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A number of day care procedures
(list available with help desk) which do not require 24
hours hospitalisation have been included in the policy
In case of death of a member /
spouse covered under the Policy, the entire hospitalisation
expenditure will be paid without any ceiling.
Expenses not connected with the
treatment and cost of non-medical items which are not presently
covered under MAFS will be excluded from the Policy.
Pathological tests and other tests
undergone by the members that do not lead to any medically justified
hospitalisation are not reimbursed under MAFS. The same rules will
apply under the Policy.
The Policy will not cover treatment taken
abroad.
In case the members have their
own individual mediclaim policies and they prefer to claim first
under their Policy, the balance amount can then be claimed under
the Bank's Policy. Alternatively, they can first claim from the TPA under
the Bank's Policy and then the balance amount under their own
Policy. |
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Salient Features of Mediclaim Policy for retired members of
MAFS |
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Group Mediclaim Policy (hereafter
Policy) covers hospitalisation expenditure c retired members of MAFS
for self and spouse.
The Policy is effective from August 15,
2007.
The Policy will be administered
by a Third Party Administrator (TPA). There are three TPAs
at present.
Regional Offices and Central Office Departments are allotted
among the three TPAs.
Each TPA has a state wise list
of network hospitals, (available with help desk and website of
respective TPAs).
Hospitalisation facility
on cashless basis can be availed anywhere in the country
through
the network hospitals of
the respective TPAs.
In case of planned
hospitalisation to a network hospital cashless facility will be
available on giving prior intimation to the TPA, while in case of
emergency, cashless facility can be availed on giving intimation to TPA
within the shortest time possible.
In case of hospitalisation to
a non-network hospital, as also claims for pre & post
hospitalisation, it will be
settled by the TPA on reimbursement basis on submission of bills /
documents in original to them without delay but not later than 30 days of
discharge / completion of post hospitalisation treatment.
In case of treatment in
Government Hospitals / Institutes where cashless facility is not
available, TPAs will extend the facility of advance payment up to
certain percentage of estimated cost of treatment within the overall
entitlement of the member.
The member may have to make a
token deposit (refundable), in case of emergency / planned
hospitalisation, if the hospital insists on such payment to cover
non-medical expenses, if any.
The hospitalisation bills will be
settled within the existing grade wise overall monetary ceiling and
indicative limit for bed charges. There would be no classification
of operations such as minor, less major, major, major plus and super
major. All other sub-limits/schedules for treatment during hospitalisation
have been dispensed with. |
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TPAs will issue an identity
card to the members which along with the MAF card issued by the
Bank will be required for identification at the time of hospitalisation.
1
In case of cashless facility, any
expenditure incurred over and above the prescribed limit per
hospitalisation will have to be settled with the hospital by the
member.
In case of any dispute over
settlement of claims between the TPA / Insurance Company and the members,
the Bank will be the final authority to decide the issue.
Other benefits available under
MAFS like dispensary facility/annual health checkup will
continue to be administered by the Bank as hitherto.
The Bank has setup a help desk
in each office to assist/guide the retired members. The TPAs can also
be directly contacted by the members in case of
need. |
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Grade-wise limits for Room Rent
(Bed charges) and overall monetary ceiling per
hospitalization |
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Pre-hospitalisation expenses up
to 30 days and post-hospitalisation expenses up to 60 days are
covered within the ceiling. |
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