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RAKSHA TPA PVT LTD

RAKSHA TPA PVT LTD. WARMLY WELCOMES FAMILY OF CONSOLIDATED CONSTRUCTION CONSORTIUM LTD WE WISH EVERYONE A VERY HEALTHY YEAR HEALTH IS WEALTH. RAKSHA ENSURES GOOD HEALTH. CONCEPT OF TPA. TPA STANDS FOR THIRD PARTY ADMINISTRATOR. ABOUT RAKSHA TPA PVT LTD.

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RAKSHA TPA PVT LTD

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  1. RAKSHA TPA PVT LTD WARMLY WELCOMES FAMILY OF CONSOLIDATED CONSTRUCTION CONSORTIUM LTD WE WISH EVERYONE A VERY HEALTHY YEAR HEALTH IS WEALTH. RAKSHA ENSURES GOOD HEALTH

  2. CONCEPT OF TPA • TPA STANDS FOR • THIRD PARTY ADMINISTRATOR

  3. ABOUT RAKSHA TPA PVT LTD • IRDA Licensed TPA (License No.015) • Promoted by Mrs.Ritu Nanda, an Icon in insurance field, Mr.Rajan Nanda, Chairman, Escorts Group and PadmaBhusanDr.NareshTrehan, Chief Cardio Thoracic Surgeon • ISO 9001-2000 Certified company by TUV of Germany • Associated with All Insurance companies in India

  4. Claim Process - Cashless NetworkHospital EmergencyAdmission PlannedAdmission Call Account Manager of Raksha TPA Hospital/Relative of the patient calls up Raksha Intimate at least 72 hours prior to admission & get AL issued Intimate Raksha within 24 hours of admission. Fax Pre-Authorization Form stating : • Name of Patient • Member ID • Ailment/Diagnosis • Pre-existing diseases if any • Approx date of admission • Approx duration of ailment/stay • Approx Cost of Hospitalization • Influence of alcohol in accident cases Authorization Letter (AL) issued depending on plan benefit & balance sum available . Cashless Medical Facility to the limit of available Sum provided to the hospitals

  5. Claim Process Non-Cashless Non-NetworkHospital Emergency Admission PlannedAdmission Get the treatment done • After Discharge send following in original to HR • Claim form (duly filled & signed) • Discharge Summary • Hospital Final bill and receipt • Investigation Reports if any • Prescriptions & Bills for medicines, Surgical items • Details of Pre & Post hospitalization expenses if any` Claim will be processed and the cheque would be sent to the Corporate HR Deficiency letter would be mailed to Corporate HR Are all documents complete ?

  6. Documents required • You must submit following documents in Original within 30 days of discharge from the hospital thro HR • Signed Claim Form of Insurance Co. • Original Final Hospital Bill along with Payment Receipt • Original Discharge Summary / Card • All Original Investigation Reports • Original Bills & Receipts for investigations done outside hospital. • Doctors Prescription, Pre – Post Hospitalisation bills (in original) • Original Bills of medicines,etc. if any purchased *kindly retain a copy of all documents for future reference

  7. Compensation Payable • Reasonable and necessarily incurred • Room Expenses in Hospital/Nursing Home • Nursing Expenses • Medical Practitioner Fee • Treatment cost • Medicines • Blood / Oxygen • Cost of Pacemaker / Artificial Limbs / Cost of Organs • Operation Theatre Charges • Surgical Appliances • Diagnostic cost • Dialysis, Chemotherapy, Radiotherapy • Pre Hospitalisation (30 days) and Post Hospitalisation expenses (60 days) • Max of Sum Insured

  8. SERVICE PARAMETERS • Issuance of ID cards 6 working day • Issuance of pre auth Within 3 hours • SMS alert for cashless approval Immediate • Settlement of reimbursement claims 14 Working days • Issuance of deficiency letter 3 working days • Processing after retrieval of deficiency 7 working days • Repudiation of claims 3 working days • Data not found cases (DNF) intimation 2 working days • MIS reports Monthly basis

  9. Policy Details • Insurance Co : ICICI LOMBARD INSURANCE • Policy No. : 4016/0002326/01 • Policy Period : 26/06/08 TO 25/06/2009 • Corporate Name : CONSOLIDATED CONSTRUCTION CONSORTIUM LTD • Address : 5, II LINK ROAD, CIT COLONY, CHENNAI – 600 004

  10. SUM INSURED ON A FLOATER BASIS OF 3 LAKHS PER FAMILY PRE EXISTING DISEASE IS NOT COVERED MATERNITY IS NOT COVERED POLICY COVERS EMPLOYEE, HIS/HER LEGALLY WEDDED SPOUSE, 2 LIVING CHILDREN AND DEPENDENT ROOM RENT CAPPING 1 % OF SUM INSURED, ICU 1.5 % OF SI PRE 30 DAYS & POST 60 DAYS HOSPITALISATION IS COVERED POLICY COVERAGE

  11. Exclusions • War / war group • Nuclear perils • Plastic surgery • Spectacles/contact lens/ hearing aid & other external appliances • Dental treatment • Intentional self injury • Influence of intoxicating drugs / alcohol • Treatment for AIDS • Diagnostic / laboratory expenses not consistent with treatment • Vitamins / tonic inconsistent with treatment • Naturopathy

  12. Contact Details Raksha TPA Mr. Rajeswaran (rajeswaran.raksha@gmail.com) Mobile No : 97909 51678 Escalations, if any Mr. R.Sethumadhavan (sethur1954@gmail.com or r.sethumadhavan@rakshatpa.com) Mobile No. 97890 86557 OR T.R.Venkatachlam (venkatachalam@rakshatpa.com or venkat17ram@gmail.com) Mobile No. 99404 55582 Chennai Office: PLN Complex, 18/4 Conran Smith Road, Gopalapuram, Chennai 600 086. Office Tel: 2835 0536 / 2835 0537 Fax: 2835 0538 Website: www.rakshatpa.com

  13. 24/7 Helpline • Mumbai • 022-22632727 • Fax : 022 - 2263 2451/57 • Faridabad • 0129-2250 0000 • Fax : 0129- 4100185/87

  14. Thank you

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