Insurance

 

Introduction

The emerging market in health sector is Health Insurance.

All the industries and corporate sectors tie up with all major hospitals for the medical needs of their employees and employers through Third Party Administrators in case of Pvt Insurance and through Employees State Insurance for their employees as Govt. /Statutory compliance.

At M. M. J E I, has an exclusive dedicated Dept. /section to cater to the needs of patients covered by insurance and Corporate. The Dept. is having a team of Committed and specially trained in Insurance and medical reimbursement modalities.

MMJEI- has developed a checklist of documents to be submitted for each insurance / corporate for fast claim processing. This cashless facility available at MMJEI will create expeditious and hassle free facility for admission as it is recognized by all the insurance and leading corporate companies.


PROCEDURES FOR CASHLESS HOSPITALIZATION

Patient Insurance Information

Patients with Medical Insurance or Medical Reimbursement who should undergo day care procedures or any eye surgery are registered for Health insurance details, The details would include Name, age, ID number, Policy number, Nature of illness, Diagnosis and Treatment to be given and estimated cost of the procedure or treatment with patient declaration of medical insurance scheme of respective insurance company.

PRE- Authorization

Once the patient is diagnosed and treatment is fixed, the Insurance Dept. will send the Pre-Authorisation request to the concerned Insurance/Corporate. It takes a minimum of 24 hours for the hospital to get the approval or authorization for the patient’s treatment. For planned surgery or treatment the hospital treat the patient, only after the approval from the insurance / corporate.

Insurance company will intimate the patients about the status via SMS. On receiving approval from the insurance company, patients can get admitted to the hospital. In case of Emergency the patients are admitted and the same will be informed to the insurance on the same day or on the next working day if the admission falls on Sunday or public holiday. . After the approval from the insurance / corporate, the patient will be informed the same accordingly

Treatment

Only with approval of the company/Insurance, Cashless hospitalization and treatment are provided to the patients. Patients should sign necessary documents to facilitate claim processing for the hospital. Patients who don’t get approval due to some reason stated by the insurance company are also treated under general patients’ category without Cashless hospitalization benefits.

In case the hospital does not receive this authorisation within 48 hours of admission and the patient is getting discharged, the patient must settle the hospital bill and claim reimbursement from your insurance provider.

List of TPA’s Central Government
  • Kaiga Power
  • Ex-servicemen
  • South Central Railway
State Government
  • Hescom
  • NWKRTC
Third Party Administrators (TPA)

Corporate Companies

  • Apollo Munich Health Insurance Co. Ltd.
  • Bajaj Allianz General Insurance Co Ltd
  • Cholamandalam Ms General Insurance Co. Ltd.
  • Future Generali India Insurance Co. Ltd.
  • HDFC ERGO General Insurance Co. Ltd.
  • Iffco Tokyo General Insurance
  • Religare Health Insurance Co. Ltd.
  • Star Health And Allied Insurance Co. Ltd
  • Universal Sompo General Insurance Co. Ltd.
  • State Bank of India General Insurance Co. Ltd

Points to Remember

  • The Insurance Department is only a facilitator for communication between the patient and the insurance company. It does not approve or deny claims and is not responsible for delay in approvals or denials from TPAs/insurance companies.
  • If the patient does not wish to wait for approval from TPA/Insurance company for cashless hospitalisation, he/she will have to pay the bill in cash and seek reimbursement later.

List of Associated with Medical Health Insurance Organisation for Cashless Services

 
Name of the TPA/Ins Co Name of the TPA/Ins Co
ABY-Police ICICI LOMBARD
aby -Fire and Emergency IFFCO Tokio
Aby- Prision Kotak Mahindra
Aby- Retd Employees Liberty Videocon
Aditya Birla Insurance MdIndia
Alankit Med Save
Ayushman Bharat Medi Assist
Bajaj Allianz MGMA Insurance
Bharati Axa Nirani Group
Care Health Insurance NPC Kaiga
East West Assist Insurance Paramount TPA
Ericson Insurance Park Mediclaim
ESI – Dandeli Raksha TPA
ESI – Hubli Reliance Insurance
ESI -Belgaum Rted EPFO (Retd. Provident Fund Org).
ESIC – Staff Safeway Insurance
FHPL South Western Railway (SWR)
Future Generalli Star Health Insurance
Good Health Insurance TATA Aig
Good Health TPA United Health Care India
HDFC Ergo United Health Care PAREKH India
Health India Pvt Insurance V-Care
Health Insurance TPA Co Vidal
Heritage Vidal health4sure
Hescom Vipul
HGML