia, Blood, Oxygen, Operation Theatre Charges, surgical
appliances, Medicines & Drugs, Diagnostic Materials and X-ray

*The expenses are payable provided they are incurred in India and within the policy period.

Day Care expenses

Expenses on Hospitalization for minimum period of 24 hours are admissible. However, this time
limit will not apply for specific treatments under Day Care, i.e. Dialysis, Chemotherapy,
Radiotherapy, Cataract , Lithotripsy (kidney stone removal), Tonsillectomy, D & C taken in the
Hospital and the insured is discharged on the same day of the treatment will be considered to be
taken under Hospitalization Benefit.
Room Rent & ICU Charges

Benefit Details
Normal Room ● 2% of Sum Insured (INR 4000/- per day)
ICU Room ● 3% of Sum Insured (INR 6000/- per day)

In case the patient is admitted to a room with rentals

higher than the eligible amount, the additional
proportionate expenses (applicable on all heads as
per hospital final bill) would have to be borne by the
claimant.
 Reimbursement Claim Process – Offline Process

Collects all medical documents

Beneficiary visits (Bills, receipts, Discharge
hospital for treatment summary, all reports and tests,
consultations etc.) on discharge

Medi Assist processes Approves / Denies the

the claim / Intimates claim once the query
Submit the documents beneficiary if any documents received
In MEIL Head office document shortfall

Claim Submission at Helpdesk or at below address : In case claim is

approved, Amount
GUNAKAR.P // L Akhil, Extn : 6248,Mobile: 9100030117 gets credited to
Tower II - First Floor Employee’s account
M/s. Megha Engineering & Infrastructures Limited
S-2, Technocrat Industrial Estate,Balanagar, Hyd - 500037.
1
 Reimbursement Claim Process – Online Process

Collects all medical

documents (Bills,
receipts, Discharge
Beneficiary visits summary, all reports
hospital for treatment and tests,
consultations etc.) on Medi Assist processes
discharge the claim / Intimates
beneficiary if any
document shortfall

1
Enter bank account Approves/Denies the
details claim once the query
Upload documents received
2 documents and
Update details of medical submit the claim
Login to MediBuddy
expenses online and Beneficiary to submit
portal and click on submit the original documents to
submit claim original
Verify document MEIL Head office
3 documents to
submission with the
helpdesk.
checklist

In case claim is
approved Amount gets
credited to Employee’s
account
Claims Document List - Reimbursement

Duly filled claim form PART A and PART B (To be filled and signed by
hospital) along with check list. Check list and Claim form
Original Discharge Summary Original with hospital seal and sign.
Original Hospital final bill with break up of it with hospital seal and sign.

Original Cash paid receipts with hospital seal and sign. ClaimsChecklist.pdf Claim Form.pdf
All Original Investigation reports & Films (X-ray/MRI/CT Scan)
Original Medicines bills with break ups with prescriptions.
Diagnosis confirmation investigation reports - Original and Mandatory.
RTPCR only for COVID cases.
A-Scan and IOL sticker and invoice for cataract ailments.
Copy of E card. Link for Network Hospital
Id proof of Patient & KYC of Employee (Copy of Aadhar and Pan card). https://www.medibuddy.in/networkHospitals

Name printed Cancelled cheque of primary member/employee. Link for E Card

(In case if cheque is not available, copy of Passbook or Bank Statement
can be shared). https://www.medibuddy.in/ecard

*Please retain photocopies of all documents submitted, Other documents may also be required on case-to-case basis
Medical Benefit – General Exclusions

• Injury or disease directly or indirectly caused by or arising from or attributable to War or War-like situations.
• Circumcision unless necessary for treatment of disease.
• Congenital external diseases or defects/anomalies.
• HIV and AIDS.
• Hospitalization for convalescence, general debility, intentional self-injury, use of intoxicating drugs/ alcohol.
• Venereal diseases.
• Injury or disease caused directly or indirectly by nuclear weapons
• Naturopathy
• Any non-medical expenses like registration fees, admission fees, charges for medical records, cafeteria
charges, telephone charges, etc.
• Cost of spectacles, contact lenses, hearing aids.
• Any cosmetic or plastic surgery except for correction of injury.
• Hospitalization for diagnostic tests only.
• Domiciliary hospitalization is not covered.
• Vitamins and tonics unless used for treatment of injury or disease.
• Infertility treatment.
• Voluntary termination of pregnancy during first 12 weeks (MTP).
 Contact points for Assistance - Medi Assist
Team (TPA)

For all type of queries related for Mediclaim policy, Cashless/Reimbursement process,
E-card, Network hospital and Assistance in claim, please follow below matrix.

Team would be happy to assist you !

Escalation Matrix Medi Assist Team (TPA)

Level Name Contact No. Email Id

Level I Mr. Pullam Raju +91 6366380244 [email protected]

Level II Mr. Shaik Razzak +91 8897427865 [email protected]

Level III Mr. Pilla Sreekanth - [email protected]

Contact points for Assistance – MEIL GMP
Help Desk

Communication Matrix for Meil GMP Help Desk

Name Contact No. Email Id
Gunakar P +91 9100030117 [email protected]

Akhil do [email protected]
Always Assuring of our best services….