Frequently Asked Questions:
A: The advent, of multi-specialty hospitals equipped with latest technology and facilities with availability of costly but more effective and newer medicines, lead to higher cost of treatment to be born by the patient. Health Insurance takes care of the unforeseen hospitalization expenses, which you may require to incur in case of any ailment or accident.
A: The most common policies are Individual and Group Mediclaim Policies (For treatment taken in India only) and Overseas Medicalim Policy (For covering treatment expenses while traveling abroad).
A: Mediclaim Policy is a hospitalization benefit policy, which takes care of medical expenses incurred during Hospitalization / Domiciliary Hospitalization of the Insured for treatment of illness / disease / injury contracted during the policy period. Pre-hospitalization medical expenses incurred 30 days before admission and Post-hospitalization expenses 60 days after discharge from the hospital are also covered under the policy but all such expenses should be consistent with the diagnosis for which the patient was hospitalized.
A: The policy covers reimbursement of reasonable and necessary expenses for treatment of illness / disease / injury contracted during the currency of the policy like room rent, nursing care, Doctor’s fee, investigations charges, medicine charges, operation theatre and like expenses, which fall within the available limit up to the maximum of Sum Insured in any one period of insurance stated in the policy schedule.
A: Mediclaim policy does not cover the following:
- Expenses incurred on cost of Spectacles, Contact Lenses, Hearing Aids, Dental Treatment unless requiring Hospitalization, Sterility, Intentional self injury and other exclusion clauses mentioned in the policy.
- Expenses incurred at Hospitals/Nursing Homes primarily for Diagnostic, X-Rays or Laboratory examination, which are not consistent with or incidental to the diagnosis and treatment of the positive existence of any ailment.
- Ambulance charges, registration / admission / file charges, extra food charges, attendant charges etc.
A: The insured has to bear the cost of medical check up.
A: Yes, your spouse, 2 dependent children & dependent parents can be covered and family discount of 10% is available on the Premium paid for them.
A: Yes, provided we are the nominated TPA in the policy covering the spouse or family members.
A: The Insurance is available to persons between age of 5 and 80 years. Children between the age of 3 months and 5 years can be covered provided one or both parents are covered concurrently.
A: Mediclaim policy covers the reimbursement of expenses incurred for the treatment taken in the Hospital/Nursing Home as in patient. It also covers the reimbursement of expenses for Domiciliary Hospitalization as per the conditions mentioned in the policy. However, for a claim to be processed under Domiciliary Hospitalization the following conditions should be satisfied:
- Medical treatment should be for more than 3 days.
The treatment should be such for an Illness / Disease / Injury which in the normal course would require treatment and care in the Hospital / Nursing Home but actually taken whilst confined at home due to any of the following circumstances:
- Condition of the patient is such that he/she cannot be shifted to the Hospital/Nursing Home or
- The patient cannot be shifted to Hospital/Nursing Home for lack of accommodation there in.
A: No, such expenses are not covered under exclusion clause 4.1 of the Policy.
A: Yes. Mediclaim policy does not cover expenses incurred on hospitalization incurred during first 12 months from the date of inception of the cover under exclusion clause 4.3 of the policy on treatment of disease such as Cataract, Benign Prostatic Hypertrophy, Hysterectomy for Menorrhegia or Fibromyoma, Hernia, Hydrocele, Congenital Internal Disorder, Fistula in anus, Piles, Sinusitis and related disorders. If these diseases are pre-existing at the time of proposal, they will not be covered even during subsequent period of renewal too.
A: No, Mediclaim policy covers treatment taken from Allopathic, Homeopathic, Ayurvedic and Unani systems of medicines but it does not cover Naturopathy treatment
A: No but Mediclaim protection is available for illness / disease / injury contracted anywhere in the World provided the treatment is taken in India.
A: When treatment such as Dialysis, Chemotherapy, Radiotherapy etc. is taken in the Hospital / Nursing Home and the insured is discharged the same day, the treatment would be considered to be taken under Hospitalization section of the policy and the claim would be admissible.
A: Operation of the Eye by Laser Capulsotomy is covered under Hospitalization benefits of Mediclaim Policy even when the treatment is taken in an Eye Clinic.
A: A treatment will be deemed to be continuous if the same illness relapses within 45 days from the date of last consultation with the Doctor. Any occurrence after a lapse of 45 days will be considered as a new illness.
A: Any Homogeneous Group / Association / Institution / Corporate body provided it has at least 100 persons to be covered and a Central Administration.
A: Group discount on premium is allowed depending upon the total number of insured persons and Maternity benefits can be extended on demand.
A: A claim is payable, when treatment is taken from a Hospital or Nursing Home registered with the Local Govt. Authority. However, in case of Non-Registered Hospital or Nursing Home the treatment can be covered under the policy subject to Hospital / Nursing Home conforming to the following features:
- The Hospital / Nursing Home should have 15 Inpatient beds.
- It should have qualified Nursing Staff round the clock.
- Qualified Doctors round the clock.
- Fully equipped Operation Theatre.
A: The TPA offers following services:
- Issues an Identity Card against your Policy, which gives you access to the TPA services.
- Cash less Service facilitation at Network Hospitals up to the available limit.
- Claim Processing and Reimbursement for Hospitalization at Non-Network Hospitals.
- Anytime access to the Call Center through a Toll Free Line & other Landlines.
- Online assistance during Hospitalization and filing of claim documents.
A: PARK MEDICLAIM is not Insurance Company and is a licensed TPA (Third Party Administrator) to ensure speedy, transparent processing of your claims and to facilitate Cash less Services in case of Hospitalization at Network Hospitals.
A: If your health policy names Park Mediclaim as your TPA. Kindly contact our office for any information regarding Policy Coverage, Card Status, procedure to avail Cash less Hospitalization & to register / submit your claim.
A: Please check whether Park Mediclaim is the Authorized TPA appointed by the Insurance Company for administration of your policy or not. If yes, then you can avail of our services.
A: Your Policy Number or ID Card Number confirms the identification. In case of an emergency situation, we can search your details through our Software based on the following information:
- Name, Address & Age.
- Name of the Insurer.
A: Cashless facility is available only at Network Hospitals. To provide this, we require the information on a Pre-Authorization Form (Specimen in the User Guide Book) to be filled in and signed by your attending Doctor. On receipt of the same, our doctors adjudge the admissibility of the claim as per the terms & conditions of the policy and then the authorization of the expenses is granted to you or the network hospital.
A: Following documents, in original are required for processing your claims on reimbursement basis:
- Claim Form properly filled and signed by the Claimant.
- Photocopy of your Mediclaim Policy / ID Card issued by us.
- Bill / Receipt and Discharge Certificate / Card from the Hospital.
- Cash Memos from the Hospital / Chemist(s) supported by the proper prescriptions.
- Receipt and Pathological Test Reports from a Pathologist supported by the note from the attending Medical Practioner / Surgeon demanding such Pathological Tests.
- Surgeon’s Certificate stating nature of operation performed and Surgeon’s Bill and Receipt.
- Attending Doctor’s, Consultant’s, Specialist’s / Anesthetist’s Bill and Receipt along with Certificate regarding Diagnosis. Record of any treatment taken prior to the hospitalization.
A: Normally within 3 days from the date of receipt of complete claim documents / information.
A: You are requested to check and sign the final Hospital Bill after verifying the charges mentioned there in for the services availed by you and to obtain the photocopies of the documents, which would facilitate treatment to be taken by you after discharge.
A: Mediclaim Policy does not cover expenses incurred during the first 30 days of the policy. However, in case of Hospitalization expenses following Accidental Injury during this period are covered and Cashless facility / reimbursement of claim can be availed.
A: All claims will be payable in Indian Currency through cheque only.
A: Yes, we can reject / deny your claim based on the evaluation in the light of the policy conditions and if the claim is not found admissible then a rejection letter mentioning the reason for rejection would be sent to you. Remedy: You have the right of appeal and to approach the Insurers.
A: You are requested to contact your Insurance Company.
A: Original documents can be returned on written request. However, we will stamp the Original Documents before return. Only X-Ray films, ECG reports etc. will be returned after approval of the claim.
A: Yes it is possible to shift the patient to another Hospital for requirement of better medical facilities.
A: No since Mediclaim Policy does not cover the OPD treatment. The TPA Card is issued to you against your Mediclaim Policy to avail Cashless Service for Hospitalization at Network Hospital.
A: This could occur because of several reasons e.g.
- The Insurance Company may not have forwarded your policy details.
- The dispatched card may be on the way.
- There may be incomplete information / photo missing in the submitted documents.
A: You may please return your ID Card, mentioning the mistakes along with the rectification required. The corrected card will be dispatched to you within 3 days without any additional cost.
A: You may write / e-mail (firstname.lastname@example.org) to our Grievance Department giving details of your grievance. We assure you that our Grievance Department will address the issue within 48 hours.
A: You may immediately call our Call Center giving details of such Hospitals / Medical providers. Our Network Department will immediately contact the concerned medical provider and sort out the matter.
A: Yes, there is a rebate in Income Tax available under section 80 D on Mediclaim premium up to Rs. 10,000/-.
A: A duplicate card can be issued to you on payment of Rs. 30/- only per card on confirmation of loss of card to us in writing with request for issuance of a new card.