Crest Insurance 2015

Information - Mediclaim Insurance

Crest Insurance 2015

Policy Coverage details Group Mediclaim

Crest Insurance 2015

Claim Process REIMBURSEMENT

In case of a medical claim where the member has already paid the hospital bill, then the following process should be followed

Intimation should be given within 48 hrs. from date of Admission

Pay the Hospital bill

Complete the claim form. Attach all the original documents & submit the same
to MD India Helpdesk / respective HR Person.

The complete set is forwarded to TPA (MD India) within 15 days from date
of discharge

In case of further
clarifications, MD India will
contact employee.

TPA will lodge a claim with the Insurance Company after verifying the
documents.

If the claim is payable cheque/ECS will be forwarded to the respective

HR/employee.
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Crest Insurance 2015

Claim Process REIMBURSEMENT

Turn Around Time

Claim Intimation should be given within 48 hrs from date of admission.

Claim documents for reimbursement should be submitted within 15 days from date of 1st discharge to MD India

Claim settlement will be done in 21 working days from the date of submission of complete claim documents.

Claim Reimbursement amount will depend on policy conditions laid down by the Insurance Companies (inadmissible
amount will be deducted).

Claim reimbursement cheques will be issued in the name of the Primary Member & confirmation will be sent to respective
HR Personal / department.

SMS & Auto e-mail Alerts, will be sent to employee & HR department during various stages of claim process.

Crest Insurance 2015

Claim Process CASHLESS

Cashless Facility is available at Network Hospitals, provided the purpose of

hospitalisation is within the scope of cover and adherence to protocol.

On Hospitalization, Intimate MD India @ 18002334505/18002331166/18602334446 or Land line

number 020 25438227/28

Hospital will send RAL & related documents to TPA (MD India)
In case of further
TPA will examine the documents, if the ailment is covered under the policy, they will ACCORD a
Cashless facility to the member.

clarifications, MD India
will contact employee.

If Cashless is accorded, TPA will inform the member and the hospital on the same & will send a
letter of approval (Authorisation Letter) to Hospital, for CASHLESS facility.

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Crest Insurance 2015

Policy Coverage details Group PA

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Crest Insurance 2015

POLICY EXCLUSIONS

The Insurance Company shall not be liable to make any payment under this Policy in respect of any expenses
whatsoever incurred by any Insured Person in connection with or in respect of:

1.The claimant is involved in illegal activities

2. Suicide
3. Accident occurred when under the influence of drugs/alcohol.

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Crest Insurance 2015

Functions of MD India (TPA)

To work as a Nodal agency between Insurance Company, Insured and the Hospitals.

To issue ID Cards to all the members covered under the policy.

To administer Cashless Facility in network hospitals & reimbursement claims settlement as per the policy terms and
conditions.

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Crest Insurance 2015

Contact Details of MD India (TPA)

Employee may also Contact MD India @ Toll Free

& UAN Numbers -

Cashless Hospitalization:

services

1800-233-1166 or 1860-233-4446

Toll free numbers for cashless

services and customer

1800-233-4505 or 1860-233-4446
Customer Care (Reimbursements):

24 x 7 for 365 days at your

queries.

Supported with Medical Query

Assistance round the clock.

Land Line Numbers 020 25438227/28

Email:
punecc@mdindia.com
customercare@mdindia.com
corpservicing@mdindia.com

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Crest Insurance 2015

Contact Details of MD India (TPA)

For any further queries, Employees may also get in touch with below mentioned representatives

Mr. Ameya Kane 9890756037 or email:

Mr. Amit Kulkarni 09372270788 or email: corpservicing@mdindia.com

Mr. Arvind Bhabad 9325358443 or email: abhabad@mdindia.com

ameya.kane@edelweissfin.com

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Crest Insurance 2015

Formats & Hospital List

Check List

FAQ's

Claim Form

ECS Form

Hospital List Hospital List 2014-15 - Pune 2014-15 - Rest of India

Day Care
Procedures List

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Thank you