FREQUENTLY ASKED QUESTIONS

Transcription

1 FREQUENTLY ASKED QUESTIONS 1. What are the treatments that are covered under day care hospitalization?. Tonsillectomy. Palatoplasty. Chemosurgery to the skin. Glossectomy And any other procedure that can be done on day care basis due to advancement of medical technology. Note The same is attached in slide number 14 in the ppt. 2. What do you mean by pre and post natal expenses? Is it payable? Expenses arising before delivery are known as prenatal expenses and those arising after delivery are known as post natal expenses. These expenses are not payable. 3. Which are the expenses that are excluded apart from those mentioned under general exclusion?. Registration Fees, File opening fees, Surcharge. Telephone, Internet charges. Food and refreshments supplied to visitors and attendants

2 . Television charges. Any other expenses not related to treatment of illness. Charges paid to organ donors 4. How can I enroll under the Medical Benefits Plan? All the present employees along with the eligible dependents will be covered from 25th April 2012 to 24th April All new employees will be covered as and when they join. You can get in touch with your HR department for the same. Should there be any clarification employee can get in touch with the TPA representative or location HR. 5. If my spouse and I are both working at Oracle Financial Services Software, how and on what basis is the coverage of our children decided? If your spouse is also a Oracle Financial Services Software employee and is enrolled as an employee in this plan, you may not cover your spouse as a dependant and only one of you may cover your children. 6. If I have recently got married how do I get coverage for my spouse? You would need to register your spouse. Intimation window will be allowed for a period of 30 days. Coverage for that person becomes effective on the date of marriage.

3 7. How do I get coverage for my new born child? The process of registering New born baby is through online enrollment and the same should be done should be within 30 days from date of birth of baby. Coverage for the baby will be effective the date of birth of the baby. * Even if the name has not been finalized, employee needs to update the details of the baby within 30 days from date of marriage as Baby/Of employee name. Later on, employee can edit the same once the name has been decided. 8. What is an E ID card? It is an identification card, which will entitle you to credit towards hospitalization and any other negotiated benefits at hospitals on the panel of TPA on pre authorization. These healthcare providers could be diagnostic centers, clinics, health and fitness centers etc. Information on this is available with the customer service. Please remember that the E ID card is not a credit card. The card does not entitle you to credit towards outpatient treatment. To avoid any misuse of your card, the hospitals may ask you to furnish some photo identification card (like Voter ID, license, passport etc) 9. How do I get an E ID card? The employees should enroll themselves/dependents through online enrollment process by logging on to within the window period provided by HR.

4 How to obtain an e Card o Complete the online enrollment process by adding self and dependent details by visiting or use your existing UHC login and password on o Upload digital photographs as a part of the online enrollment process. o Once you have added self & dependent details and have uploaded digital photographs, click on the ID Card Status button. Ensure that your local default printer settings are properly configured and that you are able to print documents. o Click on the Print ID Card hyperlink. o Your Photo ID Card is now printed. Note: You would be allowed 3 attempts per member to print the Photo ID Card and will not be allowed to change your name and photograph once you have printed the Photo ID Card. A colour printer is recommended. Should there be any clarification they can get in touch with the TPA representative or location HR. 10. Suppose the hospital does not accept my E ID card? In case hospital doesn t accept e id card then the employee needs to call the TPA

5 helpline (UHC helpline) / or What are network hospitals? What are preferred network hospitals? These are hospitals where TPA has a tie up for the cashless hospitalization. Preferred hospitals, too, are hospitals where TPA has tie up for the cashless hospitalization but where all policy holders get preferred treatment. 12. What should I do when I reach the hospital (NETWORK)? Please show your E ID card for identification. TPA will also send a letter of credit (on pre authorization) to the hospital to make sure that they extend credit facility. You will not need to pay any cash except for non medical expenditure as explained under the policy heading. If the pre authorization is not done, you must collect all reports and discharge card when you get discharged. Please make sure that you sign the hospital bill before leaving the hospital. You can then submit the claim along with all the necessary supporting documents to your HR to be submitted to TPA. 13. What if I go to a non network hospital? It is still advisable to fill the preauthorization form, which can be downloaded from the Benefit Manual. Please fill the claim form, attach the relevant documents (most important to attach discharge slip) and submit it to UHC representative in the respective locations.

6 14. What happens if I forget to bring my E ID card at the network hospital? In case a card is forgotten, the employee has to call TPA helpline / or The TPA will ensure that it is faxed to the hospital. 15. What are claim reimbursements? The employees should submit all original bills along with duly filled claim form to UHC representative in charge of concerned location and not to insurance company directly in any way. For Mumbai/Pune Bijal Palan, Bangalore Mr Pavan Kumar and Chennai Mr. Arul Jyothi. 16. How can I claim my pre & post hospitalization expenses? The policy covers pre hospitalization expenses made prior to 30 days of hospitalization and incurred towards the same illness/ disease due to which hospitalization happens. It also covers all medical expenses for up to 60 days post discharge as advised by the Medical Practitioner. All the bills with summary have to be submitted to UHC representative in charge of concerned location. Post hospitalization bills must be submitted within 7 days from the sixtieth day. 17. Within how many days should a claim be submitted? Within 25 days from the date of discharge. 18. Is pre authorization necessary? Yes. This will help you in the following ways:. You will be informed in advance regarding the coverage for your treatment so

7 that your claim does not get rejected at a later stage and you do not end up paying out of pocket.. It will help you ensure that the treatment cost is appropriate and not inflated.. This will also help TPA in planning your hospitalization expenditure such that you do not run out of the cover that you are entitled to. Pls Note For all planned hospitalizations, pre authorization should be done at least 48 hours in advance. 19. Can I continue the insurance coverage if I resign from the company? The insurance contract is arranged by your employer for the benefit of the employees. Employees who have resigned will not be able to continue enjoying these benefits. For any further questions, not covered here, you may contact your location HR or UHC representative for any assistance. 10. What are the categories not payable as per the corporate mediclaim policy? The probable details have been given in slide 19 of the ppt OFSS Health Benefit Plan on the intranet. The link is given below:

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