A special compensation increased by an insurer or by the assigned TPA for availing medical treatment as an inpatient without the obligation to pay the treatment costs up front to the hospital. Under this procedure, the amount due to the hospital will be paid either by the insurer or by the designated TPA. After the discharge from the hospital the bills about medical expenses incurred at the hospital, are sent to the Insurer /TPA, (subject to the insurance policy & conditions) for compensation by the hospital. The hospital can claim in accordance to the pre-authorised limit and further cost as envisaged by the enhancement. In any case, the upper limit of this facility cannot exceed the sum insured under the contract of insurance.
Refusal of a Pre Authorisation request /Admission liability/cashless facility and or reimbursement of a claim under the insurance contract.
The situation when an insurer tries to increase the limit of the authorized claim amount resulting from the extension of hospitalization.
The items those are clearly and expressly removed from the scope of the insurance contract and hence are not payable.
Hospitalisation: Medical treatment after getting admitted to a hospital.
It is the highest limit up to which the insured can seek medical treatment under that Mediclaim policy.
A person, who is paying a premium, settles himself to get medical treatment up to a fixed amount of money in the case of injury, loss or damage to his body.
A corporate body licensed by IRDA for supporting multiple insurable possibilities upon any or all insurable perils with an assurance to make much the loss in an unexpected eventuality.
It is a body established under the Ministry of Finance to deal with licensing, regulating and controlling all movements corresponding to the insurers, brokers, agents, corporate agents and the TPA's.
The restrictions in the operative clause of the security contract to the limit of profits, and use, etc.
It is a card issued by your TPA with a primary purpose of identification. It includes the policy number, name and validity period. Many of the TPA's prefer to place an insured's photograph & signature to increase its authenticity. Though it is famous as a cashless card, it serves only as a way to get cashless compensation subjected to the terms & provisions of the policy.
An insurance policy that includes hospitalization costs acquired during hospitalization. Please check terms and conditions of the system to explain the type and the range of risk covered.
It describes the details and the limitations of the insurance contract indicating the requirements for fulfilling or adhering to the agreement of the insurance.
An authorization assigned by the insurer or by the TPA for admission and treatment up to price as deemed fit by the insurer, for treatment by the hospital. To get preauthorization, one has to make a request providing the details contained in the Pre-Authorisation Form.
Clarification asked to remove any doubt regarding the treatment and the obligation of insurance.
It is a facility under which the insured person can insist on the expenses paid by him during hospitalization. It is claimable under his insurance contract.
It is a telephone number or calls to which charges are not applicable. The number is provided by your insurer/TPA to get in touch with them for any clarification.
It is a corporate person allowed by IRDA for processing and setting on their part, challenges to occur following medical insurance policies and to coordinate with hospitals for all relevant and related processes.
