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Health Benefit Plan 2011 - 2012
1 Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Agenda
Group Health Insurance
UnitedHealthcare Parekh TPA Service Offerings
Group Health Insurance Current Insurer The Oriental Insurance Company Ltd
Policy Benefits

Benefit commences on April 01, 2011 and ends on March 31, 2012 Sum insured : 200000 Beneficiaries: The family includes the employee, spouse, 2 children Benefits: Maternity benefit up to Rs.30000 for C-section and Rs.25000 for Normal delivery with no 9 months waiting period Baby s coverage : From Date of Birth Pre-existing diseases covered 1st-4 years exclusion waived off 30 days waiting waived off Room Rent including nursing and boarding charges 1% of sum insured and 1.5% of sum insured for ICU
Scope of Insurance Cover

Includes:
Only in-patient hospitalization expenses. Active treatment with minimum 24 hours hospitalization.
Excludes:
Non - Medical Expenses - Registration/Admission fees, hospital surcharge, food bills for attendants, telephone charges, pharmacy charges for nonmedical items etc. Out Patient (OPD) treatment Other standard exclusions
Standard exclusions to the Insurance Cover

Injury or disease directly or indirectly caused by or arising from or attributable to war or war like
situations and by nuclear weapons.

Terrorism Circumcision unless necessary for treatment of diseases Dental treatment of any kind unless requiring hospitalization Congenital external diseases or defects/anomalies Hospitalization for convalescence, general debility, intentional self-injury, use of intoxicating
drugs/ alcohol.
Venereal diseases, HIV and AIDS, Infertility treatment and Naturopathy Cost of spectacles, contact lenses, hearing aids Any cosmetic or plastic surgery except for correction of injury Hospitalization for diagnostic tests only even if prescribed by a medical practitioner Voluntary termination of pregnancy during first 12 weeks (MTP) Lasik Surgery (correction of refractive error of the eyes) Unproven or experimental treatment not approved by Indian Medical Council
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group. 6
UnitedHealthcare Parekh TPA Pvt. Ltd. - Service Offerings
UnitedHealthcare Services
e cards. Cashless Hospitalization through HealthConnect. SMS facilities for Pre-authorizations. 24 hour telephonic Nurseline. Claims Administration.
Procedure for Online enrollment

Please follow the below steps to Login Go to https//:www.uhcindia.com via the Internet. Select e-Enroll Login (bottom left) Log on with the help of the username and password which will be sent to you directly from UHC Parekh TPA. You can now view your details. To Print e-Cards Go to https//:www.uhcindia.com via the Internet. To print e-cards, click on the ID-card status link Click on the `Print ID card` for each member and print the card. You are allowed to print each ID card only 3 times. Please ensure that you save the ID cards. Log off once the e-Card is printed.
Cashless Hospitalization - HealthConnect

Our Network consists of approximately 3373 hospitals in 419 cities.

To locate a network hospital Login to www.uhcindia.com Select HealthConnect Provider Network then click on Hospital List Username uhcindia Password uhc586

How does the plan work ?

Hospitalization event can be: Planned or Emergency
In a Network hospital or Out of Network
Network Hospitalization (Planned)

Call up Nurseline (022-3065 7331) 48hrs prior to Admission date Nurseline Sends Pre-Auth (Available on www.uhcindia.com)
Fill it up by the help of the treating Doctor and fax it back to the Nurseline (022-2852 8222) Medical Management Team assesses the Pre-auth and after it is approved, Nurseline sends Credit letter to Network Hospital
All Medical Expenses including Room Rent would be covered

Network Hospitalization (Emergency)

Call up Nurseline if possible
Or else, get hospitalized into the nearest Network Hospital with the E- card
Get the Patient treated and after the patient has Stabilized, complete the Pre-auth process
You can also identify yourself as a member of UHCP so that they can assist you with the Pre-auth formality.
Procedure of discharge at Network Hospital

All the original documents and bills will be sent to us directly by the hospital.
Please sign the main hospital bill and ask the hospital for photocopies, if required
Submit a claim form signed by the claimant/employee to the hospital else the
claim is not reimbursable
If you have any reports/documents or you have incurred any other expenses for
medicines purchased pertaining to the hospitalization, submit these as well
Kindly settle the bill for non medical expenses / co-pay if applicable at the
hospital.
Non-Network Hospitalization (Planned & Emergency)

Complete the Pre-auth so that we can intimate you on your claim eligibility. Kindly make the arrangements for the admission and pay for all expenses at the hospital
Claim needs to be sent to us within 7 days from the Date of Discharge
Collect all original documents from the Hospital including the Hosp. & Dr. Reg No.
Procedure of discharge & claim at Non Network Hospital

PRE AUTHORIZATION is necessary- else the claim is liable to get rejected. The employee is requested to arrange for the admission and all other payments
required by the hospital.
Collect and submit the following documents (in original) after discharge
Discharge Card. Main Hospital Bill. Signed Claim Form. Prescriptions, reports and bills for all investigations done. Prescriptions and bills for medicines consumed during hospitalization. Break-up of the medicines bills amount to Rs.200/- or more.
Hospital s registration number is required. NOTE: A claim will not be assessed if the documents mentioned in red are not
submitted.
Claim Intimation Timelines - Important

Claim Submission Timeline - All claims to be submitted to the TPA within 7 days from date of discharge. Claim Intimation For all non-cashless claims, members would need to send an intimation mail to [email protected] with the following details, intimation for all planned hospitalization should happen two days prior to admission (or within 24 hours of hospitalization in case of emergency) Name of Employee Name of Corporate Name of Dependent Patient ( if applicable) Employee ID Name of Hospital / Provider Date of Admission Probable Cost of Hospitalisation Probable Diagnosis Any other Information as felt necessary Any delayed intimation or submission beyond the timeline mentioned above will be rejected.
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Claims Administration
Claims Administration Team
Document handling Registration of claim with insurer Liaison with insurer for payment Explanation of paid amounts and rejection Sends reminders for the missing/required document(s). In case of non-receipt of the same, may send the entire claim back to the employee or deduct the appropriate amount and send the balance claim for QC
Document Recovery Team (DR Team)
Quality Check Team (QC Team)

Re-assesses the claim to ensure that the claim is complete in all respect before sending it for payment to the insurance company.
Claim settlement
Approximate time to settle claim is 15 working days from completion of documentation
Help Line Numbers

Customer Service line Mon- Fri (9.00 am - 5.00 pm) All general queries relating to Id-card, claims status etc.
( 1800-22-4646 (Nationwide toll free) ( or 022- 3065 7351

Email: [email protected] Nurseline (24 hours): Hospitalization queries only
( 1800-22- 4545 (Nationwide toll free) ( or 022- 3065 7331

Email: [email protected]
Thank You

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iCreate Software Pvt. Ltd.

Health Benefit Plan 2011 - 2012

 Group Health Insurance

 UnitedHealthcare Parekh TPA Service Offerings

Scope of Insurance Cover

Standard exclusions to the Insurance Cover

situations and by nuclear weapons.

UnitedHealthcare Parekh TPA Pvt. Ltd. - Service Offerings

Procedure for Online enrollment

Cashless Hospitalization - HealthConnect

How does the plan work ?

 In a Network hospital or Out of Network

Network Hospitalization (Planned)

All Medical Expenses including Room Rent would be covered

Network Hospitalization (Emergency)

Procedure of discharge at Network Hospital

Non-Network Hospitalization (Planned & Emergency)

Claim needs to be sent to us within 7 days from the Date of Discharge

Procedure of discharge & claim at Non Network Hospital

Claim Intimation Timelines - Important

Document Recovery Team (DR Team)

Quality Check Team (QC Team)

Help Line Numbers

( 1800-22-4646 (Nationwide toll free) ( or 022- 3065 7351

( 1800-22- 4545 (Nationwide toll free) ( or 022- 3065 7331

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Group Health Insurance

UnitedHealthcare Parekh TPA Service Offerings

In a Network hospital or Out of Network

Document Recovery Team (DR Team)

Quality Check Team (QC Team)