Intimation & Submission Guidlines

1. Intimation & Submission Guidlines Employee Health Insurance Program For the Year 2014-2015 Enter Alliance Insurance Brokers Pvt. Ltd.

2. Claim Intimations All Claims must be Intimated Health Insurance companies are now strictly adhering to Claim Intimation timelines. Hence, we request all to ensure intimation of claims within stipulated period to avoid rejection. Claim Intimation Guidelines Claim Intimation Compulsory • The employee has the option to intimate claims to the TPA via FAX/EMAIL/SMS. • Planned Hospitalization should be intimated two days prior to admission. • Emergency Hospitalization should be intimated within 24 hours of admission. • For all claims, members needs to send an intimation mail to frd@healthindiatpa.com • along with a CC to nitesh@allianceinsurance.inwith the following details: • Name of the Employee • Name of the Corporate • Name of Patient • Employee ID/TPA ID • Member Id • Name of the Hospital/Provider • Address of the Hospital for verification purpose • Date of Admission • Probable Diagnosis • Note: Violation of the above mentioned timelines may result in denial of claims by the Insurer/TPA & any exception will be at the sole discretion of the Insurer only. Health India Details Ms. Durga Tripathi Tel No: 022-66867522 Alliance Contact Details Mr.Nitesh Sharma Cell - +91 9167980504

3. Claim Submission Timelines All Reimbursement Claims must be submitted within 15 Days * All Reimbursement claims must be submitted to the TPA within 15 daysfrom the date of discharge. Pre-hospitalization bills can be submitted along with hospitalizations bills in case of re-imbursement and in case of cashless Claims, the pre-hospitalization bills can be submitted within 7 days from the date of discharge. * In case of post-hospitalization, the timeline would be 7 days from the completion of the treatment or 60 days from the completion of hospitalization, whichever is earlier. The following documents, in ORIGINAL,must be submitted at the time of Claims submission, • Duly-filled and signed Claims form. • Discharge card or Death Summary (in case the patient passed away during hospitalization). • Final hospital bill with appropriate payment receipts, including invoices for implants and stickers in case of lenses. • All Original Reports. • Prescriptions and medicine bills. • Consultation Bill along with supporting Consultation letters. • A letter from the doctor mentioning the obstetric history in GPLA format (in case of maternity claims). • FIR/MLC copy in case of Claims related to accidents. • Indoor Case Papers, if applicable. • Kindly retain photo-copies of all documents that are being submitted to the TPA. You might need them for later reference. • Kindly note: Violation of the above mentioned timelines during the Claims Submission process may result in denial of Claims by the Insurer/TPA & any exception will be at the sole discretion of the Insurer only. For further assistance /clarification, you can contact: Alliance Contact Details Mr.Nitesh Sharma Cell - +91 9167980504

4. THANK YOU HEALTH IS NOT VALUED TILL SICKNESS COMES