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Frequently Asked Questions

What are the services I can get from TPAs in general and Vidal Health TPA in particular ?

We offer Cashless Access in Network hospitals in case of hospitalisation; we settle all claims directly to IBM employees.

Does Vidal Health TPA help with hospitals for admission? ?

Should you choose to get treatment in our Network hospital, since we have an understanding with them, they will give priority for admission.

What is Cashless Access to hospitals?

In the past, the policy holder had to pay the hospital and then claim reimbursement from the insurance companies, with the advent of the TPA system, the policy holder after getting an authorisation from TPA can avail treatment in specified hospital and get discharged after signing the bill. TPA will pay the hospital directly to the extent mentioned in the authorisation letter.

Can I have a list of hospitals from where I can get Cashless Access services ?

Yes, you can log on to our web site: www.vidalhealthtpa.com and view the list.

What are the charges not covered under my policy ? ?

Registration during hospitalization, ambulance, service charges, attendants charges are some of the charges not covered by your policy. If you have anything in particular please let us know we will clarify. These are subject to policy terms and conditions.

What type of hospitalization expenses is covered? ?

The policy covers, room rent, boarding charges, nursing expenses, surgeon, anesthetist, doctor's fee, blood, oxygen, operation theatre charges, x-ray, cost of medicine during the hospitalization and other diagnostic tests pertaining to sickness are covered.

Will you pay the claim in total.? ?

We will reimburse as per your policy. In case a particular amount is not payable we will not reimburse the same.

What are the documents required for member reimbursement claims ?

The discharge summary, hospital main bill , breakups, all original investigation reports with requests for investigation, pharmacy bills, medicine bills with prescriptions

What is the patient discharge protocol in network hospitals ?

Patient has to sign the main bill and pay non medical charges. Collect a copy of the discharge summary and final bill for future reference.

Whether treatment can be taken at any hospital or only at particular hospital ?

Any hospital, preferably network hospital Treatment at all the hospitals/ nursing home registered with local authorities is allowed. If there is no registration with the local authority, the hospital should have atleast 15 inpatient beds, full fledge operation theatre, qualified nursing staff and qualified doctor as in-charge. If these conditions are satisfied then the person can go to the hospital of own choice.

Is there any minimum time limit for stay in the hospital ?

Yes. Stay in the hospital should be for minimum of 24 hours. However, for dialysis, chemotherapy, eye surgery D&C, Lithotripsy (Kidney stone removal), Cataract etc. stay may be for less than 24hours . If the stay is more than 24 hrs and there is no active line of treatment ( only investigations done), then the claim gets rejected.

What are the expenses not covered during the hospitalization under mediclaim policy?

Non- medical expenses like registration fee visiting pass charges diet/food expenses(which is not part of the recommended diet of the hospital) Attendants charges service charges, Instrument hiring charges, Ambulance charges, Telephone bills, Documentation charges, Any other charges irrelevant to treatment.

How many days is Pre and post hospitalization covered by insurance?

30 days prior to the hospitalization and 60 days post hospitalization

Is Naturopathy treatment covered?

No it is not covered

Is expense of Vitamins and tonics covered ?

No it is not covered

What are the Non - medical expenses? ?

Misc. charges, Admission charge, stationary, Registration, Laundry and Phone.

In case of emergency whether authorization is required or not? ?

Yes, authorization for cashless access has to be obtained within 24hrs of admission.

In how many days are claims to be submitted to TTK? ?

Claim papers to be submitted to Vidal Health TPA Help desk representative within 30 days from the date of discharge.

Is InPatient treatment eligible in a foreign country with mediclaim? ?

Only treatment in India is covered.

Is Plastic surgery covered or Not? ?

No, if it's for cosmetic purpose/except incase of accident.

In case of RTA Dental treatment is covered or Not? ?

Yes it is covered

In case of orthopedic surgery, the expense on plate is covered or not ?

Yes it is covered

What are details to be included in the discharge summary?

This is a very important document; it will mention the Date .Of. Admission and Date.of.Discharge, Past History, details of treatment given, and requirement of medication post hospitalisation if any and doctors sign. This will be on the letter head of the hospital.

In a year how many times can I avail treatment in a hospital?

There is no limit on the number of times one can take treatment, however insurance company will reimburse claims upto the sum insured. And subject to policy terms.

Are bills from govt Hospital eligible for MR? ?

Yes bills from govt Hospital eligible for MR

 

What are the documents required for placing a Pre-Authorization Request?

No documents are required; the pre-authorisation request must be filled completely and signed.

What is the procedure for placing a Pre-Authorization Request?

If it's a planned hospitalization you need to send us the pre authorization request at least 2 days in advance, and if it is an emergency the hospital will do the needful.

How long will it take to receive Authorization?

We will be able to give you the authorization in six hours time provided we have all the required details

What is the procedure for obtaining Pre-Authorization in emergencies?

Please approach the network hospitals, they will send us the pre-authorization request.

My hospital is very slow in placing Pre-Authorization Request. What is the alternative?

Please give us the contact person name and number we will get in touch with him and sort out the issue. However you could collect the pre-authorisation request and fax the same to us, we will process it and issue an authorisation letter.

Should Pre-Authorization be obtained by Hospital or Employee?

If it is a planned hospitalization the pre authorization should be given by the customer, in case of emergencies the request will be given by the hospital. In some cases if the hospital does not have fax facility then the patient will have to obtain the same.

I placed a Pre-Authorization Request on ….; May I know the current status ?

Please give us the details/reference and the tel. no we will get back to u with the details

I have received a Authorization with a deduction; May I know the reason for deduction?

In case the available sum insured is less than the estimate given by the hospital then authorisation is given only upto the available sum insured. However Please give us your no. we will get back to you with the details.

My Pre-Authorization Request has been rejected. Why and What do I do ? ?

Pre authorisation is declined under the following circumstances 1) Information provided was inadequate 2) Disease not covered by policy 3) Sum Insured exhausted. Pls give us your no. and reference we will get back to you with the details.

Who will be giving the authorization? ?

The doctor in Vidal Health TPA will study the request and based on the available sum insured the authorisation will be given.

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