Symbiosis Health Insurance Programme

Every student & staff at Symbiosis is covered under a unique group medical insurance scheme with the National Insurance Company (NIC) for hospitalization upto Rs.50, 000/- in case of non-accidental emergencies (as per the Mediclaim Insurance Policy) & Rs.1, 00,000/- in case of Rail / Road traffic accidents. Policy details for Symbiosis Students


Policy details for Symbiosis Students


Policy Name: Group Mediclaim & Road Traffic Accident Policy for Symbiosis School & College Students

Campus:Pune, Nasik, Noida, Bangalore & Hyderabad

Insurance Company: National Insurance Co.

Third Party Administrator (TPA): MD INDIA Healthcare Services (TPA) Pvt Ltd (www.mdindia.com)

  • 1.Policy for School Student-
    1. School Student Mediclaim Policy

    2. Student Road Safety Policy

  • 2.Policy for College Student-

    • College Student Mediclaim Policy

    • College Student RTA Policy

Policy Period: Every year- from 05th June to next year 4th June


Policy Covers:-

  1. Policy covers medical expenses incurred for any treatment(arising out of any disease or accident) subject to stay in hospital for a minimum of 24 hrs. Hence hospitalization is a must prerequisite.No coverage for OPD treatment.

  2. Policy Sum Insured (maximum limit)-
    1. For College Student- Mediclaim Rs. 50,000/- per student. Road Traffic Accident- Rs. 1, 00,000/-
    2. For School Student- Mediclaim- Rs. 10,000/- per student. Student Safety Policy- Rs. 20,000/-
  3. Claim Settlement: cashless and reimbursement: Both.
  4. The policy document can be found on SCHC website (link)
  5. Premium once paid for Mediclaim & RTA insurance policy is not refundable in any case whatsoever.

How it works:

  1. Designated staff of the institutes is required to do the data entry of all students soon after admission as per training given by the Medical Officer, Insurance Cell, SCHC.

  2. The insurance policy period is from 05 June to 04 June next year.

  3. Identity card issued by institutes is to be produced on admission to empanelled hospital.

  4. Students are required to inform SCHC on admission to hospital. A confirmation mail is sent by SCHC Insurance Cell to the insurance company immediately after admission.

  5. For non-empanelled hospitals, information is to be sent within 3 days of admission and claim documents are to be submitted at SCHC within 20 days after discharge.

  6. Medical Officer , Insurance Cell : email Id: insurance@schcpune.org, drgirish@schcpune.org

  7. Contact No.: +91-95525-25015


Policy details for Symbiosis Staff


Policy Name: Group Mediclaim & Road Traffic Accident Policy for Symbiosis Staff

Campus: Pune, Nasik, Noida & Bangalore

Insurance Company: National Insurance Co.

Third Party Administrator (TPA): MD INDIA Healthcare Services (TPA) Pvt. Ltd (www.mdindia.com)

Policy for Symbiosis Staff:

  1. Staff Individual Mediclaim Policy

  2. Staff Family Floater Mediclaim Policy

  3. Staff Road Traffic Accident Policy.

Policy Period: Every year - from 08th May to next year 7th May

Policy Covers:-

  1. Policy covers medical expenses incurred for any treatment (arising out of any disease or accident)subject to stay in hospital for minimum of 24 hrs. Hence hospitalization is a must prerequisite. No coverage for OPD treatment.

  2. Policy Sum Insured (maximum limit)-

    1. For Staff Individual - Mediclaim Rs. 50,000/- to Rs. 5 lakh in multiples of Rs. 50,000/-.

    2. For Staff Family Floater - Mediclaim Rs. 1, 50,000/- to Rs. 5 lakh in multiples of Rs. 50,000/-.

    3. Staff Road Traffic Accident Policy- Rs. 1,00,000/-

  3. Claim Settlement: cashless and reimbursement: Both

  4. Excess (Co- payment) for each & every claim is as under-

For sum Insured

Co- payment

Rs. 50,000/- to Rs. 2,00,000/-

10% shall be deducted from net claim payable

Rs. 2,00,001 to Rs. 5,00,000/-

5% shall be deducted from net claim payable


How it works:

  1. All staff members are covered by medical insurance compulsorily, the premium will be deducted from their earnings in one lump sum (at the time of joining to Symbiosis) or in installments (after completion of one year of services). For heads of institutes the premium for Mediclaim cover & rail/road traffic accident cover for Rs 1 Lac is to be paid by the respective institutes as staff welfare activity. A 50 % for a sum insured of Mediclaim 50,000 & RTA 1 Lacs for Grade III and IV staff having completed one year service will be paid by the respective institutes as staff welfare activity.

  2. The start/ renewal date for the Mediclaim and Road/ RTA policy of the staff members is 8th May of every year. The insurance policy period is from 8th May to 7th May next year.

  3. Large No of hospitals all over the country are empanelled with our insurance TPA (MD India) where a cashless treatment facility can be availed by students, for other hospitals re-reimbursement of expenditure incurred is applicable subject to policy terms and conditions. The policy document can be found on SCHC website www.schcpune.org

  4. Designated staff member of the institutes is required to do the data entry of all staff members at the time of joining & as per training given by the Medical Officer, Insurance Cell, SCHC.

  5. The employee identity card issued by institutes is to be made on admission to empanelled hospital.

  6. A confirmation mail is sent by SCHC Insurance Cell to the insurance company immediately after admission hence staff members are asked to inform SCHC on admission to hospital.

  7. For non-empanelled hospitals, information is to be sent within 3 days of admission and claim documents are to be submitted at SCHC within 20 days after discharge.

  8. Premium once paid for Mediclaim and RTA policy is not refundable, due to any reason whatsoever.

  9. Medical Officer , Insurance Cell : email Id:insurance@schcpune.org, drgirish@schcpune.org
    contact : +91-95525-25015


CLAIM PROCEDURE


  1. Cashless Benefit- Process by which the insured can obtain treatment or medicine without being required to pay up front. The insurance company pays the hospital– often via a third party administrator (TPA).

  2. Reimbursement Benefit – Payment by an insurance scheme to a healthcare provider, or to insured persons, as a refund for all or part of fees for services.


PROCESS FLOW- CASHLESS

PROCESS FLOW- REIMBURSEMENT


DOCUMENT CHECKLIST


  1. Claim form duly signed.

  2. Xerox copy of Institute ID card.

  3. Original discharge card.

  4. History of present illness with duration: As mentioned on discharge card.

  5. Original hospital bill with receipt.

  6. All interim bills along with Final Bill.

  7. Detail hospital bill break-up with Room charges- No. of days and per day charges/ Details of Drugs Used/ Consultant – No. of visit & per visit charges/ Ward procedure (if applicable)

  8. List of medicines purchased : - Prescription & cash memo Total no-

  9. Lab/ investigation reports and their individual charges Total no-…

  10. X-Ray/ Sonography/ CT scan /2D echo/ MRI etc.-Report with film.

  11. In case of road traffic accident (RTA), copy of the Panchnama, police report or statement to police, FIR, MLC copy (All Original or Xerox copy attested by Police authority only )

  12. If RTA-Death claims then:

    a) Post Mortem Report,

    b) copy of Panchnama,

    c) Death Certificate

    d) FIR

    e) Final Police Report.(Original or Police attested copy).

  13. Hospital registration certificate.