ICICI Lombard CCCL PPT by F2F8xEX

VIEWS: 2 PAGES: 14

									     RAKSHA TPA PVT LTD



   WARMLY WELCOMES FAMILY OF
 CONSOLIDATED CONSTRUCTION
        CONSORTIUM LTD
WE WISH EVERYONE A VERY HEALTHY
             YEAR
       HEALTH IS WEALTH.
 RAKSHA ENSURES GOOD HEALTH
  CONCEPT OF TPA


      TPA STANDS FOR
THIRD PARTY ADMINISTRATOR
    ABOUT RAKSHA TPA PVT LTD
• IRDA Licensed TPA (License No.015)
• Promoted by Mrs.Ritu Nanda, an Icon in
  insurance field, Mr.Rajan Nanda, Chairman,
  Escorts Group and Padma Bhusan Dr.Naresh
  Trehan, Chief Cardio Thoracic Surgeon
• ISO 9001-2000 Certified company by TUV of
  Germany
• Associated with All Insurance companies in
  India
                           Claim Process - Cashless
                                     Network
                                         Hospital


                  Emergency Admission               Planned Admission
                                                                              Call Account Manager
                                                                                  of Raksha TPA
Hospital/Relative of the
                                    Intimate at least 72 hours
patient calls up Raksha
                                    prior to admission & get AL
                                    issued
   Intimate Raksha
   within 24 hours of
   admission.                                                  Fax Pre-Authorization Form stating :
                                                                Name of Patient
                                                                Member ID
                                                                Ailment/Diagnosis
                 Authorization Letter (AL) issued
                                                                Pre-existing diseases if any
                 depending on plan benefit &
                                                                Approx date of admission
                 balance sum available .
                                                                Approx duration of ailment/stay
                                                                Approx Cost of Hospitalization
                                                                Influence of alcohol in accident cases
                        Cashless Medical Facility to the
                        limit of available Sum provided to
                        the hospitals
               Claim Process Non-Cashless
                                  Non-Network
                                    Hospital

                                                    Emergency
               Planned Admission
                                                      Admission

                           Get the treatment done


              After Discharge send following in original to HR
              Claim form (duly filled & signed)
              Discharge Summary
              Hospital Final bill and receipt
              Investigation Reports if any
              Prescriptions & Bills for medicines, Surgical items
              Details of Pre & Post hospitalization expenses if any`



Claim will be processed                Are all                    Deficiency
                                                                  letter would be
and the cheque would                   documents                  mailed to
be sent to the Corporate HR            complete ?                 Corporate HR
              Documents required
• You must submit following documents in Original within 30 days
  of discharge from the hospital thro HR
• Signed Claim Form of Insurance Co.
• Original Final Hospital Bill along with Payment Receipt
• Original Discharge Summary / Card
• All Original Investigation Reports
• Original Bills & Receipts for investigations done outside hospital.
• Doctors Prescription, Pre – Post Hospitalisation bills (in original)
• Original Bills of medicines,etc. if any purchased



  *kindly retain a copy of all documents for future reference
             Compensation Payable
• Reasonable and necessarily incurred
   – Room Expenses in Hospital/Nursing Home
   – Nursing Expenses
   – Medical Practitioner Fee
   – Treatment cost
       • Medicines
       • Blood / Oxygen
       • Cost of Pacemaker / Artificial Limbs / Cost of Organs
       • Operation Theatre Charges
       • Surgical Appliances
       • Diagnostic cost
       • Dialysis, Chemotherapy, Radiotherapy
• Pre Hospitalisation (30 days) and Post Hospitalisation expenses
  (60 days)
• Max of Sum Insured
        SERVICE PARAMETERS
   Issuance of ID cards                       6 working day
   Issuance of pre auth                       Within 3 hours
   SMS alert for cashless approval                   Immediate
   Settlement of reimbursement claims           14 Working days
   Issuance of deficiency letter               3 working days
   Processing after retrieval of deficiency    7 working days
   Repudiation of claims                       3 working days
   Data not found cases (DNF) intimation        2 working days
   MIS reports                                Monthly basis
             Policy Details
 Insurance Co  : ICICI LOMBARD INSURANCE
 Policy No.    : 4016/0002326/01
 Policy Period   : 26/06/08 TO 25/06/2009
 Corporate Name : CONSOLIDATED CONSTRUCTION
                 CONSORTIUM LTD
 Address       : 5, II LINK ROAD, CIT COLONY,
                  CHENNAI – 600 004
              POLICY COVERAGE
 SUM INSURED ON A FLOATER BASIS OF 3 LAKHS PER FAMILY

 PRE EXISTING DISEASE IS NOT COVERED

 MATERNITY IS NOT COVERED

 POLICY COVERS EMPLOYEE, HIS/HER LEGALLY WEDDED
  SPOUSE, 2 LIVING CHILDREN AND DEPENDENT

 ROOM RENT CAPPING 1 % OF SUM INSURED, ICU 1.5 % OF SI

 PRE 30 DAYS & POST 60 DAYS HOSPITALISATION IS COVERED
                       Exclusions
•   War / war group
•   Nuclear perils
•   Plastic surgery
•   Spectacles/contact lens/ hearing aid & other external
    appliances
•   Dental treatment
•   Intentional self injury
•   Influence of intoxicating drugs / alcohol
•   Treatment for AIDS
•   Diagnostic / laboratory expenses not consistent with
    treatment
•   Vitamins / tonic inconsistent with treatment
•   Naturopathy
                      Contact Details
Raksha TPA
 Mr. Rajeswaran (rajeswaran.raksha@gmail.com)
 Mobile No : 97909 51678

 Escalations, if any
 Mr. R.Sethumadhavan (sethur1954@gmail.com or
     r.sethumadhavan@rakshatpa.com)
 Mobile No. 97890 86557
 OR
 T.R.Venkatachlam (venkatachalam@rakshatpa.com or venkat17ram@gmail.com)
 Mobile No. 99404 55582
 Chennai Office: PLN Complex, 18/4 Conran Smith Road,
                    Gopalapuram, Chennai 600 086.
 Office Tel: 2835 0536 / 2835 0537 Fax: 2835 0538
 Website: www.rakshatpa.com
24/7 Helpline

                    Mumbai
                 022-22632727
           Fax : 022 - 2263 2451/57

                   Faridabad
                 0129-2250 0000
           Fax : 0129- 4100185/87
Thank you

								
To top