FAQs Mediclaim & RTA Insurance Policy for Symbiosis School, College Student and Staff


1.What is Insurance?

Ans: Insurance is a form of risk management primarily used to shield against the risk of an uncertain loss of health and property.

It is the transfer of the risk of a loss, from one person or body to another in exchange for premium payment.


2.What is unique about Mediclaim & RTA Insurance Policy for Symbiosis staff & students?

Ans: Pre- existing diseases covered for staff from day one of joining.

24X7 assistance by Medical officer, Insurance Cell on mob. no. 9552525015

Facilitation of cashless and reimbursement of claim by Incharge, Insurance Cell.

During hospitalization, as a medical guardian we conduct Hospital visit by a Medical Officer, Symbiosis Centre of Health Care to provide moral support to staff and student.

Since the year 2000, consistency of providing quality health care insurance services through a leading public sector insurance company of India.

Training and Awareness sessions about the need for mediclaim insurance on an ongoing basis to all stakeholders


3.What is Medical (Mediclaim)Insurance?

Ans: Mediclaim insurance is getting cashless or reimbursable medical treatment in case of diseases, injuries, surgery or any medical care that is needed by an individual or family. It includes hospitalization coverage.


4.Why Mediclaim Insurance is necessary?

Ans: Medical (Mediclaim) insurance helps to reduce the financial liabilities for medical facilities in best of hospitals during emergency and routine health problems.


5.What is Road Traffic Accident Policy (RTA)?

Ans: The RTA insurance policy covers hospitalization expenses for the treatment of accidental injuries ONLY.


6.Does Symbiosis have an insurance policy? If yes, who is the insurance provider for Symbiosis staff and students?

Ans: Yes. Symbiosis has Mediclaim and RTA insurance policies for staff and students. The insurance provider for Symbiosis is National Insurance Company. (NIC)


7.Who is the Insurance service provider for Symbiosis?

Ans: The Insurance service provider for Mediclaim and RTA insurance policies for staff and students is National Insurance Company Limited (A Govt. of India undertaking), which is a subsidiary of General Insurance Council.


8.What are Mediclaim& RTA Insurance Policies available with Symbiosis?

For Staff:

Ans: 1.Group Mediclaim Individual policy (staff) : for individual health insurance only

2.Group Mediclaim Policy Family floater policy: Individual , spouse and 3 dependent children only

3.Road and Rail Traffic Accident (RTA) Group Policyfor staff: Hospitalization for rail and road traffic accidents only.

For College students:

1.College student Group Mediclaim Policy:Only college students are covered.

2.College student Road Traffic Accident (RTA) Policy: Hospitalization for rail and road traffic accidents only.

For school students:

1.School Students Group Mediclaim Policy

2.School Student Road Safety Policy.


9.What is Third Party Administration (TPA)?

Ans: It is a mediator company to provide cashless and reimbursement facilities on behalf of National Insurance Company. It is licensed and governed by the Insurance Regulatory and Development Authority (IRDA, Govt. of India).


10.Which is the TPA for Symbiosis?

Ans: MDIndia Health Care Services (TPA) Pvt. Ltd. is the TPA for Symbiosis.


11.Does Symbiosis issue any Insurance card?

Ans: Your Institute Identity Card is to be used as an Insurance card during hospitalization.


12.What is meant by 'Hospitalization'?

Ans: Any instance when and where the insured individual is hospitalized for a minimum period of 24 hours can be termed as 'Hospitalization'.

However, for specific treatment the patient is discharged on the same day is also considered as 'Hospitalization'.

( For further details please refer clause no. 2.6 of policy document from the below link:
Group_Mediclaim_Insurance_Policy.pdf)


13.What is covered under hospitalization?

Ans: Following are the hospitalization charges covered by this policy:

Inpatient hospitalization charges: Means when a person is admitted in a hospital for the treatment of the diseases, injuries, surgery or any medical care, according to the terms and conditions of the policy.

Pre-hospitalization charges: Relevant medical expenses incurred during period up to 30 days prior to the date of hospitalization.

Post hospitalization charges: Relevant medical expenses incurred during period up to 60 days after the date of discharge.


14.What is not covered under Symbiosis School and College Student policy?

Ans: OPD treatments, dental treatment etc.

All diseases & injuries existing during the time of proposing the insurance policy.

All expenses arising from HIV/ AIDS and related diseases.

Use of intoxicating drugs and alcohol

For further details on exclusions please refer:

Group_Mediclaim_Insurance_Policy.pdf)


15.What is Cashless facility?

Ans: MDIndia settles the hospital bills directly on your behalf as per the terms and conditions of the policy. For this MDIndia authorizes group of hospitals all over the India for cashless hospitalization, they are called empanelled hospitals


16.What is the procedure to avail cashless hospitalization?

Ans: For Cashless benefits in emergency & planned hospitalization in empanelled hospitals , following procedure should be followed:

a) Inform the campus Medical Officer IMMEDIATELY or within 24 hours

b) Inform the Medical Officer, Insurance cell immediately or within 24 hours.

c) Contact the TPA department of the hospital and fill up the Request for Authorization (RAL) form at the earliest.

d) Above procedure MUST be followed to avail insurance facility.

e) Your institute identity card will serve as a insurance card.

f) If any one or all of the above steps are not followed Insurance Company will reject the claim.


17.What is reimbursement facility?

Ans: Reimbursement of hospitalization/Medical expenses after discharge from the empaneled /nonempanneled(should be registered with local authorities) hospital


18.What is the procedure for reimbursement of Medical expenses?

Ans: Inform (Intimate) the campus medical officer or Insurance Cell Medical Officer immediately or within three days of hospitalization either by mobile/SMS/e-mail.

Original claim documents should be submitted to Medical Officer, Insurance cell, S.B.Road, within 20 days after the date of discharge.

If any one or all of the above steps are not followed Insurance Company will reject the claim.


19.What is the sum insured option available to a School student under the Mediclaim & Road Safety Policy?

Ans: School student is insured for Rs. 10,000/- Mediclaim & Rs. 20,000/- for Road Safety Policy


20.What is the sum insured option available to a College student under the Mediclaim and Road Traffic Accident Policy?

Ans: College student is insured for Rs. 50,000/- Mediclaim & Rs. 1, 00,000/- for Road Traffic Accident Policy.


21.What are the sum insured options available to Symbiosis staff under the Mediclaim and Road Traffic Accident Policy?

Ans:

Mediclaim: For staff Individual Policy sum insured starts from Rs. 50,000/- upto Rs.5 Lakhs
For Family Floater Policy sum insured starts from Rs. 1, 50,000/- upto Rs.5 Lakhs.

For Road Traffic Accident Policy : Rs. 1, 00,000/- per person in both Individual & family Floater policy.


22.What is defined under the Staff Family Floater policy?

Ans: Self, Spouse and eligible children are covered under the family floater policy


23.What is the Startup date for Mediclaim and RTA policy for School and College student at Symbiosis?

Ans: 5th of June every year


24.What is the Startup date for Mediclaim and RTA policy for staff at Symbiosis?

Ans: S8th of May every year


25.What documents are required to avail of claim under Road Traffic Policy (RTA)

Ans: Three documents are mandatory to claim the expenses under RTA policy as follows-

a) Medico Legal Case Certificate(MLC )

b) First Information Report in Police (FIR)

c) Panchanama Report from Police.


26.What are the important numbers and website

Ans:

A)List of empaneled hospitals: from the below link you will get the updated empaneled list , where in you can avail the cashless facility http://www.mdindiaonline.com/ProviderList.aspx

B)Insurance Policy terms and conditions document: Group_Mediclaim_Insurance_Policy.pdf

C)MDIndia website:www.mdindia.com &mdindiaonline.com


27.Will I get any Tax Benefit?

Ans: Yes, the premium paid under this policy is exempted from Income Tax under section 80D. The limits of exemptions are as per Indian Income Tax Act.