CORPORATE CLIENT
Apollo Hospital Guwahati is on panel of imminent Corporate, PSU, TPA for indoor treatment & medical services. We have designed package of corporate health services to ensure that employees of its corporate clients stay healthy and productive. The aim is to impart expert health advice and ensure that medical support is available to the employees of client organizations, whenever they need it.
The list of companies Empanelled with Apollo Hospital Guwahati
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Central Govt Health Science |
Cement Corporation of India |
Hindustan Paper Corporation Ltd |
Indian Oil Corporation Limited(IOCL) |
Numaligarh Refinery Ltd |
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National Disaster Response Force |
NIPPCD |
Oil India Limited |
Power Grid Corporation |
NEEPCO |
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Reserve Bank of India |
The Assam Valley School |
Amalgamated Plantations |
BCPL |
Cement Manufacturing Co. Ltd |
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CRPF |
HPECL |
IDBI |
SAIL |
Hindustan Paper Corporation Ltd |
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North Eastern Hill University |
Regional Health Science Centre |
SIDBI |
Vijaya Bank |
Insurance/ TPA
Your easy guide to avail cashless Hospitalization
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Apollo Munich Health Insurance Com. Ltd |
Bajaj Allianz General insurance co. Ltd. |
Cholamandalam MS General Insurance |
DHS TPA Pvt. Ltd. |
E-Meditek TPA India Services Ltd |
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Family Health Plan Ltd. |
Future Generali India Insurance Co. Ltd. |
HDFC Ergo General Insurance Co. Ltd. |
Health India TPA services Pvt. Ltd. |
Heritage TPA Pvt. Ltd. |
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ICICI Lombard General Insurance Co. Ltd. |
ICICI Prudential Life Insurance Co. Ltd. |
Med Save Healthcare (TPA) Ltd. |
Medi Assist India TPA Pvt. Ltd. |
Medicare TPA Service (I) Pvt. Ltd. |
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Paramount Health Services (TPA) Pvt. Ltd. |
Raksha TPA Pvt. Ltd. |
Star Health & Allied Ins. Co. Ltd. |
Universal Sompo General Insurance Co. Ltd. |
Vipul Medcorp TPA Pvt. Ltd. |
Today, most Health Insurance policies do offer cashless hospitalization facility and route your policy through a Third party Administrator (TPA). However you should be familiar with the terms- Network Hospital and Non-network Hospital.
Network Hospitals are those hospitals that your TPA has an agreement with. In case of hospitalization, if you get admitted to a Network Hospital you will be eligible for cashless hospitalization, subject to the other terms and conditions mentioned in your policy being fulfilled. In case you are admitted to a Non-network Hospital, you will have to settle the bills directly to the hospital and then seek re-imbursement through your TPA.
First, you need to be clear that there is no free treatment. It is just that, in the case of a cashless hospitalization, the insurance company will bear the cost of treatment either fully or partially on your behalf.
Cashless hospitalization is a facility provided by most health insurance policies and enables an insured customer to obtain admission and undergo the required treatment without a direct payment. The assigned TPA will mediate between the healthcare service provider (Hospital) and the Insurance company and settle the bills on behalf of the insured customer.
However it is important to understand the role of a Hospital in cashless hospitalization. The Hospital is only a facilitator and has no authority to approve or disapprove any request for cashless hospitalization. Certain protocols laid down by the Insurance Regulatory and Development Authority (IRDA) with respect to cashless hospitalization will need to be adhered to strictly.
Hospitalization happen fewer than two circumstances - Planned and Emergency. Pre-authorization approval of the estimated hospital expense is a must to avail this facility.
Planned Hospitalization
In the case of a planned admission, you would have first consulted a doctor who in turn would have advised you on the probable date of hospitalization. In such a case, you must have applied for an approval of the estimated hospital expenses directly with your TPA at least 4-5 days prior to the date of hospitalization.
In case you have not applied for a pre-authorization sufficiently in advance or if the doctor treating you advises you to get hospitalized immediately after the consultation, our Corporate Help Desk will assist you through the pre-authorization procedure.
However, you will need to bear in mind that the Corporate Help Desk is only a facilitator and can in no way influence the decision on the approval. The approval can be turned down.
The pre-authorization procedure is detailed below
- Establish contact with the Corporate Help Desk at the Hospital
- At the Corporate Help Desk, you need to present the original health Insurance card issued to you by your TPA. And also produce a photocopy of ID proof issued by Govt. Authorities (PAN card/ Driving Licence/Voter ID card etc). Addition to this please produce your photocopy of employee ID card if it is a corporate group insurance policy.
- Collect the pre-authorization forms pertaining to your TPA
- Your pre-authorization will have two sections -
general details on the health Insurance policy - to be filled in by you (the Corporate desk will assist you in case you have any difficulty)
pertains to the treatment recommended for you-it needs to be filled in and duly signed by the Doctor who is treating you (do not attempt to fill this section, contact the Corporate desk in case of any difficulty) - Return the completed form to the Corporate Help Desk. The personnel at the desk will verify the form for its completeness and let you know in case of any discrepancy
- Once the form is complete in all respects, the Corporate Help Desk will fax the form to the office of your TPA.
- The Corporate Help Desk will revert to you on the approval status.
Emergency Hospitalization
In case of emergency hospitalization, the corporate help desk will take up your case on a fast track basis with your TPA and is likely to receive approvals within 3 hours during any working day.
For cashless treatment it is mandatory for the hospital to have an approval from your TPA. In case of delay in receiving the approval or when you cannot wait for receiving the approval owing to medical urgency you can undertake the treatment by paying the necessary cash deposit.
If you receive approval from your TPA after paying the cash deposit, you are entitled for refund of the cash deposit.
Cashless hospitalization is linked to the approval of the estimated expenditure on your proposed treatment. In case you do not get your approval you will need to bear the entire expenditure incurred on the treatment. Therefore it is always prudent to get the approval and then get yourself admitted. You could explain the benefits of getting the approval before the date of your admission to your treating doctor as well when he recommends an immediate admission.
Normally your request for approval might be rejected when:
- The ailment for which hospitalization is being sought by you is not covered under your insurance policy for reasons like pre-existing ailment, specific exclusions (road traffic accident under the influence of Alcohol)
- Information contained in the pre-authorization form is insufficient for the TPA to arrive at a decision and further information is not available for various reasons. However the chances of rejection under this criterion are rare since the Corporate Help Desk at the hospital is experienced in complying with pre-authorization formalities and will advise you suitably
- You have exhausted your eligible Medical Insurance cover for the year.
For complete details on the medical expenses that are covered, and those that are not covered, you need to go through your health insurance policy. However, in general, the expenses listed below are not reimbursable under cashless hospitalization.
- The ailment for which hospitalization is being sought by you is not covered under your insurance policy for reasons like pre-existing ailment, specific exclusions (road traffic accident under the influence of Alcohol)
- Information contained in the pre-authorization form is insufficient for the TPA to arrive at a decision and further information is not available for various reasons. However the chances of rejection under this criterion are rare since the Corporate Help Desk at the hospital is experienced in complying with pre-authorization formalities and will advise you suitably
- Registration / Admission Fee
- Telephone Charges
- Visitors / Attenders Charges
- Ambulance Charges.
- Document Charges.
- Non-medical Expenses.
- Service Charges
