Insurance

 

Introduction

Health Insurance is an emerging market in the health sector.

Industries and corporates tie up with all major hospitals for the medical needs of their employees through Third Party Administrators in case of Private Insurance and through Employees State Insurance for Govt./ Statutory compliance.

MMJEI has an exclusive department to cater to the needs of patients covered by insurance. Our dedicated team has been specially trained in insurance and medical reimbursement modalities.

MMJEI’s checklist of documents to be submitted for each insurance/corporate helps quicken the claim processing. This cashless facility available at MMJEI will create an 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 will undergo daycare procedures or any eye surgery need to register by providing various details like name, age, ID number, policy number, nature of the illness, diagnosis and treatment details and estimated cost of the procedure or treatment. The patient also needs to declare the medical insurance scheme of the respective insurance company.

PRE- Authorization

Once the patient is diagnosed and the treatment is finalised, the insurance department 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 authorisation for the patient’s treatment. For planned surgery or treatment the hospital will treat the patient, only after the approval from the insurance/corporate.

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

Treatment

Only with the approval of the Company/Insurance, cashless hospitalization and treatment will be provided to the patient. Patients should sign the 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 the 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 their 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