TTK Healthcare Services: Third Party Administration Expertise

1. Presentation By TTK Healthcare Services

2. Incorporated in March 2002 to provide third party administration Services Our Vision “To be the most preferred third party administrator”

3. ISO Certified TTK Healthcare Services exudes operational excellence in delivery of customer requirements, through defined quality processes Only TPA to be ISO certified for branches as well as H.O

4. Role of a TPA

5. PROVIDERS Policy Holders Insurance Co Desiring less administrative burden, greater autonomy, faster payments, and greater incomes TTK Demanding better service, more information, and greater convenience Striving to reduce premiums. Make better policies. Aim at Claims Control

6. Pan India Presence • Bangalore • Mangalore • Manipal • Hubli • Hyderabad • Vizag • Chennai • Coimbatore • Madurai • Trivandrum • Cochin • Ahmedabad • Mumbai • Pune • Jaipur • Ludhiana • Delhi • Patna • Jamshedpur • Bhopal • Kolkota • Bhuwaneshwar • Sambalpur Branches All branches connected through leased lines Redundant connectivity

7. Planned Hospitalization & Emergency Hospitalization CASHLESS APPROVAL

8. Planned Hospitalization • If it is a Pre planned treatment, the cashless request should be sent before a week time • Insurance coordinator in the Network hospital will give assistance & he is the only point of contact in hospital for insurance. • Fill the Pre-Authorizations Form, available with the Network Hospitals upon showing TTK Health Card. This can also be obtained from any of the TTK branch offices or can be downloaded from this site • Submit/Fax the Pre-Authorisation Form at our local branch office 4 days in advance • If your hospitalisation is authorised, then ensure • You pay for non-medical expenses and • Before getting discharge, the final bill should be sent to ttk before a 6 hours time. • Sign the relevant documents including a claim form before leaving the hospital/ getting discharged

9. Emergency Hospitalization • Insurance coordinator in the Network hospital will give assistance & he is the only point of contact in hospital for insurance. • Get admitted into a network immediately • Please inform your family member /relative to contact the billing dept in the hospital to inform them to intimate TTK • If your hospitalisation is authorised, then ensure • You pay for non-medical expenses and • Sign the relevant documents before leaving the hospital/ getting discharged • If your hospitalisation is rejected, your treatment will be continued at the hospital. After discharge, you can then submit a claim for reimbursement purpose at the TTK Branch office near you. • After sending the fax, the insured person can get confirmation about the fax delivery by contacting the following HELPLINE NUMBERS: 044-42894444 / 044-42894445 (24hrs) & 9884604485(9am to 6pm)

10. Mandatory details to be filled up in Cashless request • Insured name & Patient name with age & sex • TTK ID NUMBER. (If the insured person doesn’t received the TTK ID Number, as an alternate the corporate name & Employee Id should be mentioned in the request). • Mobile Number of the Insured person so that the Confirmation message will be sent once the approval is sanctioned. • Ailment & its duration & plan of treatment. • After sending the fax, the insured person can get confirmation about the fax delivery by contacting the following HELPLINE NUMBERS: • 044-42894444 / 044-42894445 (24hrs) & 9884604485(9am to 9pm)

11. DON’TS WHILE SUBMITTING AS AN CASHLESS • Incompletely filled Cashless form • Sending the Final bill/Enhancement at the time of discharge sharply. • Filling the Patient Name in short (Whatever the name uploaded in the intranet should be filled in the cashless form).

12. Non - Cashless Hospitalization MEDICAL REIMBURSEMENT

13. MEDICAL REIMBURSEMENT • Claim form 1st & 2nd page (Available in the Internet ). • Medical Certificate duly filled by the Treating consultant with Hospital Seal (Available in the Internet). • DISCHARGE SUMMARY : Discharge summary (Detailed) in Original With Hospital Seal & Treating consultant’s sign (Should be in Hospital Letter head). Date of admission & Discharge with time. Detailed explanation about the treatment undergone. Duration of the ailment. Advice On discharge (Which contains Prescription). Brief description about the investigation undergone. IN CASE OF MATERNITY: Obstetric Score/History (Number of live children) should be mentioned in the Discharge summary.

14. LAB REPORTS • (DO’S WHILE SUBMITTING AS AN MEDICAL REIMBURSEMENT) •  Lab Reports in Original with Dr.prescription. • Lab bills (If not mentioned in Main Bill ). • IN CASEOF FRACTURE : X-Ray report with Film • IN CASE OF ACCIDENT : FIR Copy/MLC/AR Entry. • [MLC: Medical Legal Certificate, AR : Accident Registration Entry]

15. BILLS • (DO’S WHILE SUBMITTING AS AN MEDICAL REIMBURSEMENT) • Consolidated Main bill with detailed breakup. • Numbered Payment Receipt for the Payment made. NUMBERED PAYMENT RECEIPT Numbered payment receipt is different from the cash bill, even if the cash bill is submitted, numbered payment receipt is necessary for the claims to process. If in case, the hospital doesn’t have a option of providing numbered payment receipt the alternate document insured person can provide is a payment receipt in the hospital letter head with the revenue stamp pasted & sign & seal on it. • Consultant bill/Surgeon bill. • Pharmacy bills with prescription. (The above mentioned are only the basic documents required for processing, once the claim is scrutinized,. If necessary, medical queries will be raised for further processing)

16. Pre & Post Hospitalization • Up to 30’days prior to the date of admission any treatment related expenses for pharmacy, lab, consultation charges is payable. • Up to 60’days the post hospitalization treatment related expenses for pharmacy, lab, consultation charges is payable.

17. General Exclusions • Injury or disease directly or indirectly caused by or arising from or attributable to War or War-like situations Injury or disease caused directly or indirectly by nuclear weapons • Circumcision unless necessary for treatment of disease • Dental treatment of any kind unless requiring hospitalisation • Congenital external diseases or defects / anomalies • HIV and AIDS or treatment for Venereal diseases • Hospitalisation for convalescence, general debility, intentional self-injury, use of intoxicating drugs/ alcohol. • Naturopathy - including spas, therapeutic massages etc…. • Any non-medical expenses like registration fees, admission fees, charges for medical records, cafeteria charges, telephone charges, etc • Cost of spectacles, contact lenses, hearing aids • Any cosmetic or plastic surgery except for correction of injury • Hospitalisation for diagnostic tests only • Vitamins and tonics unless used for treatment of injury or disease • Infertility treatment • Voluntary termination of pregnancy during first 12 weeks (MTP) • Natural calamities / acts of God – floods, storms, earthquakes etc….

18. DON’TS WHILE SUBMITTING AS AN MEDICAL REIMBURSEMET • Submitting the claim documents after 30days from the discharge date. If in case of submitting after 30days, the letter from the insurance company to be enclosed for processing. (Letter from insurance should contain a valid reason for the late submission. Insured person can request to the New India Assurance for the above mentioned letter. • Photocopies of the documents are strictly not applicable as per the policy.

19. ORIGINAL DOCUMENTS RETURN • If the insured person needs the original documents back for the further treatment, It will be provided by submitting a request letter signed by the insured person. • Discharge summary & Bills will not be returned at any cost. • Request for the original documents is applicable, only if the claim is settled. • Original documents will be returned to the insured person within 20 working days from the requested date.

20. PROCESS

21. Provider Network 4749 Hospitals / Nursing Homes in 390 cities and 3536 Diagnostic Centers in 31 locations.

22. Network – Empanelment Extensive Service Provider Network 4749 Hospitals 390 Locations Network Strength in India

23. Network – Empanelment Extensive Diagnostic Center Network 31 Locations Network Strength in India 3536Diagnostic centers

24. Misuse and Fraud Prevention • Investigations Department • Verification of hospitalization records • Validation of Medical Records • Case Selection based on Past Data Analysis. • 10% of All Claims Investigated. • Investigations Team Visits for all high Value Cases • Visits as a WELL-WISHER • Carries a Get Well Soon Card!

25. Geared for Customer Convenience

26. E Alerts 098452 48885 • SMS Facility: • Give us your mobile number in the preauthorization form and you will get an • SMS sent when request received. • SMS sent when authorization processed • Email Notification: • Give us your employees email id in the proposal form and you will get an email when • pre auth request is received. • Pre authorization request is processed • claims notification

27. HELPLINE NUMBERS GENERAL HELPLINE NUMBERS CHENNAI: 044-42894444 1800-425-7575 Chennai Fax: 044-42183300 044-42024343 CORPORATE PRIORITY CALL CENTER NUMBER: 044-42894445 & 9884604485 (9AM TO 9PM) CALLS HANDLED BY CALL CENTER AGENTS

28. CONNECT TTK FIRST TPA IN INDIA to introduce New Toll free number Reachable from mobile* 1800-102 -1234 CITY SPECIFIC TOLL-FREE NUMBERS UNIQUE TO TTK ONLY. ZERO COST TO CONSUMER * Airtel subscribers only

29. 24/7 Call center • 24 hour toll free helpline to provide assistance with • Hospitalization-Pre-authorization related queries – approval status, reason for partial rejection etc • Policy Scope and Coverage related queries • Enrollment ID Card queries • Information on Network hospitals • Claim Related queries

30. Online Features Claims • Online enrollment by Corporate – real time process, easy to access, no fear of misplacing documents/details, fewer errors • Online MIS for Corporate – All details available a click away • Online Authorization facility at top hospitals, for faster processing and convenient ( paper free) • ONLINE PAYMENT OF SETTLED CLAIMS DIRECTLY TO CUSTOMERS ACCOUNT

31. Self Access All forms available online Medical Information Medical second opinion Visit us at www.ttkhealthcareservices.com

32. Please login to www.ttkhealthcareservices.com

33. Please click here & select Employee Login

34. Extended Value for our clients Medical Information section on website Information adapted for Indian scenario and available in small, easy to digest pieces with simple language and illustrative diagrams

35. Q?

36. Thank You