Dear friends,
1)Today, I have received by post detailed circular from SZO,with all necessary particulars .
1st page with details of amount of excess premium collected,refunded alongwith pension &premium payable chart Table A for employee/retired employee/spouse of deceased employee or deceased retired employee & Table B for Dependants/Addl dependant of E/RE.
2)SZO OS Dept has enclosed ECard issued by TPA Vidal Health & Gist of mediclaim policy for the year 2015-16 .ECard,in my case is 2 ,one for RBK & one for my wife Seetha Kishore
ECard is small, cute, laminated & contains 7 details such as Card No,Card Holder,Relation, Emp Name, Policy No,SR No, & Location for Both.Location refers to the concerned LIC Office& in my case DONo:Z006/do LOCATION ZO,Chennai ECard no is CHE-NI-L0291-001-0521072-A & for spouse same No but ending with B.
3)Next 4 Pages contain Group Medi claim policy details with Policy No,Contact Nos Tamil Nadu, Kerala, Toll free, Call Centre nos,Coordinators , even Divisionwise, with Mobile Nos
It contains Procedure for availing cashless in detail,Updated List of Network Hospitals ,Claim Forms in website of TPA,Hospitals have preauthorization request form to be filled by E/RE/Beneficiary claimant & Treating Doctor.
Nonmedical expenses in the bill has to be made before Discharge & same can be claimed as reimbursement.
4)Diagnostic Tests reimbursable WITHOUT hospitalization details with Maximum charge payable are indicated.Rs65,000 for the Family during Policy Year Test has to be recommended by a MD Doctor or a doctor with equivalent qualification.Limit for Cataract to Actuals or Maximim Rs 60,000 per Eye whichever is less.
All other details including Ambulance charges ,all other special treatments are provided.
b)Other General particulars to be noted like Room rent including Nursing charges are also given for easy reference.
c)Other precautions to be taken, care to be exercised in normal course like fees, limits, proper numbered Receipts only,Requirements alongwith Claim Forms, extracted from New India Group Mediclaim policy are indicated
5)Next Process for ECard generation, enrollment, preauth,claims status are supplied.
6)Vidal Health ,Health Insurance GuideBookas a 10 page Small Pamphlet ,we earlier circulated thro email with Flow chart from hospitalization to Cheque settlement is also enclosed
7)Lastly a long list of PPN-Preferred Provider Network Hospitals for Tamil Nadu
In all it contains 131,43,931 Hospitals Name,address,Telephone No
8)Respective LIC DO OS Dept would have also embarked on & furnished all necessary info like these to E/RE
Kerala Divisions OS Dept would also have given list of PPNHospitals for their area
B)IT IS ABSOLUTELY NECESSARY TO GO THROUGH, UNDERLINE IMPORTANT PROVISIONS, REQUIREMENTS, STORE ECARD ,TAKE XEROX, PRESERVE NOTING DOWN ALL ECARD DETAILS, DISCUSS WITH FAMILY MEMBERS, AS THEIR HELP WILL BE NEEDED & THEY SHOULD NOT BE IGNORANT BUT BE SURE OF COMPULSORY DATA TO GAIN ADMISSION UNDER CASHLESS OR OTHERWISE,
RIGHT NOW, GO THRO,MARK, & KEEP UR LIST OF HOSPITALS IN UR & NEARBY AREA TO BE SURE & ACCESSIBLE AT SHORT NOTICE FOR ADMISSION etc
TAKE FEW COPIES OF CLAIM FORMS & ANY OTHER REQUIREMENT TO BE SUBMITTED HANDY TO SAVE TIME LATER & BE FAIRLY AT EASE , TO MINIMISE DELAY, DOUBTS, FRUSTRATION, AS WE NOW HAVE TO PLAY A STRICT ROLE TO COMPLY WITH, ASSIST IN CORRECT, QUICK PROCESSING OF CLAIMS ETC
NOTE DOWN NAMES OF COORDINATORS, MOBILE Nos NOW ITSELF TO BE HANDY,LIC DO OS DEPT MEDICLAIM OFFICIALS,TEL NO, Mobile no FOR LATER PROCESSES TO BE AS SMOOTH AS WE CAN EXPECT
C)As we were outlining in quite a few earlier Emails, Ecard has atlast arrived & with it List of Hospitals etc for easy reference.
Greetings,warm regards,of course, prayers for good health,
R.B.KISHORE
VP,AIRIEF
