Know Your Mediclaim Policy

“Mediclaim Policy for the

students of Indian Institute of Science
Education and Research Mohali”
By Safeway TPA Services
POLICY DETAIL
• INSURER : National Insurance Co Ltd

• Policy No : 340100/48/17/8500000910

• POLICY START DATE : 22/09/2017

• COVERAGE VALID UP TO : 21/09/2017

• SUM INSURED : 100000/- (Per Student)

• POLICY TYPE : FOR STUDENT ONLY

• PERIOD : NA
 COVERAGE
1) Room, Boarding expenses as provided by the Hospital/Nursing Home.

Room rent capping

Room Rent : 2% of Sum insured
Maximum – 2000/- (Per Day)
ICU : 2% of Sum insured
Maximum – 2000/- (Per Day)

2) Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees.

3)Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical appliances any

disposable consumables , Medicines & Drugs, Diagnostic Materials and X-Ray,
Dialysis, Chemotherapy, Radiotherapy, Cost of pacemaker, Artificial Limbs and cost of
Stents and implants
 COVERAGE
• PRE - HOSPITALIZATION :-Relevant Medial Expenses
incurred during period up to 30days prior to
hospitalization on disease/illness/injury sustained
will be admissible

• POST – HOSPITALIZAION :- Relevant Medical

Expenses incurred up to 60days after hospitalization
will be admissible.
 GENERAL POLICY T&C
1) Pre-Existing:- Covered

2) 30 Days waiting: - Applicable.

3) 1, 2 years Exclusions: - Covered

4) Co Payments: - No Copayment.

5) Pre & Post Hospitalization: - 30 / 60 Days.

6) Domiciliary Hospitalization Charges: - Not Covered.

7) Dental & Spectacles & Hearing aids: - Not Covered.

8). Health Check-up: - Not Covered.

 RESTRICTIONS
Diseases In-Patient Treatment Others

Plastic Surgery Laboratory Expenses not Spectacles,Contact Lens,

(Cosmetic) consistent with treatment. Hearing Aid
Orthodontics Treatment Vitamins Use of intoxicating drugs/
alcohol
Sterility/Venereal Tonic inconsistent with Naturopathy
Disease/Circumcision treatment.
Intentional Self Injury Telephone,Fax,Barber,Photoc
opy, Vaccinations,Toiletries
and TV charges
Aids Special diet and extra diet for
patients (unless prescribed
by the Doctor)
Congenital Diseases External Implants Registration fees
(External) e.g. An operation to remove a
e.g. An operation to 6th finger, Skin Graphting
remove a 6th finger, Skin
Graphting
 RESTRICTIONS
Diseases In-Patient Treatment Others
Convalescence / Supports and Accessories, e.g. Admission fees
General Debility. Crutches
Service, Maintenance and Food & Beverages
Surcharges
Special Nursing, Attendant Pass Telephone/Fax

Health Drinks: Medical records/ Stationary

e.g. Horlicks, Complan etc Xerox or Certifying charges
Abortion done for voluntary Attendants Charges
reasons & before 12 weeks

Food and Beverage for Relatives Special Nursing charges

Diagnostic Expenses (only for Extra Bed/ Bed retaining

out-patient) charges
Damage done by the patient TV/ Laundry
(accidentally). Damage charges
not covered.
 RESTRICTIONS
Diseases In-Patient Treatment Others
Convalescence / Supports and Accessories, e.g. Admission fees
General Debility. Crutches
Service, Maintenance and Food & Beverages
Surcharges
Special Nursing, Attendant Pass Telephone/Fax

Health Drinks: Medical records/ Stationary

e.g. Horlicks, Complan etc Xerox or Certifying charges
Abortion done for voluntary Attendants Charges
reasons & before 12 weeks

Food and Beverage for Relatives Special Nursing charges

Diagnostic Expenses (only for Extra Bed/ Bed retaining

out-patient) charges
Damage done by the patient TV/ Laundry
(accidentally). Damage charges
not covered.
CLAIM PROCESS
 HOW TO AVAIL BENEFITS UNDER YOUR POLICY


Member Hospital sends
approaches Intimation to
with Network SAFEWAY
Hospitals with
ID

Member approaches
Any other Hospital Out of Pocket
Eligibility
Not payment
Avails treatment, makes Covered
upfront payment
Submits bills to SAFEWAY for
Covered
reimbursement

TAT : less than 2 hr for routine cases

Authorization as Cashless treatment
Emergency : No authorization required per eligibility at NWH

Regularization within 24 Hrs

 CASHLESS CLAIMS
To avail cashless hospitalization treatment at network hospitals –

• Step 1: SAFEWAY will provide the list of network hospitals offering cashless facility
for treatment.

• Step 2: The claimant needs to produce the SAFEWAY Health card at the hospital.

• Step 3: Hospital sends Pre-authorization Request with the treatment details; past
history and clinical notes along with estimate of hospitalization expense to
SAFEWAY local office.

• Step 4: SAFEWAY issues a letter authorizing treatment to the Hospital the

approved amount up to the Sum Insured limits.

Cont………
 CASHLESS

 Step 5: In case the treatment is taken at other non network centers, the Insured is
reimbursed the cost of treatment, subject to the provisions of the Policy on the
basis of Admit Card/Discharge Card, Diagnostic Reports and Bills/Prescriptions.
 RE-IMBURSEMENT PROCESS
• Step 1: Please intimate,SAFEWAY TPA Services within 48 hours about the hospitalization. Claim intimation
can be done by the following methods.

• Inform the Call Centre at Toll Free No: 1800-102-5671 / 45451300 And intimate the claim to
[email protected]

• Step 2: At the time of intimation, the customer should provide the following
a. SAFEWAY ID card No
b. Date of Hospitalization
c. Ailment
d. Approximate Date of Discharge
e. Approximate Date of Claim submission.

• Step 3: Download the Claim Form & Medical Certificate Form from our website and fill all columns. The
Medical Certificate Form will be filled by the treating doctor.

• Step 4: Submit filled and signed Claim and Medical Certificate Forms to your HR Deptt.

Cont……..
 RE-IMBURSEMENT
• Step 5: SAFEWAY will assess the validity of the claim based on the documents submitted,
validate the policy, validate the treatment undergone and settle the claim within the claim
settlement parameters. In case of claim is not adhering with parameters, the case would be
rejected.

• Step 6: SAFEWAY will correspond with you within 7 days of Claim receipt -
• Step 7:
– Event of Settlement: Please sign the Discharge Voucher and send it back to
local SAFEWAY office
– Event of Shortfall: Please forward the requested documents for settlement of
claim to local SAFEWAY office.
– Event of Disallowance: Please forward the necessary documentation not
submitted before to process disallowance and for addendum settlement
 RE-IMBURSEMENT
Documents Required for Re-imbursement Claims
1. Original detailed discharge summary
2. Original investigation reports along with bill
3. Original Hospital Bill-consolidated and with detail breakup of every component of the bill with
the patients signature on it.
4. Incase of surgical packages – detail breakup of the package
5. Medicine bills with prescriptions.
6. Claim Form – ( available on Safeway’s website www.safewaytpa.in )
7. MLC Certificate from the hospital in the case of Road traffic accident. Or a certificate from the
treating doctor mentioning that the patient was not under the influence of alcohol at the time
of Accident.
8. Payment receipt for the payment done to the hospital.
*30 Days pre & 60 Days Post hospitalization
Original investigation reports along with bills & receipts
1. Consultation receipts.
2. Medicine bills with prescriptions
3. Investigation Reports-Bills with Prescriptions if any
 DO’S
1. Carry your ID card (Student ID Card- IIT) at the time of admission at network

hospitals

2. Incase of emergency admission kindly contact Safeway within 24 hrs of

Hospitalisation

3. Incase of emergency kindly refer your Roll No at the time of admission

4. Take a pre approval from Safeway for all the elective cases

5. Sign on the final bill at the time of discharge from the hospital

6. For any other assistance call the account manager

 Your CRM
For any assistance you contact your CRM at below mentioned details

Mr Rahul Vij
Mail : [email protected]

Mob : +91-92-122-31982
+91-85-888-84533
Desk : +91 11 47551982

Safeway TPA Services Pvt Ltd

Gurpreet Singh
Mob : + 91 999 00 79269
Toll Free : 1800 – 102 -56-71
Phone : +91 45 45 1300
Mail : [email protected]