Student Benefit Manual

Client Delhi Technological University

Remark Benefit Manual

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Disclaimer:

This benefit summary will serve as a guide to the benefits provided by Delhi Technological University to their
students.The information contained here is only a summary of the policy documents which are kept by the
company. If there is a conflict in interpretation, terms & conditions of the policy will prevail.

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Main Menu

A. Program Details

B. FAQs, Definitions & Links

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A. Program Details

This insurance scheme is to provide adequate insurance coverage

Group Health Policy of Students for expenses related to hospitalization due to illness,
disease or injury

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1. Group Medical

1.1 Benefit Details

1.2 Enrollment in the program

1.3 Cashless Hospitalization

1.4 Non - Cashless Hospitalization

1.5 Contacts for GMC program

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 1.1 Benefit Details
Policy Parameter
Insurer The New India Assurance Co. Ltd.
Broker ANAND RATHI INSURANCE BROKERS LTD (ARIBL)

Policy Start Date 2-Sep-2019

Policy End Date 1-Sep-2020

Coverage Type Student only
Dependent Coverage Student only
Sum Insured Flat Rs.1,80,000

Benefits covered Benefits covered

Standard Hospitalization •Yes Day care Surgeries •Yes
Pre existing diseases •Yes Pre & post Hospitalization •Yes
Waiver on 1st year exclusion •Waived Room Rent •Yes
Waiver on 1st 30 days excl. •Waived Terrorism Cover •Yes
Pre & Post Natal Expenses •Yes
Ambulance Cost •Yes

General Exclusions

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Applicable Members

Students only Yes

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Policy Period

Existing Students of DTU

Commencement Date 2-Sep-2019

Termination Date 1-Sep-2020

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Coverage Levels
Individual Sum Insured Limits (INR)

All Student of DTUS

Sum Insured

INR1,80,000
• Room rent restricted to 1% of SI for normal room and 2% of
SI for ICU. All other charges in accordance with room rent
limit.

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Standard Hospitalization
Reimbursement of expenses related to
• Room and boarding
• Doctors fees
• Intensive Care Unit
• Nursing expenses
• Surgical fees, operating theatre, anesthesia and oxygen and their administration
• Physical therapy
• Drugs and medicines consumed on the premises
• Hospital miscellaneous services (such as laboratory, x-ray, diagnostic tests)
• Dressing, ordinary splints and plaster casts
• Costs of prosthetic devices if implanted during a surgical procedure

A) The expenses shall be reimbursed provided they are incurred in India and within the policy period. Expenses will be
reimbursed to the covered member depending on the level of cover that he/she is entitled to.

B) Expenses on Hospitalisation for minimum period of 24 hours are admissible. However this time limit will not apply
for specific treatments i.e. Dialysis, Chemotherapy, Radiotherapy, Eye surgery, Dental Surgery, Lithotripsy (kidney stone
removal), Tonsillectomy, D & C taken in the Hospital/Nursing home and the insured is discharged on the same day of
the treatment will be considered to be taken under Hospitalisation Benefit.
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 Customized Benefits
Pre existing diseases

√
Definition Any Pre-Existing ailments such as diabetes, hypertension, etc or related
ailments for which care, treatment or advice was recommended by or received Covered
from a Doctor or which was first manifested prior to the commencement date of
the Insured Person’s first Health Insurance policy with the Insurer

First 30 day waiting period

√
Definition Any Illness diagnosed or diagnosable within 30 days of the effective date of the
Policy Period taken by the Policyholder with the Insurer. √
Waived Off

First Year Waiting period

Definition During the first year of the operation of the policy the expenses on treatment of
diseases such as Cataract, Benign Prostatic Hypertrophy, Hysterectomy for
Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital Internal Diseases,
Fistula in anus, Piles, Sinusitis and related disorders are not payable. If these
diseases are pre- existing at the time of proposal they will not be covered even
√ Waived Off

during subsequent period or renewal too

Baby Cover Day 1

Definition In consideration of additional premium, this policy is extended to cover the new
born child of an employee covered under the Policy from the time of birth till 90
days. Not withstanding this extension, the Insured shall be required to cover the
√ Covered

newly born children after 90 days as additional member as mentioned elsewhere

under this Policy.

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Ambulance Cost

√ Applicable

Ambulance Services

Definition The Insurer will pay for Emergency ambulance and other road transportation by a
licensed ambulance service to the nearest Hospital where Emergency Health
Services can be rendered. Coverage is only provided in the event of an
Emergency.

Amount restriction Road ambulance charges are covered up to INR 1,000/- per incident in case of
emergency.

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 Customized Benefits
Covered

√
Day Care
Definition Day Care Procedure means the course of medical treatment or a surgical procedure
listed in the Schedule which is undertaken under general or local anesthesia in a
Hospital by a Doctor in not less than 2 hours and not more than 24 hours.

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Pre & Post Hospitalization expenses

√ Applicable

Pre-hospitalization Expenses
Definition If the Insured Person is diagnosed with an Illness which results in
his Hospitalisation and for which the Insurer accepts a claim under
a) above, the Insurer will reimburse the Insured Person’s Pre-
hospitalisation Expenses for up to 30 days prior to his
Hospitalisation as long as the 30 day period commences and ends
within the Policy Period.
Applicable Yes
Duration 30 Days

Post-hospitalization Expenses
Definition If the Insurer accepts a claim under a) above and, immediately
following the Insured Person’s discharge, he requires further
medical treatment directly related to the same condition for which
the Insured Person was Hospitalized, the Insurer will reimburse the
Insured Person’s Post-hospitalisation Expenses
Applicable Yes
Duration 60 Days

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General Exclusions

• Injury or disease directly or indirectly caused by or arising from or attributable to War or War-like situations Injury
or disease caused directly or indirectly by nuclear weapons
• Circumcision unless necessary for treatment of disease
• Dental treatment of any kind unless requiring hospitalization
• Congenital external diseases or defects / anomalies
• Hospitalization for convalescence, general debility, intentional self-injury, use of intoxicating drugs/ alcohol.
• Naturopathy - including spas, therapeutic massages etc….
• Any non-medical expenses like registration fees, admission fees, charges for medical records, cafeteria
charges, telephone charges, etc
• Cost of spectacles, contact lenses, hearing aids
• Any cosmetic or plastic surgery except for correction of injury
• Hospitalization for diagnostic tests only
• Vitamins and tonics unless used for treatment of injury or disease
• Infertility treatment
• Voluntary termination of pregnancy during first 12 weeks (MTP)

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1.3 Cashless Hospitalization
Cashless hospitalization means the insurer may authorize upon a Policyholder’s request for direct settlement of
eligible services and it’s according charges between a Network Hospital and the insurer. In such cases the
insurer will directly settle all eligible amounts with the Network Hospital and the Insured Person may not have to
pay any deposits at the commencement of the treatment or bills after the end of treatment to the extent as these
services are covered under the Policy.

List of hospitals in the TPA’s network eligible for cashless hospitalization

Hospital List
https://www.medsave.in/NetworkHospital.aspx Medsave TPA.

Planned Hospitalization

Emergency Hospitalization
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Planned Hospitalization

Step 2
Step 1 Admission, Treatment
Pre-Authorization & discharge

All non-emergency
After your hospitalisation has
hospitalisation instances must Patients seeking treatment
been pre-authorized, you
be pre-authorized with the under cashless hospitalization
need to secure admission to
insurer, as per the procedure are eligible to make claims
a hospital. Kindly present
detailed below. This is done under pre and post
your ID card at the Hospital
to ensure that the best hospitalization expenses. For
admission desk. The
healthcare possible, is all such expenses the bills
employee is not required to
obtained, and the and other required documents
pay the hospitalisation bill in
patient/employee is not needs to submitted
case of a network hospital.
inconvenienced when taking separately as part of non
The bill will be sent directly to,
admission into a Network cashless claims.
and settled by, insurer.
Hospital.

Process Process
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Pre-Authorization

Member intimates insurer of Claim

the planned hospitalization in Registered Yes Insurer authorizes cashless
a specified pre-authorization by insurer within 3 hours for planned
format 48 hours prior to on same hospitalization to the hospital
hospitalization day

Pre – Authorization Form No

Send a Mail to Medsave
insurance TPA Ltd Follow non cashless Pre-Authorization Completed
process

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Admission, Treatment & Discharge

Member gets treated and

Member produces ID card at
discharged after paying all Hospital sends complete set of
the network hospital and gets
non entitled benefits like claims documents for
admitted
refreshments, etc. processing to insurer

Release of payments to the

Claims Processing by Insurer
hospital

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Emergency Hospitalization
Step 1
Get Admitted
In cases of emergency, the
member should get admitted
in the nearest network
hospital by showing their ID
card.
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Step 2
Pre-Authorization by
hospital
Relatives of admitted member
should inform ARIBL/insurer /
HR within 24 hours about the
hospitalization & seek pre
authorization.
The preauthorization letter
would be directly given to the
hospital. In case of denial
member would be informed
directly
Step 3
Treatment &
Discharge
After your hospitalisation has
been pre-authorized the
employee is not required to
pay the hospitalisation bill in
case of a network hospital.
The bill will be sent directly to,
and settled by, insurer.
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Emergency Hospitalization Process
Member gets admitted in the
hospital in case of emergency
by showing his ID Card
Hospital sends complete set of
claims documents for
processing to the insurer
Claims Processing by insurer
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Member/Hospital applies for
Insurer verifies applicability of
pre-authorization to the
the claim to be registered and
insurer within 24 hrs of
issue pre-authorization
admission
Member gets treated and
Pre-
discharged after paying all
authorizatio
non entitled benefits like
n given by
refreshments, etc.
the insurer
No
Release of payments to the Non cashless
hospital Hospitalization
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1.4 Non-Cashless Hospitalization

Admission procedure
In case you choose a non-network hospital you will have to liaise directly for admission.
However you are advised to follow the pre authorization procedure to ensure eligibility for reimbursement of
hospitalisation expenses from the insurer.

Discharge procedure
In case of non network hospital, you will be required to clear the bill and submit a claim to insurer for
reimbursement. Please ensure that you collect all necessary documents such as – discharge summary,
investigation reports etc. for submitting your claim.

Submission of hospitalisation claim

1. After the hospitalisation is complete and the patient has been discharged from the hospital, you must submit
the final claim within 15 days from the date of discharge from the hospital. (Applicable in case of Non Network
hospital)

Claims Process Claim Docs

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Claims Process
Member intimates insurer
before or as soon as
hospitalization occurs
Insured admitted as per Insured sends relevant A
Claim registered by
hospital norms. All documents to insurer
insurer after receipt of
payments made by office within 15 days of
claim intimation
member discharge

•Insured will create the

Is summary of Bills (2 copies)
Is claim and attach it with the bills
Yes document
liable •The envelope should
Insurer performs medical received
(coverage/ contain clearly the Employee
scrutiny of the documents within 15
applicabilit ID & Employee e-mail
days from
y)
discharge

No No
Yes Claim Rejected

Is Payment to be made to
documenta Yes
Insurer checks document Claims processing done Employee. The discharge
tion voucher and copy of payment
sufficiency within 30 days
complete receipt to be sent to
as required Employee.

Send mail about deficiency

Back and document requirement
A
No

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Claims Document List
Signed Claim form

Main Hospital bills in original (with bill no; signed and stamped
by the hospital) with all charges itemized and the original
receipts

Discharge Card (original)

Attending doctors’ bills and receipts and certificate regarding

diagnosis (if separate from hospital bill)

Original reports or attested copies of Bills and Receipts for

Medicines, Investigations along with Doctors prescription in
Original and Laboratory

Follow-up advice or letter for line of treatment after discharge

from hospital, from Doctor.

Break up with details of Pharmacy items, Materials,

Investigations even though it is there in the main bill

In case the hospital is not registered, please get a letter on the

Hospital letterhead mentioning the number of beds and
availability of doctors and nurses round the clock.

In non- network hospitalisation, you may have to get the

hospital and doctor’s registration number in Hospital
letterhead and get the same signed and stamped by the
hospital, if required.
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*Documents highlighted in red are mandatory. Claim will not be
.
processed without these
*Please retain photocopies of all documents submitted

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Timelines for submission of Reimbursement claims documents

Group Mediclaim

Timelines for submission of Claim documents submission within 15 days from Date Of Discharge of patient
claims

Address for sending the Kind Attn: Mr. Sateesh Sahu

Reimbursement claims Assistant Manager
documents Anand Rathi Insurance Brokers Ltd.
A-254, First Floor, Defence Colony, New Delhi – 110024
Mobile No: +91-9650668959

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Contact Details
Escalation 1 Escalation 2
Anand Rathi Insurance Brokers Ltd Mr. Sateesh Sahu Ms. Richa Pali
Mobile No: 9650668959 Mobile :8447662225
Email Id: sateeshsahu@rathi.com Email: richapali@rathi.com

Medsave TPA Mr. Ashutosh Srivastava Dr Ashwani Choudhary

Mobile No: 9560026078 Mobile No:9312880019
Email Id : delhicrm3@medsave.in crmcorporatesolutions@medsave.in

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