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FAQs [Frequently Asked Questions]
  1. What is the process of availing cashless facility in the hospital?
  2. What are the formalities to be followed after discharge of patients in case of reimbursement facility?
  3. What are our rights and duties as a policy holder to the hospitalization?
  4. On hospitalization, what is the time frame for intimation to the TPA or the Insurance Company ?
  5. What is the time frame for submitting your reimbursement claim after getting discharge from the hospital?
  6. In case we get treated in a non-network hospital, where should we lodge our claims?
  7. Can we claim medical expenses incurred before or after a surgery?
  8. Can medical costs be reimbursed from day one of the cover?
  9. If we have a health insurance policy in Mumbai, can we make a claim in case of Transfer to Delhi?
  10. Is there a minimum time limit for stay within the hospital under the health insurance plan?
  11. How can I view my profile detail on E-Meditek Web site?
  12. How to download the E-Card from web site?
  13. Where and how to check network provider list?
  14. How to enroll dependents name under mediclaim insurance policy?
  15. How to correct mistake in TPA Card?
  16. How to correct mistake in policy?
  17. Can we claim medical expenses incurred before and after the hospitalization?
  18. What are pre-existing diseases?
  19. What are the Non-Mediclaim expenses?
  20. In case a person has a corporate policy but he has resigned from the corporate last week, can he take the treatment benefit from this policy?
1. What is the process of availing cashless facility in the hospital? Top
 

In case of a planned hospitalization, client needs to inform E-Meditek two to three days in advance by faxing us the pre-authorization form (form on Website) signed by the treating doctor. Your claim would be assessed in the light of the policy issued to you by your insurance company and a letter of authorization will be issued to the hospital authorizing the patient's treatment. In case of an emergency the hospital will fax the pre-authorization letter. Once the Authority letter is sent to the hospital from E-Meditek, you need not pay to the hospital. E-Meditek will pay your hospital bills up to the amount authorized in the Authority letter. 

 
2. What are the formalities to be followed after discharge of patients in case of reimbursement facility? Top
 

You need to follow the below mentioned process.

  • Completely fill the claim form with address and contact number of the claimant
  • Discharge Summary of the hospital in original mentioning the following:
    • Date of Admission
    • Date of Discharge
    • Final Diagnosis
    • Disease since when------with original first consultation paper
    • Treatment provided
    • Condition on discharge
  • Final Hospital Bill
  • The complete breakup of the final hospital bill (breakup of medicines given, laboratory tests)
  • The receipt of payment in lieu of the final hospital bill
  • All the investigation reports (e.g. blood test reports, X ray films and reports, MRI films and report)---whichever applicable.
  • All the bills/receipts for which claimant is claiming.
  • All the prescriptions, medicine bills and the investigations report
  • All past policy copies if any

Documents should be submitted to Emeditek, within 15 days of discharge from the hospital. All the above documents have to be submitted in original and have to be couriered to the nearest Emeditek office.

 
3. What are our rights and duties as a policy holder to the hospitalization? Top
 

Rights

    • You have a right to be treated in any duly registered hospital of your choice
    • You have a right to know the status of your claim and if your claim has been found admissible you have a right to be paid
    • You have a right to represent to us or to the insurance company in case you disagree on any matter

Duties

  • Inform E-Meditek in case of an admission (Intimate your claim)
  • Provide complete and correct information as required by your treating doctor who would in turn provide the same to E-Meditek
  • Send all relevant documents to EMSL. Please quote your policy number/card number.
 
4. On hospitalization, what is the time frame for intimation to the TPA or the Insurance Company ? Top
 

You are required to intimate the TPA or your insurer within 24 hours of hospitalization.

 
5. What is the time frame for submitting your reimbursement claim after getting discharge from the hospital? Top
 

In general you are required to submit your reimbursement claims within 15 days from the date of discharge. (However it varies from insurer to insurer). 

 
6. In case we get treated in a non-network hospital, where should we lodge our claims? Top
 

You can lodge your claims at our office at Plot No. 577 Udyog Vihar Phase V, 122016. Send your intimation to intimation@emeditek.com or call us at 1800 102 3242 on a 24x7 basis. If your claim is found admissible, it shall be paid within 15 days of receipt at our end.  

 
7. Can we claim medical expenses incurred before or after a surgery? Top
 

You can claim medical expenses incurred 30 days before and 60 days to 90 days (as specified in your policy), provided they are related to the ailment/accident for which you were hospitalized. Such expenses are termed as pre and post hospitalization expenses.

 
8. Can medical costs be reimbursed from day one of the cover? Top
 

Typically there is a waiting period of 30 days, within which no claims by the insured are entertained by the insurer. This waiting period may vary from one insurance company to insurance company. We strongly recommend you to read your policy document carefully and clarify the matter with your insurance agent.

 
9. If we have a health insurance policy in Mumbai, can we make a claim in case of Transfer to Delhi? Top
  Yes you can, all health insurance policies are valid across the country.  
10. Is there a minimum time limit for stay within the hospital under the health insurance plan? Top
  Typically, the insured can make a claim if his/her hospitalization is more than 24 hours. However, for certain treatments, such as dialysis, chemotherapy, eye surgery, etc, the stay could be less than 24 hours.    
11. How can I view my profile detail on E-Meditek Web site? Top
 

Login to E-Meditek’s website (www.emeditek.com), click on the “User login” option at right hand side corner of the website, to proceed enter your user name and password in the given option.

 
12. How to download the E-Card from web site? Top
 
  • Login to www.emeditek.com and click “User login”
  • Select card holder option
  • Put your User Name and Password in the given option
  • Click Proceed to enter in user domain
  • Click on membership card to download your TPA E-Card  
 
13. Where and how to check network provider list? Top
 

Please visit www.emeditek.com, click on network provider if you are a corporate policy holder. For individual policy holders you have to click on PPN List (GIPSA)

  • Select the hospital name
  • Select the state name
  • Select the city name and search to get the status of desired hospital
 
14. How to enroll dependents name under mediclaim insurance policy? Top
 

To enroll the dependent's name under the mediclaim policy

  • You must directly contact the insurance company
  • The insurance company will forward the endorsement letter (for adding dependents) to E-Meditek
  • Then E-Meditek will add their dependents name(s) under his policy.
 
 
15. How to correct mistake in TPA Card? Top
 

If there is any mistake in TPA card like : Name, Gender, Age, Photo etc, you can send an e-mail to customercare@emeditek.com for correction and also you can call us on 18001023242, informing the customer care department to make the requisite changes.

 
16. How to correct mistake in policy? Top
 

If there is any mistake in policy like name/age/gender/address etc, you need to contact the insurance company, they will forward us the endorsement letter for the necessary correction. After receiving the endorsement letter from the insurance company, E-Meditek will make corrections in the requisite field.

 
17. Can we claim medical expenses incurred before and after the hospitalization Top
 

Yes, under the mediclaim policy, medical expenses from the date of admission before 30 days will be incurred as a pre-hospitalization and from the date of discharge after 60 days will be incurred as a post-hospitalization.

 
18. What are pre-existing diseases? Top
  Before taking mediclaim policy if there are any existing diseases before taking the policy, these diseases are classified as pre-existing diseases.  
19. What are the Non-Mediclaim expenses? Top
 

The non-mediclaim expenses are mentioned as below:

  • Admission charges
  • Extra bed charges for attendant
  • Telephone expenses
  • Food and beverage charges for attendant
  • Vaccination & Dietician charges etc.
  • Cotton & some internal injection and bandage charges etc.
  • Some other charges not payable under the mediclaim policy terms & conditions
 
20. In case a person has a corporate policy but he has resigned from the corporate last week, can he take the treatment benefit from this policy? Top
 

after tendering his/her resignation, client can not continue this policy - it will lapse once we receive the e-mail from his/her HR dept regarding the employee's resignation from the company.

 
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