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Benefit Guide Now Avalable In Different Languages
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E–Meditek (TPA) Services Limited (EMSL) as a Third Party Administrator ( IRDA License No. 007) takes pleasure in welcoming you to the health insurance family. Our web interface ensures that all important Information is available to you within no time at www.emeditek.com
While representing your insurer we promise to offer quality service, and should you require any support call our 24 hr. Helpline at : 0124 – 4555030-38.
The toll free line may be used for all emergencies.
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Identity Card: |
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On the basis of details provided by the insurer, EMSL issues an identity card to of the beneficiary under the policy. The card is issued for identification purpose only and should not be construed as an authorization to the hospital to proceed with the treatment.
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Cash Less Hospitalization Procedure: |
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Cashless Hospitalization facility is available only at Network Hospitals. Cashless Hospitalization facility enables the Insured to obtain admission at designated hospitals after obtaining an Authority Letter from EMSL
In such cases, EMSL settles the hospital bills directly on your behalf. To avail cashless facility the insured needs to obtain an Authority Letter from EMSL by providing all relevant information. This certificate will authorize the hospital to deliver treatment up to the limits.
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Planned Hospitalization : |
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Following are the steps that need to be completed for a Planned Cashless Hospitilization : |
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| Step 1: |
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Authority Letter from EMSL, the insured should fill up a Request for Cashless Hospitalization and send it by courier/fax to EMSL. The Request should reach EMSL at least 72 hours before the planned admission . copies of the request for Cashless Hospitalization can be downloaded from our web site: www.emeditek.com
Kindly ensure that “Part B” to be filled in by the treating Doctor at the Hospital and “Part C” to be filled in by the hospital / Nursing Home and ensure it is correct.
The Request for Cashless Hospitalization can either be faxed (Fax No. 0124 – 4555071/72/73) Or mailed to EMSL at customercare@emeditek.com
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| Step 2: |
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EMSL will subsequently scrutinize the admissibility of the Request and either approve or deny the request. Authority Letter / Rejection Letter will be faxed to the Hospital with intimation to the insured.
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Please note that rejection of a request for Cashless Hospitalization is only denial of Cashless Service and is in no way to be treated as denial of treatment. The insured retains the right to get treated and submit bills to EMSL for subsequent reimbursement (if any ) as per policy terms & condition.
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| Step 3: |
The patient will contact the Admission Desk of the Network Hospital on the planned admission date with the EMSL identity Card. The identity of the patient will be validated before admission.
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Emergency Hospitalization: |
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1.
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The Policy Holder is advised to get admitted. |
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2.
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In case of admission to a Network Hospital, the hospital will admit the patient as per the hospital procedure.
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3.
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Policy Holder / relative will then contact EMSL and send the request for Cashless Hospitalization duly completed.
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4.
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EMSL will confirm or deny the request for Cashless Hospitalization on going though the request.
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In the event of denial Request for Cashless Hospitalization by EMSL the hospital shall treat the insured as any other patient for the purpose of payment of services rendered, and EMSL will not be liable for payment.
If the Authority Letter for proceeding with the Cashless Hospitalization is not issued by EMSL, cashless facility can not be availed by the insured. However , non-issue of Authority Letter due to non-availability of any specific information does not mean denial of treatment or denial of claims settlement. In such cases, claims can be submitted to EMSL after discharge, and the same , shall be dealt on its merit for reimbursement.
EMSL shall not be responsible for availability, quality and clinical outcome of the treatment and selection of network or outside network hospital is a prerogative of the insured.
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| The cashless facility may be denied in the following circumstances: |
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(a)
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Where sufficient medical/past insurance information is not available to us. |
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(b)
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Where the reported symptoms/available inputs are inadequate in the opinion of EMSL medical team as regard to determine the liability under the policy. |
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(c)
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Where the intimation of claim has not been given in time.
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(d)
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Where any information has been concealed or misrepresented in the proposal form available on record. |
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(e)
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Where the reported ailment/treatment is excluded under the policy. |
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Expenses not covered under standard medical policy : |
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(a)
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Admission Charges, |
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(b)
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Extra bed charges for attendant, |
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(c)
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Expenses on luxury items unless within the room package, |
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(d)
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Telephone expenses, |
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(e)
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Expenses on vitamins, tonics if not directly related with the treatment, |
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(f)
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Food & beverages for attendant, |
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(g)
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Xerox/certifying charges if any, |
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(h)
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Sanitary items |
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(i)
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Vaccination, Dietician Fee etc. |
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(j)
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Expenses of external aids e.g. spectacles, hearing aids, clutches etc. |
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(k)
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Or any other expenses as specified under the policy. |
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Non-CashLess/Non-Network Claims: |
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If cashless facility is not availed/or pre-authorization is denied or treatment is availed at a non-network hospital, the insured will have to settle the bills directly with the hospital and subsequently claim reimbursement form EMSL by submitting the following documents in original : |
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1.
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All doctors prescriptions. |
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2.
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All test/investigation reports along with the prescription of Doctor. |
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3.
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All cash memos and bills for medicines. |
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4.
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Discharge Summary of the hospital. |
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5.
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A duly filled Claim Form along with a signed Discharge Voucher. |
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6.
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Package Break-up (if Applicable). |
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7.
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Copy of ID Card. |
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8.
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Hospital Registration Certificate. |
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Please ensure that the hospital/nursing home where you are contemplating treatment fulfills the criteria for Hospital/Nursing Home as per the policy wording for definition of the hospital/Nursing home.
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Note: Kindly refer to the term and conditions of the Insurance Policy issued to you for any ambiguity regarding the expenses admissible and/or non-admissible under the policy. |
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