ICSL – FHPL Mediclaim Policy How to Access you Mediclaim Card.

ICSL – FHPLMediclaim Policy

How to Access you Mediclaim Card.

Policy No. : 161000/48/11/41/00000458 Policy Period : 02/05/2012 To 01/05/2013 Insurance Company : United India Insurance Company LimitedTPA : Family Health Plan (TPA) LimitedPremium Rate for Employee : Rs.2371/-Premium Rate for Dependant : Rs.415/-

(Rs.830/-)Add Service Tax : 10.30%Coverage of Rs.1 Lacs for Family Floater

Policy Details:

Maximum family size allowed : 4 (1+3)Definition of Family : Employee + Spouse + 2 Dependent Children

(unmarried & non-earning only) OR 2 Dependent Parents (Father, Mother).

Nomination Process:During policy period additions of newly married &

new born baby are only allowed in case member has less than three dependents covered. Others are not allowed during policy period. Changes of nominations during policy period will not be allowed.

Policy Details

Basic Sum Insured / Limit Per family : Rs.1 Lacs per family on Floater Basis

Claim Co Payment(employee) : 90%(Insurance):10%(Employee) Ratio

Claim Copayment (Dependent)85%(Insurance):15%(Employee) RatioPre-Existing Diseases : Covered from day 1Pre & Post Hospitalization Expenses: Covered upto 30

days and 60 days respectivelyMaternity Benefit: Allowed Max. upto 2 children (2

deliveries) Normal Rs.20,000/- & Caesarian Rs.25,000/- No Cashless will be given for maternity. No pre-post expenses allowed.

Dental Coverage : Not Covered

Coverage Details

Ambulance Charges : Ambulance Charges Rs.1,500/- depending on case to case

Room Rent : Room rent restricted to 1%, ICU 2% of sum insured

Monthly addition of employees: Coverage for new joinees from the date of joining by paying Pro-rata Premium

Monthly deletion of Employees : Coverage ceases from the date of leaving the organization/retirement with refund on Pro-rata basis

Domiciliary Hospitalization not covered

Coverage Details

How to access Mediclaim E-card?

Type www.fhpl.net

Click on login &Select E-card

Enter Corporate ID : 174, User Name as Emp__code and

PASSWORD :First letter of your name in CAPITAL AND last three digits of your

Emp_Code and click on Login

Click on Member Details to see your nominees details

Click to get E-cards of your family members

Your nomination details are displayed

To check claims status click on claims

Click on Open

Take Printout of E-cards

Eligibility

Covered

Not Covered

Hospital sends Intimation to

FHPL

Authorization as per eligibility

Out of Pocket payment

TAT : less than 2 hr for routine cases

Emergency : No authorization required

Regularization within 24 Hrs

Member approaches with Network Hospitals with ID

Cashless treatment at NWH

How to avail benefits under your policy

Member approaches Any other Hospital

Avails treatment, makes upfront payment

Submits bills to FHPL for reimbursement

Do’s

1. Carry your ID card (IDEA)/ E Card (FHPL) at the time of admission at network hospitals

2. Incase of emergency admission kindly contact FHPL within 24 hrs of hospitalization

3. Incase of emergency kindly refer your companies name and your Emp No at the time of admission

4. Take a pre approval from FHPL for all the elective cases

5. Sign on the final bill at the time of discharge from the hospital

6. For any other assistance call the account manager

What are the documents essential for claiming for reimbursement?1. Original detailed discharge summary2. Original investigation reports along with bill3. Original Hospital Bill-consolidated and with detail breakup of every

component of the bill with the patients signature on it.4. Incase of surgical packages – detail breakup of the package5. Medicine bills with prescriptions.6. Claim Form – ( available on FHPL website )7. MLC Certificate from the hospital in the case of Road traffic accident.

Or a certificate from the treating doctor mentioning that the patient was not under the influence of alcohol at the tome of Accident.

8. Obstetric history (GPLA) in the case of maternity claims 9. Payment receipt for the payment done to the hospital.10. Original investigation reports along with bills & receipts11. Consultation receipts.12. Medicine bills with prescriptions.

Hospitalization Intimation

Please send the intimation mail within 24 hours with following details on mail IDs [email protected] or [email protected] with a cc to HR on [email protected]

Intimation Details:-Employee Name             :Employee Code             :Name of Patient             :Relationship with Employee :Name of Hospital/Doctor :Date of Admission          :

Also remember to submit your claims within 7 days from date of discharge from the hospital.

All India FHPL Contact NumbersHyderabad040-23556464

Delhi011-41678916

Mumbai022-22834686

Kolkata033-24659421

Chennai044-28293222

Jaipur0141-5170502

Pune020-4024022

Jharkhand

Bangalore080-22356256

Chandigarh0172-2603264

Ahmedabad07926441773Vimal Sinha9227207002

Guwahati0361-2340599

Cochi0484-2350115

Jammu0191-2473971

Nagpur0712-3096446

Bhubneswar0674-2534560

Coimbatore0422-2540036

Srinagar0194-2442065

Indore0731-5045400

Madurai0452-3106620

Lucknow0522-2239804

Bhopal0755-2572110

Vizag0891-2526938

Thank You Thank You

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Good Luck