- Rourkela Steel Plant

Transcription

GROUP MEDICLAIM SCHEME
2016 - 2017
For Retired SAIL Employees
&
Their Spouse
RAKSHA TPA PVT LTD
ISO 9001:2008 Certified Company
1
Dear SAIL Mediclaim Member,
We would like to take this opportunity to thank SAIL for choosing Health Insurance cover from IFFCO
TOKIO GENERAL INSURANCE Co. Ltd. We assure you quality and hassle free service whenever and
wherever you need help on health claims.
Our policy has been designed to provide you with more than a healing touch in unfortunate, yet
unavoidable circumstances of life. We have made every effort to keep our procedures simple, transparent,
convenient and customer friendly.
This booklet will take you through various aspects of health insurance claims and the procedures to be
followed in order to avail the benefits under the policy. Please read the booklet carefully to understand and
maximize the benefits of your policy.
So go ahead and live the life you so very well deserve.
IFFCO TOKIO GENERAL INSURANCE Co. Ltd.
Unit Nos. 52-63, Mezzanine Floor,
Ansal Fortune Arcade,
Sec 18, Noida, Uttar Pradesh - 201301
2
Dear Insured,
We RAKSHA TPA Pvt. Ltd. an IRDA licensed Third Party Administrator (License No.- 015) is one of the
leading and most comprehensive health service facilitator in the Indian Market. The aim of the company is
to provide unique & innovative services in the emerging health care market through web based technology
linking insured, insurer & provider. As Third Party Administrators we take pleasure in welcoming you to the
Raksha Family.
This hand book will guide you through various aspects of your Mediclaim Policy with particular reference to
the Claims Settlement and Cashless Hospitalization procedures.
A list of Healthcare service Providers with whom we have tied up for offering Cashless Hospitalization is
also enclosed. Our Network hospitals are revised on regular basis thus we would request you to log on to
our website www.rakshatpa.com for updated list of Network hospitals.
Assuring you best of our Services & wish you to stay Healthier with us.
Pawan Kumar Bhalla
C.E.O.
3
TABLE OF CONTENTS
PAGE
DOs & DONTs
5-6
OBJECTIVE OF THE SCHEME
7
PERSONS COVERED
7
SCHEME
7
POLICY COVERAGE
7-8
DEFINITIONS
8-9
BENEFITS
9-11
CAPPINGS
11-12
IMPORTANT EXCLUSIONS
13
CLAIM PROCEDURE
14-16
CUSTOMER CARE SERVICES
17
TECHNOLOGICAL ADVANCEMENT
18
RAKSHA TPA OFFICES
19-20
CASHLESS REQUEST FORM
21
CLAIM INTIMATION FORM
22
CLAIM FORM – IPD
23-25
CLAIM FORM - OPD
26
NEFT FORM
27
SAIL FAQs
28-33
INDICATIVE LIST OF DAY CARE PROCEDURES
34-37
LIST OF SAIL APPROVED HOSPITALS FOR OPD TREATMENT
38-44
LIST OF EMPANELED HOSPITALS TO AVAIL CASHLESS SERVICES
45-57
LIST OF DIAGNOSTIC CENTRES/PHARMACIES OFFERING OPD SERVICES AT
NEGOTIATED RATES TO SAIL MEMBERS
58-59
LIST OF HOSPITALS/DIAGNOSTIC CENTRES OFFERING IPD/OPD SERVICES AT
NEGOTIATED RATES TO SAIL MEMBERS
60-61
DETAIL OF INTERNAL RESOURCE PERSON (IRPs) AT SAIL PLANTS AND UNITS
62-63
FEEDBACK FORM
64
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DO’s & DONT’s
DO’s
1. Mandatory Claim Intimation: Reimbursement & Cashless
The Mediclaim member is required to intimate/inform the Insurance Company/TPA at
least 48 Hours prior to the planned hospitalization.
In case of emergency hospitalization, the Mediclaim member is required to inform the
Insurance company/TPA within 24 Hours of such hospitalization.
Claim Intimation can be sent via Letter/Email/Fax or personally delivered at Insurance/TPA
offices. For detail of TPA offices, please refer Page nos. 19-20.
2. Mandatory Claim Intimation documents:
The Mediclaim member is required to submit the prescription indicating diagnosis, purpose of
Hospitalization etc. at the time of intimation. For Claim Intimation form, please refer Page no. 22.
3. Timelines for submission of claims for reimbursement:
a) The Mediclaim member is required to submit the reimbursement claim with respect to IPD/
Hospitalization Claim within 30 days from date of discharge from the hospital.
b) The reimbursement claims pertaining to Post Hospitalization (IPD treatment), to be
submitted to the Insurance Company/ TPA within 30 days after the completion of
permissible post Hospitalization treatment period of 60 days.
c) OPD Claims to be submitted by the Mediclaim member, to the Insurance company/TPA
at any time but necessarily when the expenses exceed Rs. 2000 per person per policy
period or within 90 days from the date of completion of the treatment, whichever is earlier.
Please refer Page nos.19-20 for detail of TPA offices for claim document submission.
4. Submission of Claim Documents:
The Mediclaim member can submit the Claim documents in any Raksha TPA branch irrespective of
centre opted by the members. You can refer to the updated branch list of Raksha TPA with contact
details mentioned in the booklet/website. For Raksha branch list, please refer Page no. 19-20. For
Raksha website, please visit – www.rakshatpa.com
5. In case of any Implant being used:
The Mediclaim member is required to submit the outer pouch of the implant used (having barcode
embossed) along with signature of treating doctor on the pouch for reimbursement of the claim.
6. Availing Cashless Facility:
The Mediclaim member should always carry Photo-ID Cards like Driving License, Aadhaar Card,
Voter ID card, Passport etc. along with the Mediclaim Photo-ID card issued by the TPA, for availing
Cashless facility.
7. Requirement of ECS Form:
For early/ hassle-free disbursement of claims, the mediclaim member is kindly requested to ensure
the submission of duly filled ECS Form along with a cancelled cheque to Raksha TPA, while
submitting the reimbursement claim.
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8. Visit Raksha TPA website: www.rakshatpa.com or Raksha TPA Mobile APP (Details
available on page no. 18) or Call on 1800 180 1555 (Toll Free) for:
a. Updated Hospital list & Details
b. View & Download E-card
c. Membership Details & claim status
9. Issuance of Photo ID card:
Photos are Mandatory for issuance of Photo-ID Card. In case you have not submitted your
Photograph, kindly submit them at concerned SAIL Plant/Unit for issuance of the cards.
DONT's
1. Don't insist upon admission for investigation or evaluation or Health check-ups.
2. Don't carry back any original document at the time of discharge from the hospital.
3. Don’t forget to sign on the Claim Form.
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MEDICLAIM SCHEME FOR THE EX-EMPLOYEES
OF SAIL AND THEIR SPOUSES (2016-17)
OBJECTIVE OF THE SCHEME:
To extend the Medical Benefits to the eligible ex- employees of SAIL and their Spouses.
PERSONS COVERED:
a. Retired employees of SAIL and their spouses.
b. The employees who have taken voluntary retirement and their spouses.
c. The employees who cease to be in employment on account of permanent total disablement and their
spouses.
d. The spouse of an employee who dies in service.
e. Employee who resigns from the Company at the age of 57 or above and their spouse.
This scheme is optional and those who opt for this scheme will hereinafter be referred to as "Members".
Apart from Fresh Enrolments during the year, only the person(s) who were members of SAIL Mediclaim
Scheme as on 31-03-2016 are eligible to renew membership under SAIL Mediclaim Scheme 2016-17.
SCHEME
The members will be covered through Group Insurance Mediclaim Policy of the Insurance Company and
will be operated through IFFCO TOKIO General Insurance Co. Ltd., SCO - 10, First Floor Sector – 14,
Gurgaon - 122001, Haryana - India
The period of the policy is 01/04/2016 (00:00 hrs IST) to 31/03/2017 (24:00 hrs IST)
Raksha TPA Pvt. Ltd - Head office at C/O Escorts Corporate Centre, 15/5, Mathura Road, Faridabad121 003, Haryana has been authorized to offer TPA (Third Party Administrator) services for the Group
Mediclaim Policy issued for the ex-employees of SAIL and their spouses. Raksha would operate from 34
locations for the purpose of claim deposits, the bills & other related documents should be directly sent to
any branch of Raksha.
POLICY COVERAGE
The policy covers reimbursement of Hospitalization and also Cashless Facility and Out-Patient Department
(OPD) expenses within the prescribed limits under the policy for illness/diseases contracted or injury
sustained by the insured person. In the event of any claim becoming admissible under the policy, the
Insurance Company will pay to the insured member (Reimbursement)/Hospital (For Cashless Treatment),
the amount of such expenses as reasonably and necessarily incurred anywhere in India, but not exceeding
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in any one period of insurance, amounts under the respective category in the BENEFITS mentioned in this
booklet.
For the purpose of SAIL Mediclaim scheme, the ex-employee & his/her spouse, to be treated as two
distinct members.
DEFINITIONS
a) Hospital/Nursing Home means any institution in India established for Indoor care and treatment of
sickness and injuries and which has been registered either as a Hospital or Nursing Home with the local
authorities and is under the Supervision of a registered and qualified Medical Practitioner or
Hospital/Nursing Home which complies with minimum criteria as under :
It should have at least 15 inpatient beds
Fully equipped operation theatre of its own wherever surgical operations are carried out.
Fully qualified nursing staff under its employment round the clock.
Fully qualified Doctor(s) should be in charge round the clock.
For the purpose of O.P.D. treatment, "Hospital" shall mean:
A Government Hospital,
Dispensaries/Clinics run by local Government authority/Municipalities,
SAIL Plant Hospitals/Dispensaries
SAIL approved Hospitals/Nursing Homes (Refer to Page No. 38-44 for list of SAIL Approved
Hospitals)
Branches/ Franchisees of major renowned chains of Hospitals/ Diagnostic Centres like
Apollo, Max, Fortis, Sankara Nethralaya, Centre for Sight, Shroff Eye, Arvind Eye, Sharp
Eye, Narayana Hrudalaya, Global Hospitals, Yashoda Hospitals, Dr. Lal Path Labs & SRL
Religare anywhere in India.
Note: The terms Hospital shall not include an establishment which is a place of rest, a place for the aged, a
place for drug addicts or alcoholic, a hotel or a similar place.
b) Hospitalization (IPD):
a) Hospitalization facility can be availed from any Hospital or Registered Nursing Home in India. However,
the Mediclaim member can avail Cashless Facility under Hospitalization only in Hospitals, which are
empanelled by the Insurance Company/TPA.
b) When treatment/surgeries such as Dialysis, Chemotherapy, Radiotherapy, Ophthalmic
Surgeries(Cataract/Glaucoma Surgeries etc.), Lithotripsy, Laparoscopic surgeries, Microsurgery etc., is
taken in the Hospital/Nursing Home and the insured is discharged on the same day, the treatment will be
considered to be taken under Hospitalization Benefit Section. Indicative List of such procedures is given at
Page No.34-37.
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While Hospitalization facility can be availed from any Hospital or Registered Nursing Home in India, OPD facility
can only be availed from any Govt. Hospitals/SAIL Plant Hospitals/ Dispensaries or Hospitals listed in this
Booklet.
c) O.P.D. Treatment: OPD Means treatment taken as an out-patient in any Hospital/Nursing Home/
Diagnostic Centre as mentioned at (a.) above. The Charges incurred for treatment taken from Registered
Medical Practitioners or other than Hospitals/Nursing Homes/ Diagnostic Centres as mentioned at para (a.)
above, will not be reimbursed. The Medicine should be prescribed by the treating doctors on the letter
Head of the hospitals covered under Para (a.) above. Even though a medical practitioner is attached to any
of the approved hospitals for OPD treatment and if the treatment is taken by him/her privately, the OPD
Claim amount will not be reimbursed, under any circumstances.
For the benefit of Members of the scheme, the TPA has negotiated with prominent Diagnostic
Centres/Pharmacies in various locations Pan India, details of which are available on page no. 58-59.
d) Medical Practitioner: Means a person who holds a degree/diploma of a recognized Institution and is
registered by Medical Council of respective State of India. The term Medical Practitioner would include
Physician, Specialist and Surgeon. (Cross Field Treatment will not be payable)
e) Qualified Nurse: Means a person who holds a certificate of a recognized Nursing Council and who is
employed on recommendations of the attending Medical Practitioners.
BENEFITS
HOSPITALIZATION BENEFIT:
Hospitalization benefit, Reimbursement and/or cashless will be paid up to Rs.2, 00,000/- per member (with
clubbing facility between employee & spouse), as per policy terms and conditions.
Reimbursement: Reimbursement of actual charges up to Rs. 2,00,000/- per member per policy
period (with clubbing facility between employee & spouse) is permissible for Expenses incurred
towards room rent, IC Unit, nursing expenses, surgeon and anaesthesia charges, consultation fee,
diagnostic investigations (Laboratory &radiological) cost of blood/blood components and its
transfusion, oxygen/gas, operation theatre charges, surgical appliances/implant, medicines and
drugs, Dialysis, Chemotherapy, Radiotherapy, cost of pacemaker, artificial limbs and similar other
expenses.
CLAIM UNDER HOSPITALIZATION BENEFIT SHALL BE ADMISSIBLE ONLY WHEN THE
PATIENT IS ADMITTED IN A HOSPITAL FOR A MINIMUM PERIOD OF 24 HOURS.
Hospitalization expenses for Ayurvedic/Homeopathic/Unani Treatment are admissible only
when the treatment is taken in a Government Hospital/Medical College Hospital.
Pre-hospitalization: Relevant medical expenses incurred during the policy period, up to 30 days
prior to the hospitalization specifically for that particular disease/ illness, for which hospitalization
has taken place, shall be considered as part of claim under hospitalization. HOWEVER,
MEDICINES BEING PRESCRIBED UNDER REGULAR OPD FOR DISEASES/ ILLNESS NOT
RELATED TO THE SAID HOSPITALIZATION SHALL NOT BE REIMBURSABLE UNDER
HOSPITALISATION CLAIMS.
Post-hospitalization: Relevant medical expenses incurred during the policy period, up to 60 days
after the hospitalization, specifically for that particular disease/ illness for which hospitalization had
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taken place, shall be considered as part of claim under Hospitalization. HOWEVER, DURING
POST-HOSPITALISATION PERIOD, MEDICINES PRESCRIBED UNDER REGULAR OPD
TREATMENT FOR DISEASES/ ILLNESS NOT RELATED TO THE SAID HOSPITALIZATION,
SHALL NOT BE REIMBURSABLE UNDER HOSPITALIZATION CLAIMS.
Cashless: The member can also avail cashless hospitalization facility in any hospital (more than 50
beds) empanelled by Insurance Company/TPA for the provision of cashless hospitalization. List of
such empanelled hospitals for availing cashless treatment may vary from time to time, however
updated list may be referred from Raksha TPA Website (www.rakshatpa.com) /Raksha centres,
prior to Hospitalization. Insurance Company/ TPA to settle the hospital bills directly on behalf of
Insured.
OUT-PATIENT BENEFIT (OPD):
1. Rs. 4000/- per member, for members below 70 years of age as on 31.03.2016
2. Rs. 8000/- per member, for members 70 years and above as on 31.03.2016, for the policy period.
NOTE Persons completing 70 years of age on 01.04.2016 will also be considered for enhanced OPD. Unlike IPD
facility, the OPD facility cannot be clubbed between the ex-employee and his/her spouse.
3. O.P.D, treatment can be availed at the following institutions:
a. Government Hospital
b. Dispensaries/Clinics run by local Government authority/Municipalities,
c. SAIL Plant Hospitals/Dispensaries
d. Hospitals/Nursing Homes as per List at (Page no.38-44)
e) Branches/ Franchisees of major renowned chains of Hospitals/ Diagnostic Centres like Apollo,
Max, Fortis, Sankara Nethralaya, Centre for Sight, Shroff Eye, Arvind Eye, Sharp Eye, Narayana
Hrudalaya, Global Hospitals, Yashoda Hospitals, Dr. LaL Path Labs & SRL Religare anywhere in
India.
4. The members can avail OPD treatment facility in the above Hospitals. In case, the OPD treatment
is taken in a SAIL Plant Hospital, the members are not required to pay any expenses. SAIL Plant
Hospitals will make claims with the TPA for the Treatment given to the member. In case OPD
treatment is taken at approved Hospital other than SAIL Plant Hospital, the claim should be
submitted at any Centre of Raksha TPA Services Ltd. (Refer to Page No.19-20 for the list)
5. OPD treatment availed from the listed Hospitals should be necessarily claimed on the Letterhead of
the listed Hospital. OPD treatment, wherein the prescription is on the letterhead of the doctor and
not on the letter head of the Hospital, will not be reimbursed.
6. OPD Claims to be submitted by the Mediclaim member, to the TPA at any time but Necessarily
when the expenses exceed Rs. 2000 per person per policy period or within 90 days from the date
of completion of the treatment, whichever is earlier.
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7. Dental Treatment can also be availed of within the existing limit of Rs. 4000/- or Rs. 8000/ - per
member (as applicable) for the policy under O.P.D. treatment. Cost of dentures will not be
reimbursed.
8. Ophthalmic consultations for refractory error will be covered under OPD Benefits only. Cost of
spectacles/ contact lenses shall not be reimbursed.
9. In case of treatment of ear, cost of hearing aid is not reimbursable.
SAIL Hospital/Dispensary Reimbursement:
SAIL will claim reimbursement against the treatment (OPD/ IPD) provided through its Hospital & Health
Centres including SAIL dispensaries and the same will be adjusted against the available Sum Insured for OPD/
IPD of the concerned member, as the case may be.
CAPPING:
ROOM RENT: Maximum entitlement of room to be restricted to:
For Metro Cities (Hyderabad, NCR, Bangalore, Mumbai, Chennai, Kolkata) - Ceiling of 2% of the sum
insured per member, i.e. Rs. 4000, or a single A/c non-deluxe room per day whichever is lower.
For Non Metro Cities which are state capitals - Ceiling of 1.5% of the sum insured per
member, i.e. Rs. 3000, or a single A/c non deluxe room per day whichever is lower.
For rest of the country - Ceiling of 1 % of sum insured per member, i.e. Rs. 2000, or a single A/c non
deluxe room whichever is lower.
In case a member goes for a higher category room, the consultation charges/investigation
charges/procedural charges/surgical charges/package rates etc. shall be limited to actual or as per their
corresponding rates for single AC non-deluxe room of the concerned hospital, whichever is lower.
IMPLANT UTILIZATION:
1. Intra Ocular Lens (IOL): Ceiling rates for different types of intra Ocular Lens (IOL) Implants to be as per
actual or Rs. 10000/- whichever is lower and shall be reimbursable in addition to the package rates for
cataract surgery procedure wherever IOL is not a part of package. It should be mandatory for the operating
surgeon of all hospitals to attach the empty IOL sticker, bearing the signature and stamp of the operating
surgeon on it along with the bill in support of the type of IOL used containing its batch number. In case the
same is not followed, the claim with regards to IOL implant may be rejected.
2. Coronary Stents: Ceiling rates for different types of Coronary Stents to be as per the actual or the rates
as mentioned below, whichever is lower.
Name of Drug Eluting Stent /Bare
Metal Stent
Cypher Stent
Capping
Rs. 95000 + VAT
Taxus Stent
Rs. 67300 + VAT
Element Stent
Rs. 95000 + VAT
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Endeavor
Rs. 85000 + VAT
Xience VEECSS
Rs. 95000 + VAT
Yukon choice
Pronova
Supralimus
Bare Metal Stent
Rs. 55000 + VAT
Rs. 50000 + VAT
Rs. 55000 + VAT
Rs. 45000(all inclusive)
a) Ceiling rates for Coronary Stents other than the Stents mentioned above, to be as per actual or Rs.
95000/- plus VAT, whichever is lower.
b) Maximum of three (3) Coronary Stents shall be permitted on the advice of the specialist, of which not more
than two (2) shall be of Drug Eluting Stents (DES).
- It is essential for the hospital to quote the batch number when a Coronary Stent of any type (Ordinary
metal/Drug Eluting Stent) is implanted in the case of a beneficiary. In addition to this, the outer pouch
of the Stent packet along with the sticker on it on which the details of the stent are printed shall also be
enclosed with the Hospital bill for claiming reimbursement.
- In case hospital has not given the batch number and / or outer pouch of the stents in a particular
case, the claim with regards to the implant may be rejected.
3. Joint Replacement Implants: Capping for different types of Knee and Hip implants, to be as per the actual
rates or the rates as mentioned below, whichever is lower.
1. Maximum ceiling for Knee implant to be Rs. 75000/-. (Including cost of Bone cement).
2. Maximum ceiling for Hip implant to be Rs. 75000/-. (Including cost of Bone cement).
Capping on Procedures/Packages given below:
Capping per
Hospitalization
Rs. 40,000/Rs. 45,000/-
S.No. Treatment
1 Hernia repair
2 Cholecystectomy
3 Haemorrhoidectomy
4 Appendectomy
5
Rs. 25,000/-
Hysterectomy
Rs. 35,000/Rs. 45,000/-
Coronary Angiogram/ Angiography
Rs. 16,000/-
6
7 Tonsillectomy
Rs. 15,000/-
The capping/ ceilings are applicable on ‘per hospitalization' basis and only for cases where
there are no complications/multiple diseases.
Pre-Hospitalization & Post-Hospitalization claims pertaining to the above treatments do not
come under the purview of the aforementioned capping.
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IMPORTANT EXCLUSIONS:
Under SAIL Group Mediclaim Insurance Policy, the Insurance Company shall not be liable to make any
payment in respect of any expenses whatsoever incurred by the insured person in connection with:
a. Any Disease/ complication caused due to alcohol intake.
b. Any disease/ injury caused by War/Nuclear Weapons/Radiations / Breach of Criminal law.
c. Circumcision, cosmetic or Plastic Surgery unless necessitated by an accident or as a part of any
disease/ illness.
d. Cost of dentures, hearing aid, spectacles, cost of glasses/ contact lenses etc.
e. Convalescence, general debility, "Run-down" condition or rest cure, congenital diseases or defects,
sterility, venereal diseases, intentional self-injury and use of intoxicating drugs.
f. The Hospitalization charges in which Radiological/Laboratory investigations/other diagnostic studies have
been carried out which are not consistent with or incidental to the diagnosis of treatment of positive
existence or presence of any ailment, sickness or injury for which confinement at any Hospital/ Nursing
Home, has taken place.
g. Expenses on vitamins and tonics unless forming part of treatment for injury or disease as certified by the
attending physician.
h. Voluntary medical termination of pregnancy during first 12 weeks of conception
i. Naturopathy Treatment.
j. External and/ or durable Medical/ Non-Medical equipment of any kind used for diagnosis and/ or
treatment including CPAP, CAPD, Infusion pump etc. Ambulatory devices, i.e. walker, crutches, belts,
collars, caps, splints, slings, braces, stockings etc of any kind. Diabetic foot wear, Glucometer/
Thermometer and similar related items etc., and also any medical equipment which subsequently used at
home etc.
k. Any kind of service charges, attendant food charges, surcharges, admission fees/registration charges &
Non-Medical expenses levied by the Hospital.
l. Treatment for age related Macular degeneration with Injection Avastin/ Lucentis/ Macugen.
m. Cytotron Therapy & Ozone Therapy.
n. Preventive Health Check-ups from OPD as well as IPD benefit.
o. Enhanced External Counter Pulsation Therapy (EECP)
p. Robotic Surgery/ Robotically assisted surgery.
q. Any unproven therapy.
r. Ayurvedic treatment if it is not an active line of treatment.
s. Rejuvenation therapy/ Massage/Panchkarma.
t. Stem cell Transplantation except Haemopoetic Stem Cell Transplant/ Bone Marrow Transplant.
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CLAIM PROCEDURE:
Mandatory Claim Intimations:1. The Beneficiary to inform / intimate, in writing, the Insurance Agency/TPA at least 48
hours prior to any elective / planned Hospitalization / Admission.
2. In case of Emergency Admission / Hospitalization, the Insurance Company/ TPA to be
informed by the Mediclaim member, in writing within 24 hours of such hospitalization.
3. The Claim Intimation is mandatory for both Cashless & Reimbursement claims.
4. In case, Claim intimation is not submitted or not sent within defined timelines, the claim
may stand to be rejected or deductions made
5. Claim Intimation can be sent via Letter/ Email/ Fax/ personally delivered at Insurance/
TPA offices.
6. Claim intimation format is provided on page no. 22.
NOTE:
For availing the facility of cashless hospitalization in hospitals, empanelled by TPA
for the said purpose, the members can avail the facility of TPA desk in such
hospitals.
For cashless hospital list, please refer to updated hospital list on
www.rakshatpa.com
Intimation can be sent via:
Toll Free No
24 Hrs Helpline no
Fax No
E-Mail ID
Website
: 1800 180 1555
: 0129- 4289980
: 011-66173411
: [email protected]
: www.rakshatpa.com
Personally delivered at Raksha TPA branches mentioned in the guidebook.
Acknowledgement to member will be given via email/SMS subject to details provided.
CASHLESS SERVICE AT NETWORK HOSPITAL:
Cashless hospitalization facility is available only at Network Hospitals. Cashless facility enables the SAIL
Members to obtain admission at designated hospitals subject to obtaining an Authority Letter from Raksha
TPA. Raksha TPA will settle the Hospital Bills directly on behalf of insured.
For Your Reference:
List of Network Hospitals on Page No. 45-57.
Format of Pre-Authorization form - Available on Page no. 21
Cashless Intimation: [email protected]
Whenever the Member is advised admission to one of the network hospitals for treatment:
Part A to be filled by Treating Consultant
Part B needs to be filled by the Hospital and Part C to be signed by Member
Then Pre Authorization form needs to be faxed/emailed by the hospital to Raksha TPA
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How to Avail Cashless Services:
Step 1: Forward your Pre –authorization request letter duly filled and signed by the Treating Doctor
and Hospital with Hospital Stamp:
Planned/Elective Surgeries - 48 hours prior to hospitalization
Emergency – within 24 hours of hospitalization
Step 2: Raksha TPA will confirm receipt of Request and will issue an Authorization letter for the
coverage as per the policy terms and conditions to Network Hospital. The Authorization letter is valid
only for the period of Hospitalization sought as per the request.
Step 3: Member approaches the Network Hospital Admission desk on the day of planned
hospitalization with Raksha ID card, Authorization letter and Self Photo ID Card. The identity of the
patient will be validated before admission.
Step 4: Network Hospital will extend cashless treatment to the Member up to authorized amount.
Step 5: At the time of discharge, Member/patient leaves back all the documents and also signs on the
Claim Form and Final Hospital bill.
Step 6: Member makes the payment in cash to the Network Hospital for those services that are not
covered under the policy.
On receiving the Pre Authorization request, Raksha TPA will do either one of the following:
A. Authorize: In case the cost of hospitalization exceeds the sum insured in the policy, the
policyholder will have to pay the difference to the hospital. Raksha will not be liable for any
amount in excess of the amount specified in the Authorisation Letter (AL). The AL is valid only
for the period of hospitalization as specified on the RAL (Request for Authorization Letter).
B. Request Additional Information: In case the information provided in the Pre Authorization
form is incomplete, unclear or insufficient, Raksha will request clarification from the
policyholder/hospital. Request Additional Information may be approved or rejected subject to
obtaining the Additional information and based on the terms and conditions outlined in the
policy. Raksha will fax/email Denial of Authorization Letter directly to the hospital with intimation
to the insured through SMS or email (if subject to availability of email or phone number).
Cashless facility may be denied in some situations as mentioned below:
Any ambiguity in the policy terms and conditions with respect to the present ailment.
Insufficient sum insured to cover the hospitalization expenses.
Pre Authorization form is not received by Raksha in time.
If the information sent to Raksha is insufficient to confirm the coverage.
Hospitalization not justified as per Terms & Conditions of Policy.
The policyholder or his/her relative must sign the claim form and hospital bills at the time of
discharge from the hospital.
Note: Please note that Denial of Authorization Letter is only denial of cashless facility and is no way to be
interpreted as denial of treatment. You retain the right to get treated, pay for the services and then submit
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the bills to us for reimbursement, subject to policy terms and conditions. In case of hospitals/cities not
included in the list, call at the Toll free number of Raksha TPA - 1800-180-1555. Each request would be
dealt on a case to case basis.
REIMBURSEMENT/SERVICE AT NON - NETWORK HOSPITAL:
If the treatment is availed in a Non-Network hospital the insured will have to settle the claim directly with
the hospital and file claim for reimbursement. To avail services in a Non-Network hospital kindly follow the
below steps:
Step 1: In case of Hospitalization at Non-network hospital, the Policyholder is required to intimate
Raksha TPA 48hrs prior for planned hospitalization or Elective surgeries and within 24 hours in
case of Emergency hospitalization.
Step 2: Policyholder avails treatment from hospital and makes payment for the entire treatment.
Step 3: After discharge Policyholder needs to submit the following within 30 Days from the date of
Discharge from the Hospital to help us in settling the claim faster.
IPD Claim form duly filled & signed as per format given on Page No.23-25
Original detailed Discharge Summary
Original Hospital bill with break-up and Payment receipts
All Original Doctors prescription for medicine purchased
All Original cash memos and bill for medicines
Package/Bill Break-up (if applicable)
Original Investigation reports along with films.
Bank details with cancelled Cheque for NEFT or you can also upload Bank details on our
website www.rakshatpa.com or can be uploaded through the Mobile App.
OUT-PATIENT (OPD) TREATMENT:
OPD claim should be submitted to the concerned office of Raksha TPA (Refer page no. 19-20 for detail of
offices) along with:
OPD claim Form duly filled in (Claim form available on page no. 26)
All Doctor’s Prescription
All Receipts/Bills for Drugs/Diagnostic Tests
All Diagnostic Reports
All the above documents should be submitted in Original, in proper sequence, duly tagged/stapled.
16
GRIEVANCE LODGING:
For prompt handling of grievances, a separate Grievance Team has been constituted to ensure Grievance
disposal. To raise your grievance you can log on to our website www.rakshatpa.com and raise the same on
Online Grievance redressal or mail to [email protected] or send the Grievance to a local office
on the address mentioned in the guide book.
In case of major dispute in any claim, the concerned member is required to contact the dealing Executive
of his/her respective SAIL Plant/ Unit, to which the member belongs. The concerned SAIL Plant/unit would
constitute a committee of SAIL & IFFCO –TOKIO officials to resolve the dispute. The decision of the
committee in this regard will be binding on both the parties and the member will have to wait for a
reasonable time for the decision of the committee.
Note: - For any queries/observations/complaints/grievance, the members are required to be in touch with
the Mediclaim Officer of their respective Plant /unit only. No communication with dealing officers of
Mediclaim of other plants / units, including Corporate Office, will be encouraged.
CUSTOMER CARE SERVICES:
In case of any queries or require assistance during hospitalization/ claims processing feel free to contact us
at our toll free number. We offer 24*7*365 days support through our Customer Care Centre.
Toll Free No.
: 1800-180-1555
24 Hours Helpline
: 0129-4289980 / -129-4289999
Fax Number
: 011-66173411
E-Mail ID
: [email protected]
Website
: www.rakshatpa.com
17
TECHNOLOGICAL ADVANCEMENTS:
Mobile Application – Please follow the below steps to download Raksha TPA Mobile application:
STEP 1 - Search for Raksha TPA application from Play Store in Android Phone and from App
Store in Apple I-phone.
STEP 2 - Click on install button.
STEP 3 – Pop up window appears showing location and photo media files .Click on Accept
and
then click on Open.
STEP 4 – Next a window opens where you need to type your member id, e-mail id, mobile number
and state. Then click on save and a new window opens from where you can access your account
for real time update of Policy Status, Request E-card ,Cashless status, Claim status, Claim
Intimation, Claim Registration, Update Bank Details ,Search Hospital and Contact Us.
SMS Pull Service - The following services are available in SMS pull service:
Service Details
SMS format
To register your mobile number as customer Rakshatpa<space>CID<space><Your member
identification number
id>SMS to 56161
To register your email id (after creating CID)
Rakshatpa<space>EM<space><Your
email
id>SMS to 56161
To get Claim status using claim number
Rakshatpa<space>CLMNO<space><Your
claim no>SMS to 56161
To get Claim Status using member id number
Rakshatpa<space>CLAIM<space><Your
member id>SMS to 56161
To get Cashless Status
Rakshatpa<space>CASHLESS<space>< Your
member id >SMS to 56161
To get ID Card Status
Rakshatpa<space>IDCARD<space><
member id >SMS to 56161
18
Your
DETAILS OF DEALING OFFICES FOR SAIL MEDICLAIM SCHEME ARE GIVEN BELOW:
Location
Kolkata
Bengaluru
Mumbai
Delhi-NCR
Chennai
Asansol
Durgapur
Rourkela
Bhilai
Bokaro
Badravati
Salem
Dhanbad
Ranchi
Nagpur
Chandigarh
Ludhiana
Office Address
Raksha TPA Private Limited, 8 Camac Street, Shanti Niketan Building, 6th
Floor, Space No. 7, Kolkatta-700 017,
Raksha TPA Private Limited, No 412, JINDAL CENTER 4th Floor, 100 ft Road,
4th Block, Koramangala, Bengaluru- 560034
Raksha TPA Private Limited, Unit no.2,A wing Time Square,3rd Floor, Marol,
Andheri Kurla Road Mumbai-400 059
Raksha TPA Private Limited, C/o Escorts Corporate Center, 15/5 Mathura
Road, Faridabad, Haryana-121 003
Raksha TPA Private Limited, 18/4 PLN Complex, Conran Smith Road,
Gopalapuram, Chennai-600 086
Raksha TPA Private Limited, "Shanti Niwas" apartment, 1st floor, Beside
Income Tax building (near Bhagat Singh more), Asansol. Ph: 09851930381
Raksha TPA Private Limited, A-2/4, Allaunddin Khan Bithi, City centre Durgapur
713216, Near Chaturanga Puja Maidan, Dist – Burdwan, West Bengal. Ph:
09474112572
Raksha TPA Private Limited, Pani Market Complex, Udit Nagar Chowk,
Rourkela, Pin-769012. Ph: 09937937569
Raksha TPA Private Limited, Plot No. 330/46 ,Opp Kalinga Computer training
Center, Pragati Nagar, Azad Market Rosali, Bhilai C.G. Ph. 9752509888
Raksha TPA Private Limited, HF 12,City Centre Sector-4 Near Bokaro Mall,
Beside OBC Bank, Bokaro Steel City, Jharkand 827004. Ph: 08102030396
Raksha TPA Private Limited, Sri Venkateswara krupa, #18/1 Lingayath Street,
Jannapura, Bhadravathi. Ph: 09739998767
Raksha TPA Private Limited, 5/9-1, 2nd Floor, Om Shanthi Complex, near avr
tower circle, Tata colony road, Salem 636005. Ph: 08883210863
Raksha TPA Private Limited, UG-37, shri Ram Plaza Bank More Dhanbad826001, Jharkhand. Ph: 09835328242
Raksha TPA Pvt Ltd, Fortune Plaza, Opposite gate no. 4, Ashok Nagar, Ranchi,
Jharkhand 834002. Ph: 09304630302
Raksha TPA Private Limited, Mohsin Majid Somwari Quarter No. 219/2 Near
ESI Hospital, Aashiyana Manzil, Nagpur- 440009. Ph: 08806503786
Raksha TPA Private Limited. SCO 359-360, 1st Floor, Sector 44-D,
Chandigarh-160047 Ph: 0172-5008705, 5008716, 4634707
Raksha TPA Private Limited, SCO 122 (Basement), Cabin No 5, Feroze Gandhi
Market, Ludhiana- Punjab. Ph: 0161-5085707
Jaipur
Raksha TPA Private Limited, S-101 102 Second Floor, Sumer Complex,
Gautam Marg, Behind Bagaria Bhawan,C-Scheme, Jaipur (Raj)-302001 Ph:
01412225257
Lucknow
Raksha TPA Private Limited, IInd Floor, Uttar Bharat Yuva Bhavan, 13 Rana
Pratap Marg, Lucknow-226 001, Ph: 0522-6546595,3202201,2204263
19
Cochin
Raksha TPA Private Limited, Door No.35/1947 B First Floor MS & S Center
Sabarmati Road Near J N Stadium Palarivattom Kochin - 682 025. Ph:
09840096191, 04844000506
Hyderabad
Raksha TPA Private Limited, 8-2-248/26/1, Plot No. 26 Snr Towers , Ground
Floor (Beside Bvrit City Centre/Next To Vishnu Nursing Home) Nagarjuna Hills,
Panjagutta. Ph: 040 66680190
Mangalore
Raksha TPA Private Limited, MANGALA Complex, 3rd Floor, Balamatta Road,
Hampanakatta Mangalore 575 001, Phone No 0824-4278910
Bhubaneswar
Raksha TPA Private Limited, C/O RNIS College of Insurance, Plot No: A/8,
Near Angan Restaurant, Sahid Nagar, Bhubaneswar-751007 Ph: 09040831020
Guwahati
Raksha TPA Private Limited, Prag Plaza, 2nd Floor, Near Hub Super Market,
Bhangagrh, G S Road, Guwahati-781005. Ph: 00361-2466056, 00361-2466057
Patna
Raksha TPA Private Limited, C/o RNIS College of Insurance, Kamal Cottage,
2nd Floor, Dadiji Sweet Lane, Boring Road, Patna-800001. Ph: 0129-4289999
Ahmedabad
Raksha TPA Private Limited, 112, Anand Managal, 1, B/h Femina Town, CG
Road, Ahmedabad 380009. Ph: 0265-6641122
Pune
Raksha TPA Private Limited, 28, Sangam II & III, Dr Ambedkar Road, Shivaji
Nagar,( Land mark - Near RTO ) Pune 411001. Ph: 020 - 26058125
Mumbai CST
Raksha TPA Private Limited, 7,Kumtha Street, Opp. Hotel Maharaja, Ballard
Estate,Mumbai-400 001. Ph: 022-67876666
Vadodara
Raksha TPA Private Limited, 401-402 (4th Floor) Arundeep Complex, Beside
Landmark, Racecourse Circle, Vadodara 390007. Ph: 0265-6641122
Indore
Raksha TPA Private Limited, Commerce House, 5th Floor, 7- Race Course
Road, Indiore-452001. Ph: 0731-4003652
Raipur
Raksha TPA Private Limited, Off. No. 105, 1st floor,M M Silver Plaza, Opp.
Udyog Bhawan, Ring Road No. 1,Raipur CG. Ph: 09981211034,08109039868
Bhopal
Raksha TPA Private Limited, 130,Zone 2, 2nd Floor, Near SBI Bank, Above
Abhishek Restaurant, MP Nagar, Bhopal, MP, Ph: 9770499406,9179564854
Dehradun
Raksha TPA Private Limited, Shop No. G/18 H/17 Janpath Complex, Chakrata
Road, Dehradun. Ph: 01725008705, 5008716, 4634707
Jammu
Raksha TPA Private Limited, C/O Rnis College, 17-A, Gandhi Nagar, Jammu.
Ph: 09419178520
20
CASHLESS REQUEST FORM
Raksha TPA Pvt Ltd. (IRDA License No. 015)
Customer Care: - 1800 180 1555 (Toll Free)/0129 4289980 Fax: - 011-66173411
E-Mail:[email protected]
PART A – TO BE FILLED IN BY TREATING CONSULTANT
Patient Name:________________________ MIN No:____________________________
Raksha Member ID.:
Age:___
Years. Gender: Male / Female
Patient‘s Tel No. (Off.)___________________Mobile: ______________________________________
Treating Doctor with contact no: _________________________
Name of Hospital:
Presenting Complaints & Clinical Findings with Durations: _________________________________________________________________________
__________________________________________________________________________________________________________________________
Past History:
Disease
DM
HTN
IHD / CAD
Surgical History
Duration
Disease
Arthritis
COPD / TB / Asthma
Any Other Chronic Ailment
Similar Ailment
Para
Maternity Cases: Gravida
LMP
EDD
In C/O Accidents, influence of Alcohol / Intoxicant: Yes / No Whether MLC Done: Yes / No
Proposed Line of Treatment: -
Duration
No. of Live Children: __________
In C/O Injury, whether suggestive of self-inflicted injury: Yes / No
_____________________________________________________ Class of Accommodation
Date of Admission: ___________Expected duration of stay:
_______Room No. ________ Admitting Diagnosis:
________________
________________
PART B – TO BE FILLED BY HOSPITAL
Amount in Rs.
Room Charges with breakup
-
Consultant Visit Charges, Surgeon Fees, Anaesthetist Fees with breakup
-
Investigation Charges with breakup
-
Anaesthesia, OT Charges, Surgical appliances, Medicines, Dialysis, Chemotherapy,
Radiotherapy, Cost of Stent and Implant etc with breakup
-
Total Estimated Expenses:
Rs
Raksha TPA Pvt. Ltd. will not be held liable for the payment in the event of any discrepancy between the facts presented at the time of admission & in final
documents submitted.
If the nature of treatment is different from what has been declared in the “Cashless Request Form” and for which “Pre Approval Certificate” has been issued then
the said pre approval will automatically stand withdrawn. A fresh “Pre Approval” for the changed treatment will have to be applied for and obtained as soon as
such a difference is noticed but in any case before discharge of the patient.
SIGNATURE & STAMP OF CONSULTANT
SIGNATURE & STAMP OF THE HOSPITAL
PART C – TO BE FILLED BY THE INSURED / CLAIMANT INSURED CONSENT / AUTHORIZATION
I have ‘no objection’ in Raksha TPA Pvt. Ltd. obtaining details of my treatment / collecting documents / verifying hospital records and also authorize
Raksha TPA to pay the hospital bill & reimburse itself / receive the amount from my claim receivable from my insurance company. In case my claim is rejected,
I hereby undertake to pay Raksha TPA Pvt. Ltd. the amount paid by them to the hospital. This consent is also final discharge for hospitalization part of the
claim where it has affected the payment. I reserve the right to submit pre / post hospitalization or other claim separately as and when required and as per policy
terms and conditions, which I have read and understood. In case, the letter of authorization is not utilized at the above hospital, I agree to inform and surrender
the letter of authorization to the Raksha TPA Pvt. Ltd. I am aware that Raksha TPA will update my sum insured only after receipt of the letter (in case of non
utilization of authorization letter).
I hereby warrant the truth of the foregoing particulars in every respect and I agree that if I have made or shall make any false or untrue statement, suppress or
conceal any material fact, then, my right to claim reimbursement of the said expenses would stand forfeited. I further declare that in respect of the above
treatment, no benefits are admissible under any other medical scheme or insurance.
Name:_____________________________________
Signature (Insured / Claimant)
21
ANNEXUREC: CLAIM
INTIMATION
CLAIM
INTIMATION
FORM FORM
Claim Intimation Form- Steel Authority of India Ltd. Mediclaim Policy for Retired Employees
Name of the Patient:
Full Address:
City:
Phone No.:
Hospitalization Information
MIN no.:
State:
E-Mail:
Pincode:
Date:
Age:
Gender:
M
F
Contact no.:
Diagnosis:
Date of Admission:
Date of Discharge:
Planned Treatment/ Emergency Treatment:
Hospital Information
Name of the Hospital:
Address:
City:
Contact no.:
State:
Pin code:
Doctor Information
Name of the Treating Doctor:
Qualification:
Landline Contact no.:
Estimated Expenses:
Any other relevant information
Additional attached Documents
Intimation Submitted by:
Name:
Registration no.:
Mobile no.:
Insured
Patient
Relative
Contact no.:
I hereby authorize Raksha TPA Pvt Ltd./ Insurance Company/ Representative of Insurance Company to
obtain my medical record/ Information from Hospital/ Nursing Home/ Treating Medical Professionals/ Family
Physician/ diagnostic Centre/ medical shops necessary to process the claim
Kindly Keep In Notice
Photo ID of the patient has to be carried to hospital during hospitalization
Attachments of prescriptions and Admissions notes is a mandate
Photo Identity of the patient has to be attached along with Claim Intimation/ Documents
SIGNATURE OF THE PATIENT
22
IPD Claim Form – Part - A (To be filled by the Insured)
Policy no: - 52613304
TPA :- Raksha TPA Private Limited
Insured Name :- ................................................... Date of Birth : -.....................Gender:-..........
Address:-…………………………………………………………………………………..................
.......................................................................................................................................................
Email id :- ................................................................................Mobile no.......................................
Details of Insurance history:- Currently Insured by any other Mediclaim policy: - No
/ Yes
If yes then :- Policy no:-..................................... Ins. Co..................................................................
Details of Hospitalization
Name of the Hospital where admitted :- .........................................................................................
Room Category :- Single occupancy/ Twin sharing/ 3 or more beds per room/ Day Care
Hospitalisation due to : - ......... Injury/ Illness
Date of Admission :-..................... Date of Discharge :-.........................
Date of injury / disease first detected :-......................
If injury give cause :......Self inflicted .........Road/Traffic accident...........Substance abuse/alcohol consumption
Whether .......Medico/Legal
or ........Reported to Police. If yes,,.............MLC report & Policy FIR attached Yes No
Details of Claim:Details of the expenses claimed under Hospitalization (To be supported by
Bills/ Receipt, Cash Memos etc)
Amount Claimed
Hospitalisation Benefits
Pre Hospitalisation Expenses (Within 30 days prior to admission to the hospital)
Post Hospitalisation Exp (up to 60 days from the discharge)
Pharmacy
Total
Claims document submitted :- (Details of NEFT FORM - Kindly fill up Annexure - C)
Claim form duly signed
Investigation reports
Copy of Claim intimation
Pre authorisation request
Copy of the Pre-Authorization approval
CT/MRI/USG/HPE/ECG Investigation reports
Copy of photo ID card of Patient verified by the hospital
Doctors reference slip for investigation
Hospital Discharge summary
Pharmacy Bills
Operation Theatre Notes
MLC reports & Police FIR
Hospital Main Bill
Original Death summary from hospital where applicable
23
Hospital Break up bill
Any other, Please specify
Dr’s Prescription
Hospital Payment Receipt/s
Insured declaration :- I hereby declare that the information furnished in the claim form is true & correct to the best
of my knowledge and belief. If I have made any false or untrue statement, suppression or concealment of any material
fact with respect to questions asked in relation to this claim, my right to claim reimbursement shall be forfeited. I also
consent & authorize TPA / Insurance Company to seek necessary medical information / documents from any hospital
/ Medical Practitioner who has attended on the person against whom this claim is made. I hereby declare that I have
included all the bills / receipts for the purpose of this claim & that I will not be making any supplementary claim
except the Pre/Post hospitalization claim, if any.
Date:-............................ Place...................................... Signature of the Insured..................................
Claim Form- Part- B (To be filled by the Hospital)
Details of the Hospital
Name of the Hospital :-.....................................................................................Hospital ID :-.............................
Type of Hospital :-
Network
Non Network
Name of the Treating doctor :.........................................................Qualification...........................................
Registration no. with State code :-................................... Phone no :-....................................
Details of the Patient Admitted
Name of the Patient :-................................................IP Reg. No................................
Gender :-......Male.......Female
DOB :-................................. Date & Time of Admission :-............................... Date & Time of
Discharge.............................
Type of Admission :- ..........Emergency..............Planned.............Day care
Status at the time of Discharge :-..........Discharged to Home.........Discharged to another Hospital......
Deceased
Total bill amount..............
Details of Ailment Diagnosed:
Diagnosis
Primary
Diagnosis 1
ICD 10
Codes
Description
Procedure ICD 10
Codes
Procedure
1
24
Description
Additional
Diagnosis
Procedure
2
CoMorbidities
Procedure
3
CoMorbidities
Details of
Procedure
Pre authorization obtained: .......Yes.....NO
Pre authorization Number :-..................
If authorization by network hospital not obtained, give
reason..........................................................................................................................................
Hospitalization due to Injury:-........Yes..........NO, If yes. Give cause :- ......Self inflicted
.........Road/Traffic accident...........Substance abuse/alcohol consumption
Whether .......Medico/Legal
or ........Reported to Police. .......If yes, FIR No..................If not, reported to police, give
reason................................................................................................................................................................
Additional Details in case of Non Network Hospital (Only fill in case of Non - Network Hospital)
Address of Hospital :..........................................................................................................................................
City.....................................State.........................................Pin code.................Phone no..........................
Registration no. with State code :-............................Hospital PAN :-........ Number of Inpatient
Beds..............
Facilities available in hospital :-
OT:-........Yes....... NO....
ICU
Yes......... NO....
Others:.............................................................................................................................................................................
.....
Declaration by the Hospital
We hereby declare that the information furnished in this claim form is true & correct to the best of our
knowledge and belief, if we have made any false or untrue statement, suppression or concealment of any
material fact our right to claim under this claim shall be forfeited.
Date:-.................................
Place.................................
Signature & seal of Hospital authority........................................
25
ANNEXUREB: FORM
CLAIM- OPD
FORM- OPD
CLAIM
O.P.D TREATMENT CLAIM FORM
Raksha TPA Pvt Ltd.
1) Name
2) MIN No
3) Address (IN BLOCK LETTERS) :
4) Phone Number
5) Nature of Illness
6) Period of Illness
7) Expenses Incurred
Type of Expenses
Bill
Date
Bill
No.
Name of the
Hospital/Lab/Medical Shop
Amount
a) For Consultation
b) For Medicines
c) For Pathological &
other diagnostic tests
d) Any other
Total Expenses Incurred:
I declare that the given information is correct and that I have not claimed reimbursement for the above expenses
incurred by from any other source.
I also consent and authorize Raksha TPA Pvt Ltd/Iffco Tokio General Insurance Co. Ltd/SAIL to seek medical
information/documents from any hospital /provider who has any time attend on the insured person.
Place:
(Signature of Insured)
Date:
Note : Please enclose the following documents in original along with the claim form :
a) OPD Card of SAIL approved I Govt. Hospital.
b) Chemist/Nursing Home Bills/Receipts and Original prescriptions.
c) All Pathological & other test report and bills, if any.
d) Discharge Voucher duly signed.
All the above should be in original. No Photocopies will be accepted.
26
NEFTD:FORM
ANNEXURENEFT FORM
Raksha TPA Pvt Ltd.
15/5, C/o Escorts Corporate Centre, Mathura Road, Faridabad - 121003
NEFT Form
To,
Raksha TPA Pvt Ltd.
Madam/Sir,
I furnish below details of my bank account to be used for effecting payments due to me by NEFT/RTGS
Registration for NEFT/ RTGS Payments
Beneficiary Name:
Card number
Mediclaim Index Number (MIN):
Bank Account Details For NEFT/RTGS Payments
Name as appearing in Account
IFSC Code *(11 digits)
PAN Number (10 digits)
Bank Name
Bank Branch Name
Bank Branch Address
MICR Code (9 digits)
Full Bank Account No. (for NEFT)*
Account Type
Current Account
Saving Account
*Please attach a copy of a cancelled cheque to verify the details of your bank account
Please refer your cheque book for IFSC/MICR Code of your bank branch or contact your bank's Branch Manager
I wish to receive alerts from the company on processing of payments to my account through SMS and/or Email
Mobile Phone No. (for SMS alert)
1)
2)
E-Mail ID (for mail notification) (please provide the IDs which will be
valid throughout the policy period)
3)
4)
NOTE:- Please Include a confirmation of account information on bank letterhead/Copy of Passbook or a cancelled cheque. If bank
letterhead is used, then bank officer's name and signature is also required. This information will be used to verify your account no.
DECLARATION
• I / We hereby declare that the particulars given above are correct and complete and no blanks have been left. If the transaction is
delayed or not effected at all for reason of incomplete or incorrect information I / we would not hold Raksha TPA Pvt Ltd responsible.
• I / We further undertake to refund, at any time, any excess amount whether demanded by Raksha TPA Pvt Ltd or not, which has been
credited to my account [due to any reason] by Raksha TPA Pvt Ltd, in excess of (i) the amount due to me, or (ii) Claim/Refund/ Any other
payment.
• I / We agree that the payment will be endeavoured to be credited starting from the date of next payment cycle and unless the Mandate is
revoked by me/us issuance of relevant credit instruction for electronic payment from Raksha TPA Pvt Ltd into the aforesaid account will
be valid discharge to Raksha TPA Pvt Ltd for having paid (i) the amount due to me, or (ii) Claim/Refund/ Any other payment.
• I / We further confirm that we understand this mode as a method of payment introduced by Reserve Bank of India, which provides us an
option to receive the amount and or to collect our payments by electronic payment mode directly through my/our bank accounts.
• I / We further confirm that I/we understand, Raksha TPA Pvt Ltd, shall make electronic payment to my account by issuing the Payment
instruction electronically through its banker to the Clearing Authority and the Clearing Authority would ensure credit to my/our specified
bank account provided hereinabove.
• I / We further undertake to inform Raksha TPA Pvt Ltd with an advance notice of 15 days, to withdraw from this mode of electronic
payment.
• I / We further confirm that Raksha TPA Pvt Ltd will have, at its sole discretion, the right to return back to the option of paying to me/us by
way of cheque if there are more than 2 consecutive failures in remittances for no fault on the side of Raksha TPA Pvt Ltd.
• After Raksha TPA Pvt Ltd issuing the Payment instruction electronically through its banker, for whatever reasons, if I/we do not get the
credit to my/our account, then same shall neither constitute the default in (i) Payment of amount requested by me, or (ii) Payment of
amount due to me/us, or (iii) Payment of claim/ Refund/Any other payment by Raksha TPA Pvt Ltd nor constitute default of any terms and
conditions of any Claim/Refund/Other contract with me/us.
Name of the Authorised Person:
Signature of Authorised Person
Date
D
D
/
M
M
/
Y
Y
Y
Y
27
SAIL FAQ’S
1) What is the validity of SAIL Mediclaim Scheme - 2016-17?
Answer: The SAIL Mediclaim scheme 2016-17 is valid till 31st March, 2017 (24:00 hrs - IST)
2) What is claim intimation?
Answer: Claim intimation is the notice of hospitalization/admission which is required to be sent
to any centre of Raksha TPA in writing through letter/fax/email/Personally delivered at TPA
offices, 48 hours prior to planned hospitalization or within 24 hours in case of emergency
hospitalization. The claim intimation should include all the relevant details like Name of Patient,
age, sex, Mediclaim Index Number (MIN), contact details, diagnosis, name-address-contact
details of the Nursing home/hospital, date of admission along with a copy of Admission Note of
the treating doctor.
3) Where do I submit the claim document?
Answer: You can submit the documents to the nearest Raksha branch (branch details have
been provided in the SAIL guide book) OR You can send the documents to Raksha TPA head
office at the following address, C/O Escorts Corporate Centre, 15/5 Mathura Road, Faridabad,
Haryana-121 003.
4) What I have to do for availing cashless hospitalization facility?
Answer: In case of planned hospitalization, Raksha TPA should be informed 48 hrs in advance,
through the duly filled-in/ Pre Authorization form (available at Raksha TPA website/in the guide
book /at the TPA desk of the concerned hospital). Ensure that the Pre Authorization Form is
signed by the member and the treating doctor. Your claim would be assessed as per terms and
conditions of the policy by the insurer and a letter of authorization will be issued to the hospital
authorizing treatment
In case of emergency hospitalization/admissions, the concerned hospital is required to send the
request for Authorization for cashless hospitalization to Raksha with in 24 hours of
hospitalization/admission. Once Raksha authorizes the concerned hospital, the cashless
treatment through an Authority letter, you are not required to pay the hospital up to the amount
which has been sanctioned by the said authority letter. Raksha will pay your hospital bills up to
the amount authorized in the Authority Letter only.
5)
What is the time limit for claim submission for reimbursement in case of hospitalization?
Answer: All the claim documents should be submitted within 30 days from the date of
Discharge from the hospital to any nearest Raksha TPA Branch Office or Head Office.
28
6) What is the time limit for claim submission for reimbursement in case of OPD?
Answer: OPD Claims to be submitted by the Mediclaim member, to the TPA at any time but
necessarily when the expenses exceed Rs. 2000 per person per policy period or within 90 days
from the date of completion of the treatment, whichever is earlier.
7) Where can I avail cashless hospitalization facility?
Answer: You can avail the cashless hospitalization facility in the Hospital mentioned in the
guidebook under the head List of empanelled hospitals for cashless hospitalization under TPA.
The updated list of such empanelled hospitals may also be seen at the TPAs website
(www.rakshatpa.com) or you can call toll free number1800-180-1555
8) What are the documents required to be submitted for claiming reimbursement for
hospitalization?
Answer: Kindly submit the following documents for processing your claim.
4. Claim form duly filled & signed
5. Copy of Raksha ID Card & Govt. Photo ID Proof Like Aadhaar Card, Passport, Driving
License
6. Original detailed Discharge Summary
7. Original Hospital bill with break-up and Payment receipts.
8. All Original Doctor’s prescription for medicine purchased.
9. All Original cash memos and bill for medicines.
10. Package Break-up (if applicable)
11. Original Investigation reports along with films.
12. Hospital Registration Certificate.
13. Your telephone numbers & e-mail ID.
14. Bank details with cancelled Cheque for NEFT or you can also upload Bank details on our
website www.rakshatpa.com.
9) Whom do I contact in case of any grievance?
Answer: In case of any grievance you may get in touch with the local branch office of Raksha
TPA or you can contact Head Office of Raksha TPA on:
a. 24 Hrs Helpline: 0129-4289980
b. Customer Care Help line (Toll Free No): 1800-180-1555
c. Email ID:[email protected]
d. Or you may Fax on: 011-66173411
29
10) What do you mean by Pre-Hospitalization & Post hospitalization?
Answer: The Pre hospitalization period is 30 days prior to Hospitalization and Post
Hospitalization period is up to maximum of 60 days from the date of discharge from the
Hospital.
11) What is the procedure for claiming reimbursement for Pre hospitalization as well as Post
hospitalization period?
Answer: The expenditure incurred during 30 days prior to Hospitalization (Pre-hospitalization)
and 60 days from the date of discharge from the Hospital (Post-Hospitalization), for the
treatment of a particular disease for which Hospitalization takes place, is considered for
reimbursement under IPD/Hospitalization. This along with the claim form and prescriptions,
medicine bills, investigation reports, investigation advices should be submitted within 30 days
from the date of last consultation, or 90 days from the date of discharge, whichever is earlier.
12) Spouse cannot sign on claim form can she give let hand thumb impression on Claim
form?
Answer: Yes, she/he can put left hand thumb impression on the Claim form and submit the
documents.
13) My OPD expenses are only 850/- can I claim for the amount?
Answer: OPD Claims to be submitted by the Mediclaim member, to the TPA at any time but
necessarily when the expenses exceed Rs. 2000 per person per policy period or within 90 days
from the date of completion of the treatment, whichever is earlier.
14) Are only diagnostic test covered under IPD?
Answer: Diagnostic tests which are not consistent with line of treatment are not payable as per
policy terms and conditions. However, Charges for diagnostic test consistent with or incidental
to the diagnosis and IPD treatment of the positive existence or presence of any ailment,
sickness or injury are payable.
15) What do I need to do at the time of discharge in case of a cashless facility?
Answer: You need to sign your bills, Fill up a claim form and sign the same, leave all your
investigation/diagnostic reports and X-ray/ultrasound films etc. with the Hospital. The hospital
authorities will send the documents to Raksha TPA for assessment and payment.
30
16) What is room restriction?
Answer:
For metro cities (Hyderabad, NCR, Bangalore, Mumbai, Chennai, Kolkata) Ceiling of
2% of the sum insured per member, i.e. Rs. 4000, or a single AC Non Deluxe room per
day, whichever is lower.
For Non- Metro cities which are state capitals Ceiling of 1.5% of the sum insured per
member, i.e. Rs. 3000, or a single AC non- deluxe room per day, whichever is lower,
For rest of country ceiling of 1 % of the sum insured per member, i.e. Rs. 2000 or a
single AC non deluxe room per day, whichever is lower.
17) Are there any limits on IOL (implant used in Cataract Surgery)?
Answer: Ceiling rates for different types of Intra Lens (IOL) implants to be as per actual or Rs
10,000/- whichever is lower and shall be reimbursable in addition to the package rates for
cataract surgery procedure. It is mandatory to attach the empty IOL sticker bearing the
signature and stamp of the operating surgeon on it along with the bill in support of the type of
IOL used containing its batch number at the time of claim submission.
18) What are the details on ECS/NEFT Payments?
Answer: Electronic clearance system is process where the amount is directly transferred to
claimants account. Claimant needs to fill in the ECS form available on the Raksha TPA website
(www.rakshatpa.com) or avail it from its branches. Once duly filled they can send the document
to the branch or Head office along with a cancelled cheque.
19) Will the company claim reimbursement for treatment/ medicines disbursed to the
members through its Hospitals & Health Centres?
Answer: Yes, SAIL will claim reimbursement against the treatment (OPD/ IPD) provided
through its Hospital & Health Centres including SAIL dispensaries and the same will be adjusted
against the available Sum Insured for OPD/ IPD of the concerned member, as the case may be.
20) When is my membership activated/ renewed?
Answer:
You have paid your premium fees through the various payment procedures as informed.
31
You have sent your receipt of payment along with the renewal application form (complete in
all aspects) to your concerned plant/ unit for activation/ renewal of your Membership.
Renewal will not be complete till payment receipt is sent to concerned plant/ unit along with
application form.
21) Is Robotic surgery payable?
Answer: No, robotic surgery or robotic assisted surgery is not payable under this policy.
22) Can I Claim hospitalization expenses of Ayurvedic/Homeopathic/Unani treatment of any
hospital?
Answer: Hospitalization expenses of Ayurvedic/Homeopathic/Unani treatment are Admissible
only when the treatment is taken in Government Hospital/Medical College Hospital.
23) Can I claim the expenses of Rejuvenation therapy/Massage/Panchkarma?
Answer: These are not payable under this Policy.
24) Can I Claim hospitalization expenses for Stem cell Transplantation?
Answer: Stem cell Transplantation is not covered in this policy except Haemopoetic Stem Cell
Transplant/ Bone Marrow Transplant.
25) From where I can get the updated OPD list?
Answer: Updated OPD centres are mentioned in the guidebook 2016-17.The updated list of
OPD list may also be seen on Raksha TPA website (www.rakshatpa.com) or you can call
Raksha TPA toll free number 1800-180-1555
26) Are there any limits on IOL (implant used in Cataract Surgery)?
Answer: Ceiling rates for different types of intra Ocular Lens (IOL) Implants to be as per actual or
Rs. 10000/- whichever is lower and shall be reimbursable in addition to the package rates for
cataract surgery procedure. In case the Lens cost is part of the packages agreed by the
Insurance/TPA then the reimbursement of IOL implant will be restricted to Rs. 10000/- or actual
whichever is lower. It should be mandatory for the operating surgeon of all hospitals to attach the
empty IOL sticker, bearing the signature and stamp of the operating surgeon on it along with the
bill in support of the type of IOL used containing its batch number. In case the same is not
followed, the claim with regards to IOL implant may be rejected.
27) Are there any treatment wise capping/ceilings in the policy?
Answer: In addition to the capping on Stents/ implants, the following capping on procedures/
packages as given below, shall also be applicable:
32
Capping per
Hospitalization
Rs. 40,000/Rs. 45,000/-
S.No. Treatment
1 Hernia repair
2 Cholecystectomy
3 Haemorroidectomy
Rs. 25,000/-
4 Appendicetomy
Hysterectomy
Rs. 35,000/Rs. 45,000/-
Coronary Angiogram/ Angiography
Rs. 16,000/-
5
6
7 Tonsillectomy
Rs. 15,000/-
The capping/ ceilings are applicable on ‘per hospitalization' basis and only for cases
where there are no complications/multiple diseases.
Pre-Hospitalization & Post-Hospitalization claims pertaining to the treatments do not
come under the purview of the aforementioned capping.
28) Are there any Discounts on treatment services for cash patients?
Answer: Few hospitals offer IPD/OPD treatment facilities to members of SAIL Mediclaim Scheme
2016-17 at negotiated tariff even when payment is made on cash basis but on production of
Raksha Member Card.
33
Sr.
Name of Day Care Procedures
Suturing - CLW -under LA or GA
Sr.
22
Therapeutic ERCP
Surgical debridement of wound
23
Brochoscopic treatment of bleeding Iesion
Therapeutic Ascitic Tapping
24
Brochoscopic treatment of fistula /stenting
Therapeutic Pleural Tapping
25
Bronchoalveolar lavage & biopsy
Therapeutic Joint Aspiration
26
Tonsillectomy without Adenoidectomy
Aspiration of an internal abscess under
ultrasound guidance
Aspiration of hematoma
27
Tonsillectomy with Adenoidectomy
28
Excision and destruction of lingual tonsil
Incision and Drainage
29
Foreign body removal from nose
Endoscopic Foreign Body Removal - trachea /pharynx-larynx/ bronchus
Endoscopic Foreign Body Removal (Oesophagus/stomach /rectum
True cut Biopsy - breast/- liver/- kidney-Lymph
Node/-Pleura/-lung/-Muscle biopsy/ Nerve
biopsy/-Synovial biopsy/-Bone^ trephine
biopsy/ pericardial biopsy
30
Myringotomy
31
Hydrocele surgery
32
Epididymectomy
Endoscopic ligation/banding
33
Orchidectomy
Sclerotherapy
34
Myringotomy with Grommet insertion
Dilatation of digestive tract strictures
35
Myringoplasty /Tympanoplasty
Endoscopic ultrasonography and biopsy
36
Antral wash under LA
Nissen fundoplication for Hiatus Hernia /Gastro
esophageal reflux disease
Endoscopic placement/removal of stints
37
Quinsy drainage
38
Direct Laryngoscopy with or w/o biopsy
Endoscopic Gastrostomy
39
Reduction of nasal fracture
Replacement of Gastrostomy tube
40
Mastoidectomy
Endoscopic polypectomy
41
Removal of tympanic drain
Endoscopic decompression of colon
42
Reconstruction of middle ear
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
34
Sr.
Incision of mastoid process & middle Ear
Sr.
64
Corrective surgery for blepharoptosis
Excision of nose granuloma
65
Foreign body removal from conjunctiva
Blood transfusion for recipient
66
Foreign body removal from cornea
Therapeutic Phlebotomy
67
Herniorrhaphy
Haemodialysis/Peritoneal Dialysis
68
Hernioplasty
Chemotherapy
69
Radiotherapy
70
Incision and excision of tissue in the
perianal region
Surgical treatment of anal fistula
Coronary Angiography (PTCA)
71
Surgical treatment of hemorrhoids
Pericardiocentesis
72
Sphincterotomy/Fissurectomy
Insertion of filter in inferior vena cava
73
Laparoscopic appendicectomy
Insertion of gel foam in artery or vein
74
Laparoscopic cholecystectomy
Carotid angioplasty
75
TURP (Resection prostate)
Renal angioplasty
76
Varicose vein stripping or ligation
Tumor embolisation
77
Excision of dupuytrens contracture
TIPS procedure for portal hypertension
78
Carpal tunnel decompression
Endoscopic Drainage of Pseudopancreatic
cyst
Lithotripsy
79
Excision of granuloma
80
Arthroscopic therapy
PCNS (Percutaneous nephrostomy)
81
Surgery for ligament tear
PCNL (percutaneous nephrolithotomy)
82
Surgery for meniscus tear
Suprapubic cytostomy
83
Surgery for hemoarthrosis/pyoarthros|s
Tran urethral resection of bladder tumor
84
Removal of fracture pins/nails
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
35
Sr.
Removal of metal wire
85
Incision of bone, septic and aseptic
Sr. Name of Day Care Procedures
110 Simple restoration of surface continuity of the
skin and subcutaneous tissue
111 Free skin transportation, donor site
86
87
88
Closed reduction on fracture, luxation or
epiphyseolysis with osetosynthesis
Suture and other operations on tendons and
tendon sheath
Reduction of dislocation under GA
112 Free skin transportation recipient site
113 Revision of skin plasty
Excision of lachrymal cyst
114 Destruction of the diseases tissue of the skin
and subcutaneous tissue
115 Incision, excision, destruction of the diseased
tissue of the tongue
116 Glossectomy
Excision of pterigium
117 Reconstruction of the tongue
Glaucoma Surgery
118 Incision and lancing of the salivary gland and
salivary duct
119 Resection of a salivary duct
89
Cataract surgery
90
91
92
93
Surgery for retinal detachment
94
Chalazion removal (Eye)
95
Incision of lachrymal glands
96
Incision of diseased eye lids
120 Reconstruction of a salivary gland and
salivary duct
121 External incision and drainage in the region
of the mouth, jaw and face
122 Incision of hard and soft palate
97
Corrective surgery for entropion & ectropion
123 Excision and destruction of the diseased
hard and soft palate
124 Incision, excision and destruction in the
mouth
125 Surgery to the floor of mouth
Incision of Cornea
126 Palatoplasty
Foreign body removal from lens of the eye
127 Transoral incision and drainage of
pharyngeal abscess
128 Dilatation and curettage
Excision of eye lid granuloma
98
Operation on canthus & epicanthus
99
100
101
102
Foreign body removal from posterior chamber
103 of eye
Foreign body removal from orbit and eye ball
104
Excision of breast lump /Fibro adenoma
105
Operations on the nipple
106
Incision/Drainage of breast abscess
107
129 Myomectomies
130 Simple Oophorectomies
131 Coronary Angiography
132 Dental Surgery (following Accident)
36
Incision of pilonidal sinus
133 Hysterectomy
108
Local excision of diseased tissue of skin and
109 subcutaneous tissue
134 Laproscopic Therapeutic Surgeries
Any other surgeries /procedures agreed to by SAIL, Insurance Company and TPA requiring less than 24
hours hospitalization will also be considered under Hospitalization
37
LIST OF SAIL APPROVED HOSPITALS FOR OPD TREATMENT
Apart from the following list of Hospitals, Branches/ Franchisees of major renowned chains
of Hospitals/ Diagnostic Centres like Apollo, Max, Fortis, Sankara Nethralaya, Centre for
Sight, Shroff Eye, Arvind Eye, Sharp Eye, Narayana Hrudalaya, Global Hospitals, Yashoda
Hospitals, Dr. Lal Path Labs & SRL Religare anywhere in India are also approved for OPD
Treatment.
38
39
40
41
42
43
44
LIST OF EMPANELED HOSPITALS TO AVAIL CASHLESS SERVICES (IPD)
Please note that below list doesn’t carry Single Specialty Network Hospital List and is not a
permanent list. Empanelment & De-empanelment of Network Hospitals is a ongoing process and
updated list of SAIL Cashless Hospitals can be referred from www.rakshatpa.com
45
46
47
48
49
52
53
54
55
56
57
List of Diagnostic Centres/Pharmacies which offer OPD services at Negotiated
Rates to Members of SAIL Mediclaim Scheme 2016-17
S. No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
S. No.
1
2
3
4
MEDICAL SHOP DETAILS
Name of Centre
Sri Vinayaka Medicals
Bhavani Medicals
Kamath Medicals
Vishveswaraya Medicals
Sri Ram Medicals
Apollo Pharmacy
DELUXE MEDICALS
MAYUR MEDICALS
MALTI MEDICALS
A YO Z MEDICALS
Asansol Medicals
Jayatri Medical store
Maa Medicine centre
Rashmi Medicine
Sarala medical store
Subhara medical
Nihar Medical
Medicine centre
Shubham Medical
Bharat Medicals
City Medical
SUJOY MEDICAL HALL
RAJA MEDICINE CENTRE
CITY MEDICAL STORES
MANGAL DEEP PHARMACY
Jaiswal medical store
Priyanka medical
Durga Medical
Astha Medical
Shurti Medical
Karunamayee Medical
Shurti Medical
Puja Medical
DIAGNOSTICS CENTRE DETAILS
Name of Centre
Shivamogga Diagnostics Centre
Gokul Diagnostic Centre
BOKARO PATHOLOGY
HI TECH DIAGNOSTIC
58
Location
Bhadrawati
Bhadrawati
Bhadrawati
Bhadrawati
Bhadrawati
Bhadrawati
Bokaro
Bokaro
Bokaro
Bokaro
Asansol
Rourkela
Rourkela
Rourkela
Rourkela
Rourkela
Rourkela
Rourkela
Bhilai
Bhilai
Bhilai
Durgapur
Durgapur
Durgapur
Durgapur
Dhanbad
Dhanbad
Dhanbad
Dhanbad
Dhanbad
Dhanbad
Dhanbad
Dhanbad
Location
Bhadrawati
Bhadrawati
Bokaro
Bokaro
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
Asansol Diagnostics
Uromad Diagnostics
Aviskar Diagnostics
S.D.M. PATHOLAB
DR. Lal Pathlabs Pvt. Ltd.
Florence Computerized Path Lab
Patliputra nursing home
Surksha diagnostic center
Clinitest pathology center
Singh Pathology
Asarfi hospital
Care diagnostic center
Hi-Tech diagnostic center.
MAYUR LAB
Clinilab
59
Asansol
Asansol
Asansol
Durgapur
Durgapur
Durgapur
Dhanbad
Dhanbad
Dhanbad
Dhanbad
Dhanbad
Dhanbad
Dhanbad
Bokaro
Dhanbad
List of Hospitals/Diagnostic Centres which offer IPD/OPD services at
Negotiated Rates to Members of SAIL Mediclaim Scheme 2016-17 on
Cash Basis
1. Global group of Hospitals
a) Global – Hyderabad
b) Global – Bengaluru
c) Global – Chennai
d) Global – Mumbai
2. Ruby General Hospital, Kolkata
3. BM Birla Hospital, Kolkata
4. Peerless Hospital, Kolkata
5. Kothari Medical Centre, Kolkata
6. Fortis Group of Hospitals
a) Fortis – Delhi
b) Fortis – Bengaluru (2 units)
c) Fortis – Chennai (2 units)
d) Fortis – Kolkata (2 units)
e) Fortis – Mumbai (Mulund)
f) Fortis – Raipur
7. Yashoda Hospital, Hyderabad (3 units)
8. Narayana Hrudayalaya Group of Hospitals
a) Narayana Hrudayalaya – Kolkata (Rabindranath Tagore)
b) Narayana Hrudayalaya – Bengaluru (2 units)
c) Narayana Hrudayalaya – Shimoga
9. Apollo BSR, Bhilai
10. Sanjeevai CBCC USA Cancer Hospital, Raipur
11. Kailash Hospital, Noida, Uttar Pradesh
12. Pushpanjali Crosslay Hospital, Ghaziabad, Uttar Pradesh
60
13. Moolchand Hospital, New Delhi
14. Saroj Super Specialty Hospital, New Delhi
15. Jaipur Golden Hospital, New Delhi
16. Yashoda Super Specialty Hospital, Ghaziabad, Uttar Pradesh
17. Dharamshila Cancer Hospital and Research Centre, New Delhi
18. Branches & Wellness Centres of M/s Dr Lal Pathlabs Ltd. in Delhi/ NCR
19. Maharaja Agrasen Hospital, New Delhi
20. Rockland Hospital, Qutub Institutional Area, New Delhi
21. Artemis Hospital, Gurgaon, Haryana
22. Rockland Hospital, Dwarka, New Delhi
23. National Heart Institute, New Delhi
24. Sri Balaji Action Medical Inst. & M/s. Action Cancer Hospital, New Delhi
25. Noida Medicare Centre, Noida, Uttar Pradesh
26. Sunder Lal Jain Hospital, New Delhi
27. Indian Spinal Injuries Centre, New Delhi
28. Mata Channan Devi Hospital, New Delhi
29. Paras Hospital, Gurgaon, Haryana
61
SAIL MEDICLAIM SCHEME (1ST APRIL, 2016 TO 31ST MARCH, 2017) - DETAILS
OF INTERNAL RESOURCE PERSON OF SAIL PLANTS AND UNITS
Plant/
Name
Designation
Phone
Email ID
Address
Unit
BSP
Hemalatha B.
DGM(P-ES)
07882857074
[email protected]
Building 4-A, CEZ Area,
BSP, Bhilai-491001 (CG)
Bhuwan Lal Sahu
AM (PFSS/SEWA)
07882854702
[email protected]
DSP
R.C.Mishra
Manager(Pers
)
03432745092
[email protected]
R.No.206, TA Building,
Durgapur-5, Burdwan,
West Bengal, PIN713205
RSP
Somajeet
Badpanda
AGM (P) C,
W&ES
06612642343
somajeet.badpanda@sailrs
p.co.in
Rourkela Steel Plant, At–
Public Health Office
Complex, Sector – 5,
P.O. - Rourkela – 769002
(Odisha).
06612344460
BSL
Dr. Nanda
Priyadarshini
AM (PMPC&FSC)
06542280630
nandapriyadarshini@gmail.
com
Personnel-Final
Settlement Cell, Old
Administrative Building,
Ispat Bhawan,Bokaro
Steel City, Jharkhand827001
ISP
Pragya Kumari
JM (PMPP&CPD,
Admn.)
03412240313
[email protected]
IISCO Steel Plant, POBurnpur, Dt-Burdwan
(W.B), Pin-713325
ASP
Sarmistha Datta
AM (CSR &
Admn)
03432546224
dattasarmistha931@gmail.
com
Alloy Steels Plant,
Administrative Building,
Durgapur-713208, Dist
Burdwan
SSP
Debariki Suresh
AM (Pers.)
04272382281
[email protected]
Personnel Department,
Salem Steel Plant,
Salem-636030 (TN)
VISL
Pradeep Kumar
Pati
Senior
Manager
(Pers.)
[email protected]
SAIL-VISL, New Town,
0828227160
Bhadravathi-577301
Karnataka
RMD
Sanjit K. Das
AGM (Pers)
033 22820900
62
[email protected]
SAIL, Raw Materials
Division, Industry House
(6th floor), 10, Camac
Street, Kolkata - 700 017.
CMO
Rajat Sarkar
AGM(P-HRW)
03322880073
[email protected]
SAIL,CMO, Ispat
Bhawan, 40 JL Nehru
Road, Kolkata-700071
I. Mukhopadhyay
Mgr.(P-R&W)
03322888825
[email protected]
RDCIS &
CET
Manas Rath
AGM (Pers.)
06512411596
[email protected]
MTI
Daisy Mala Hemb
rom
AGM(P&T)
06512411057
[email protected]
DS Patnaik
DM(Pers &
Trg)
GD
Dr. Rituparna
Mukherjee
Sr. Medical
Officer
03322263399
[email protected]
97, Park Street (2
Floor), Kolkata-700016
SGWKulti
Dr. S. Misra
Asstt. Director
(Med.)
03412515391
[email protected]
I.G.M. Hospital, SAIL
Growth Works, Kulti
CO
Neelam
Sabharwal
DGM (P-CSR,
ITB&Med.)
01124300335
neelam.sabharwal@sailex.
com
Neeraj Seth
AM (PITB&Med.)
01124300327
[email protected]
Prabal Sadhu
JO (PITB&Med.)
01124300329
[email protected]
Coll.
Divn.
Sanjay
Choudhury
Asst Manager
(Pl)
03262385002
sanjaychoudhary102@gma
il.com
CFP
P.P.Chakrabarty
DGM(P&A)
07172278222
[email protected]
RDCIS, SAIL, Ispat
Bhawan, PO-Doranda,
Ranchi-834004
Management Training
Institute, Ranchi –
834002 (Jharkhand)
nd
rd
SRU
Arthi.G
Asstt.
.Mgr(P&A)
07172278222
[email protected]
Sebastian Lakra
Sr. Manager
(P)
06542233233
[email protected]
63
Personnel Directorate, 3
Floor, Ispat Bhawan, Lodi
Road, New Delhi-110003
Personnel Department,
Central Office, Chasnalla
Colliery Complex, P.O.
Chasnalla, Dhanbad 828135
SAIL-CFP,
MUL Road, Chandrapur,
Maharashtra-442401
SRU, Indira Gandhi
Marg, Sector-IV, Bokaro
Steel City-827004
(Jharkhand)
CUSTOMER SATISFACTION FEEDBACK FORM
Insured Name:
Min No:
Scale of 1 to 4 where 4 to be considered as highest level of
satisfaction
1. How would you rate our services Please tick any one.
Member Enrollment
4
3
2
1
Cashless Authorization Service
4
3
2
1
Network of Hospitals
4
3
2
1
Call Centre Support
4
3
2
1
SMS & Mail Alert Features
4
3
2
1
Claim settlement
Grievances resolution
4
3
2
1
4
3
2
1
E-card Facility
4
3
2
1
Profile View
4
3
2
1
Claim Tracking
4
3
2
1
Claim Status
4
3
2
1
2. Online Services for Card holders:
3. Whether you will encourage others to prefer Raksha TPA as
their TPA
Yes
No
4. Any Suggestions:
64

- Rourkela Steel Plant

Transcription

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