Claim Form Ttk

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					        TTK Healthcare Services Private Limited
Registered Office: 11th Floor, Brigade Towers, 135 Brigade Road, Bangalore-560 025



                                     CONTENTS


             1-Third party Administration Service and its role.


             2-Cashless access


             3-Admission


             4-Pre-authorisation


             5-Authorisation


             6-Billing & discharge


             7-Additional requirements
1. THIRD PARTY ADMINISTRATION SERVICES AND ITS ROLE (TPA)
      The Insurance Regulatory and Development             Authority has granted TTK
      Healthcare Services Private Limited licences to provide Third Party
      Administration Services. We have subsequently been authorized by Insurance
      Company to extend our services to the policyholder. The scope services will
      include:
          a) Issue of Identity card to all policy Holders.
          b) Provide information to policyholders about hospitals.
          c) Provide Cash Less Access.
          d) Provide a Toll free number to contact us.


2. CASHLESS ACCESS
      Till recently the Mediclaim policyholders had to pay the hospital for treatment
      and then send the bills to the insurance company for reimbursement.
      Henceforth the insured will not have to pay the network hospitals after
      undergoing treatment. He will have to sign the bills and we will pay the
      hospital for the treatment undertaken by the insured (subject to Policy Terms
      and Conditions).
a) How does this work?
         Each person covered under the Policy will be issued an identity card.
         When ever there is a need for hospitalization the policyholder should
         obtain an Authorization Letter from TTK. The authorization letter will
         indicate the name of the insured/patient, the name of the hospital where
         treatment is required, the nature of illness/ disease for which treatment is
         required and the monitory limit above which the insured/ patient will have
         to pay. The policyholder will have to submit this authorization letter along
         with the identity card given by TTK to the admission counter in the
         hospital. The hospital will then start treatment.
b) How does one obtain the Authorization letter?
         The policyholder is required to fill the request for authorization or pre-
         authorization letter (a specimen copy is enclosed) and send it to the
         nearest TTK office mentioned in this booklet/ web site. Additional copies
         of the Pre-Authorization letter can be obtained from any of the TTK offices
         given or you could call our toll free number and we will send it to you. TTK
         will scrutinize the request for authorization letter and send an
         authorization letter or regret letter.
c) Can a request for Authorization for cash less be declined?
          Yes, a request for authorization for cash less access may be declined if,
                     a)       In adequate information is provided and the TPA is unable to get
                              access to further information.
                     b)       The ailment/ disease for which hospitalization is required is not
                              covered by Insurance.
                     c)       The person does not have adequate insured amount left to
                              cover the hospitalization costs.
                     This only means that cashless access is declined, AND IS IN NO WAY
                     TO BE CONSTRUED TO BE DENIAL OF TREATMENT. The
                     policyholder must obtain the treatment as per his/ her treating doctors


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                     advice. The denial of preauthorization letter shall not be construed to
                     mean that the Policyholder cannot claim under the terms and
                     conditions of the policy from the TPA as and when the policyholder
                     provides all the relevant medical details.


4. ADMISSION:

Planned Hospitalisation.

Card Holder contacts admission desk of Hospital with the following documents
        1) TTK Healthcare / Identity Card
        2) Authorization letter issued by TTK addressed to the hospital.
The admission department must satisfy itself about the identity of the person before
admitting the patient. The Hospital to cross verify with documents such as voters
identity card, driving license, photo credit card etc. In case the TTK Health card is a
photo card then the hospital can check the photo card and authorisation letter and
admit the patient.

On admission the hospital will inform TTK’s nearest office giving the Name of patient,
TTK Healthcard number and authorization number. In case there is any discrepancy
TTK will immediately inform the hospital accordingly.

The hospital will inform the patient if the estimated treatment cost exceeds the
authorization amount given in the authorization letter. If the final bill exceeds the
authorized amount the hospital will have to revert back to TTK for fresh authorization
with reasons. TTk will then authorize the amount admissible. The difference if any
will be collected from the cardholder. TTK will not be responsible for the
difference.

 Emergency Hospitalisation:
TTK Healthcard holder will contact casualty for admission during emergency. The
hospital should admit the patient as per the policy of the hospital. The hospital will
fax the pre - authorisation request to TTK completely filled within 3 hours of
admission. TTK will revert within 6 hours of the receipt of the pre- authorisation
request.

5. Pre-authorization:
In case of emergency hospitalisation the hospital is required to obtain an
authorization letter from TTK. A request for authorization (pre-authorization) has to
be filled and faxed to TTK. TTK will send an authorization to the hospital based on
the policy terms and conditions of the insured. TTK will stand guarantee for
hospitalisation expenses incurred by the hospital on a TTK Healthcard holder only if
an authorization is obtained. A mere possession of the TTK Healthcard does not
guarantee that TTK will pay the hospital. A specimen copy of the pre-authorisation is
attached. Additional copies can be obtained from the nearest TTK office. The hospital
is required to send TTK a complete pre-authorization request form. TTK will revert
within 6 hours.

6. Authorization:
This is a very important document. TTK will send an authorisation addressed to the
Hospital. This authorisation may be faxed to the hospital or sent to the policyholder.
The Authorisation letter will carry the following details:


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          1)   Name of the patient
          2)   Age & Sex
          3)   TTK Healthcare Number
          4)   Ailment/ disease/injury for which hospitalisation is being sort.
          5)   Recommending doctor’s name if any.
          6)   Hospitalisation expenses up to which TTK will stand guarantee.

Please note: Denial of authorisation does not mean denial of treatment. Denial only
means that TTK will not stand guarantee for cashless access. The patient is at liberty
to get hospitalized and pay for the hospital for the same and submit the claims to
TTK Healthcare Services directly

7. Billing and Discharge.

At the time of discharge, the hospital will collect a signed claim form from the patient
and send the same along with the final bill of the patient to TTK. The documents that
are required are as follows:
       1) Original Final Bill
       2) Original discharge summary
       3) Original supporting documents
       4) Authorization letter given by TTK.

          The following services should not be billed to TTK. These have to be billed to
          the patient and collected from the patient directly.

      1) Amount in excess of the authorisation limit.
      2) Registration / Admission fee.
      3) Telephone charges.
      4) Visitor’s charges, attender charges, ambulance charges.
      5) Service charges, charges for Diet not forming part of the treatment.
      6) Other non-medical expenses/ bills.
On receipt of the bills with the supporting documents, TTK will pay the bills as per
the MOU between the parties.

8. Additional Requirement:

                     1) ICD 10: The hospital is expected to follow IDC 10 codification level
                        1 by April 2003 and levels 1&2 by September 2003 and use the
                        same in the discharge summary. This is required to be followed by
                        completely by September 2003.
                     2) The hospital will permit Medical office or representative of TTK to
                        visit the hospital and discuss the case with the attending physician.
                        The hospital will provide access to the case history file and other
                        associated files of the patient in case of requirement.
                     3) Should there be any change in your telephone or fax numbers, or
                        the contact person has changed please inform us in writing so that
                        we can update our records. Similarly if you have added any new
                        facility/ department or suspended any of the facility you should
                        inform us.

9.   ASSISTANCE:
     Should you need any assistance you could contact our nearest branch office or
     mail to drnilima@ttkhealthcareservices.com

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