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Guide Book
MDIndia Health Insurance TPA Pvt. Ltd.
S. No. 46/1, E-space, A-2 Building, 3rd floor,
Pune Nagar Road, Vadgaonsheri, Pune 411014.
Phone: 020-25230000

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+91 91 75 45 5225

Contact Us:

 Toll Free Customer Care:- 1800 209 77 77

 Toll Free Cashless:- 1900 209 7800
 Email:- [email protected] / [email protected]
 For Senior Citizens:- 020 25300 126
 Email for Senior Citizens:- [email protected]
 Business WhatsApp:- +91 91 75 45 5225
 CONTENTS

MDIndia Journey

Our Services

ID Card

Cashless Services and its Benefits

Reimbursement Services

Policy Information and Benefits

TPA and Insurer Agreement

FAQ’s

MDIndia Journey

MDINDIA, as a Third-Party Administrator (TPA) has not only grown in numbers – from about 20 to more than
7,000 highly skilled and competent personnel since it commenced operations in the year 2000 – but has
emerged as a leading TPA in India, priding itself on the value-added services it provides clients and end
customers through customer centricity and innovation with continually evolving expertise in technology,
operations and medical proficiency.

Our Company-wide reputation is built on Integrity, Knowledge and Service Excellence

Our Services

MDIndia is India’s leading TPA providing healthcare services across the nation. It has a widespread network
of hospitals all over India.

Our endeavor is to serve you at all times, each time, every time and on time.

Our Service Suite includes:

ID Card & Guidebook

We will provide an Identity Card & guidebook to you, the beneficiaries / insured persons under the policy.
This ID card is issued for identification purposes only.

The guidebook helps you understand processes to be followed during cashless/ reimbursement claims.

Cashless Services

You can avail Cashless services at MDI network hospitals. The hospital will be paid by MDI on behalf of the
Insurance Company (subject to policy terms and conditions)

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Reimbursement Services

In case, you avail treatment in a non-network hospital, MDI will reimburse the amount to you (subject to
policy terms and conditions)

Customer Care Services

In case you have any questions or require assistance during hospitalization / claims processing, we oFer
complete support to you, 24/7 through our multi-lingual Customer Care Centre.

ID Cards

You are requested to show the enclosed MDIndia ID card at the time of hospitalization. In case of non-photo
card, please carry a photo ID with you at the time of hospitalization (Passport, PAN Card, Driving license etc.)

The Photo ID with the card has to be faxed along with a request for authorization.

The identity cards contains an identification number which is unique to each insured under the policy. Please
quote MD ID number in case of any correspondence for faster response.

The ID card is to be properly maintained by the insured in order to avail cashless facilities from our network
hospitals.

The card is to be issued only for identity purpose and should not be considered as an authorization to the
hospitals to proceed with treatment.

This identity card will be valid for the current year, as well as during subsequent renewal of policy.

Cashless Hospitalization

You can obtain treatment at any of our network hospitals without payment, subject to the terms and
conditions of the policy.

MDIndia will settle the hospital bills directly on your behalf. Please check the list of hospitals in out network
forming a part of this welcome kit. It is advised to check our website www.mdindiaonline.com for updated
list or call on our Toll-free number.

Steps to follow for availing cashless facilities:

• Select the hospitals/ nursing home from our network list (For updated list visit our website
www.mdindiaonline.com)
• Show the ID card which is sent along with this welcome kit and obtain the cashless request from the
hospital.
• Hospitals/ nursing home submit the duly filled cashless request form to MDIndia.
• Get admitted, take treatment and get discharged without payment of bill.
• Please ensure that IRDAI claim form is filled duly and final bill is signed prior to discharge.
• Hospitals / nursing home will submit all claim documents along with bills to MDIndia.
• Payment will be made to hospitals / nursing home directly by MDIndia.
• In case of emergency hospitalization, the patient first gets admitted into our network hospital and then
proceeds with all the aforesaid steps.

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PLANNED HOSPITALIZATION

When the policyholder is advised admission to one of network hospitals for treatment, he/she will:

• Fill up Section A of “Request for Authorization” (RAL) (part of this guidebook)

• Get Section B of the RAL filled by the attending doctor/surgeon.
• Get Section C of the RAL filled by the network hospital.
• RAL to be faxed by the hospital to MDIndia Head OFice at 020-25300003 at least 72 hours before
admission.

On receiving the RAL, MDIndia will do either one of the following:

a. Authorize

MDIndia will fax an “Authorization Letter” (AL) directly to the hospital. In case the cost of hospitalization
exceeds the sum insured in the policy, the policyholder will have to pay the diFerence to the hospital.
MDIndia will not be liable for any amount in excess of the amount specified in the AL. The AL is valid only for
the period of hospitalization as specified on the RAL.

b. Request Additional Information

In case the information provided in the RAL is incomplete, unclear or insuFicient, MDIndia will request
clarification from the policyholder/hospital. RAL maybe approved or rejected subject to obtaining the
additional information and based on the terms and conditions outlined in the policy.

c. Denial

MDIndia will fax “Denial of Authorization Letter” (DAL) directly to the hospital. Cashless facility maybe denied
in some situations as mentioned below:

• Any ambiguity in the policy terms and conditions with respect to the present ailment.
• Ailment or condition not being covered under the policy.
• InsuFicient sum insured to cover the hospitalization expenses.
• RAL is not received by MDIndia in time.

If the information sent to MDIndia is insuFicient to confirm the coverage. The Policyholder must sign the
IRDAI claim form and hospital bills at the time of discharge from the hospital.

*Please note that DAL is only denial of cashless facility and is no way to be interpreted as denial of treatment.
You retain the right to get treated, pay for the services and then submit the bills to us reimbursement,
subject to policy terms and conditions.

*Please ensure that RAL has:

1) Diagnosis
2) Line of treatment
3) Tentative length of stay
4) Individual bill amount

EMERGENCY HOSPITALIZATION

In case the insured is admitted to one of our network hospitals in any emergency or accident, the RAL should
be faxed to MDIndia Head OFice or Branch within 24 hours of admission. MDIndia would authorize or deny

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 the request as mentioned earlier. If the insured gets admitted to a non-cashless hospitalization services
section.

Benefits of availing of cashless access services

• Immediate access to treatment

• Financial relief from arranging for money
• Large networks of hospitals
• Reduced paperwork and documentation
• Cost estimate for payables
• No need of paying first and then claiming

Reimbursement Services

Reimbursement / Non cashless hospitalization service maybe available if:

• The insured is admitted to a non-network hospital.

• MDIndia has not received the RAL from the hospital or policyholder within stipulated period mentioned in
the terms and conditions of the policy.
• DAL has been issued.

Procedure

Claim intimation is to be sent within 24 hours of hospitalization.

The policyholder pays the hospital charges in full at the time of discharge.

He/She should submit the following documents in originals at the nearest MDIndia branch.

IRDAI Claim Form duly signed by the insured.

Photocopy of ID card
Photocopy of policy scheduled (and a previous policies, in case of continuous coverage)
In case of corporate policy, date of joining the company
Original discharge card/Summary
Original hospital bills, for consolidated amounts, a detailed breakup of the amount
For purchased medications, the bills in original need to be supported by a prescription from the
attending doctor/ surgeon (with hospital Seal)
All investigation reports and bills in original supported by a note from the attending doctor/ surgeon
recommending such investigations
Surgeon’s certificate stating nature of surgery performed and bill and receipt of the same.
Attending doctors/consultants/specialists/anesthetists bill, receipt and certificate
Certificate from attending doctor/surgeon giving reasons for allowing treatment at home
Certificate from attending doctor that patient is fully cured
In case of accident, FIR/MLC from the hospital
Signed discharge Voucher (DV)
Please enclose cancelled cheque of your bank account (your banker named should be participant of
NEFT/RTGS facility)

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Customer care

24*7 assistant is provided to our valuable customers. All the numbers have been provided on your ID card
issued by MDIndia as well as guidebook or you can visit to our website https://mdindiaonline.com/ for any
information needed.

Policy Information and Benefits

This Health Insurance Policy oFers comprehensive health coverage tailored to diverse healthcare needs. Key
benefits include hospitalization expenses, pre- and post-hospitalization coverage, day-care procedures, and
wellness incentives. Additional advantages may comprise coverage for alternative treatments, ambulance
charges, and cumulative bonus. For detailed information, please refer to your policy document.
For all legal purposes and disputes, the insurer’s policy terms and conditions will apply and prevail.

Agreement (TPA and Insurer)

The TPA shall render the services detailed hereunder to the insurer under the agreement in connection with
the health insurance business.

a) Servicing of claims under health insurance policies by way of pre-authorization of cashless treatment or
processing or recommending of claims other than cashless claims or both, as per the underlying terms and
conditions of the respective policy and within the framework of the guidelines issued by the insurers for
settlement of claims.
b) Servicing of claims for Hospitalizations cover, if any, under Personal Accident Policy and domestic travel
policy.
c) Facilitating carrying out pre-insurance medical examinations in connection with underwriting of health
insurance policies.
d) Any other services as may be mentioned by the Authority during the currency of the HSA.
e) While performing the services as indicated in the HSA as above, a TPA shall not
i) Directly make payment in respect of claims
ii) Reject or repudiate any of the claims directly
iii) Handle or service claims other than hospitalization cover under a personal accident policy.
iv) Procure or solicit insurance business directly or indirectly.
v) OFer any service directly to the policyholder or insured or to any other person unless such service
is by the terms and conditions of the policy contract and the agreement entered into in terms of the
regulations of the IRDAI.

FAQ’s

Whether charges for diagnostic test are also covered?

Diagnostic test which are not consistent with line of treatment are not payable at all. However charges for
diagnostic test consistent with or incidental to the diagnosis and treatment of the positive existence or positive
existence or presence of any ailment, sickness or injury are payable.

What I have to do for availing cashless facility in the hospital?

If hospitalization is planned, you should inform us two or three days in advance by sending a (form on website)
signed by the treating doctor. Your claim would be assessed as per terms and conditions of the policy issued
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 to you by your insurance company and a letter of authorization will be issued to the hospital authorizing
treatment. In case of any emergency, the hospital will fax the pre-authorization letter. Once the authorization
letter has been sent to the hospital, you need not pay at the hospital. MDIndia will pay your hospital bill up to
the amount authorized in the Authority letter.

What do I need to do at the time of discharge in case of cashless facility?

You need to sign your bills, fill up a claim form and sign the same, leave all your investigation/diagnostic
reports and X-ray/ ultrasound films etc. at the hospital so that the hospital authorities will send the
documents to us for assessment and payment.

If I avail cashless facility for my hospitalization, how will claim for my post hospitalization expenses?

You can file a claim for reimbursement of your Pre & Post hospitalization expenses with MDIndia (subject to
policy terms and condition)

What does my Mediclaim policy cover?

Your policy covers hospitalization expenses subject to hospitalization being for a minimum period of 24
hours (with certain exceptions and exclusions) as per policy benefits.

What is meant by exclusion?

Certain diseases that are not covered under the policy as mentioned in the exclusion clauses are called
exclusions.

Is dental treatment covered?

No, dental treatment of any kind is covered, unless requiring hospitalization and arises due to accident.

Quick Links
IRDAI Claim Form: http://mdindiaonline.com/documents/claimform.pdf
ECS Form: https://mdindiaonline.com/documents/ecsform.pdf
Check List: https://mdindiaonline.com/documents/claimdocumentschecklist.pdf
Network Hospitals: https://mdindiaonline.com/ProviderSearch.aspx
ABHA Registration: https://abha.abdm.gov.in/abha/v3/register

Our Branch Offices & Contact Numbers

011-47456424/25/ Pune
Ahmedabad 079-27542665 Delhi 26/27
Kolhapur 9168618862 020-25438227
Branch
033-24220521/
Asansol 0341-2252677 Dhanbad 0326-2305550 Kolkata 0545
Pune (HO) 020-25300000

Bangalore 080-26549834/9854 Durgapur 0343-2606811 Lucknow 0522-2982121 Raipur 8956023678

0265-357660/ 2323244/
Baroda 2357256/ 2357666/ 2320602
Goa 0832-2220056 Ludhiana 0161-2770972/73 Ranchi 0651-2332734
0755-2460795/ 2430511/
Bhopal 2430533/ 3200070
Guwahati 8486925241 Mangalore 8483961053 Rourkela 8114357222

Bhubaneshwar 7420072457 Hubali 9156350139 Mohali 9115601943 Sambalpur 8084243710

040-23414121/ 022-22679692/
Bokaro 06542-233099 Hyderabad 32962260
Mumbai 93/94/95
Satara 02162-228182

Chennai 044-24343011/ 12 Indore 0731-2554890 Nagpur 7769923988 Surat 0261-2345636

Coimbatore 0422-2302171/2302172 Jaipur 0141-4008321 Nashik 0253-2591050/51 Vijayawada 0866-2471265
Dehradun 0135-2658722 Kochi 0484-2401327/37 Patna 0612-2660341 Vizag 0891-2795268

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 MDIndia Health Insurance TPA Pvt. Ltd.

KYC (know your customer) FORM

Name of Proposer (Payee)

Name of Patient

Address of Proposer

Proposer’s Recent
Photograph
City

State

Pin code

Mobile No.

Email ID
Kindly note that no further documentation is necessary for proof of residence where identity proof submitted also gives
address proof.
(Please provide the copy of self-attested document from the list below)

Passport Telephone Bill

Aadhar Card Current Passbook (Updated to previous
month)
PAN Card Bank Account Statement
Voter ID Card Letter from a recognized public authority
Driving License Electricity Bill (Latest)
Letter from a recognized public authority Ration Card
(with photo)
Insurance Policyholder Identity Card/ Valid lease agreement with rent receipt
Certificate from Insurer (with Photo) (Not more than 3 months old)
Employer’s Certificate

Bank Letter Confirming Identification & Proof of Residence

Date: ___________

Place:___________ Signature of Proposer

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 MDINDIA Health Insurance TPA Private Limited

Customer Satisfaction Survey

CCN No.
MDIndia Card No.
Policy No.
Name.
Contact No*.
Email ID*:

To enable us to serve you better, we shall be glad if you spare sometime in filling up the below feedback form for
services rendered. This will help us improve our quality of service and work on the weaker points to give you desired
outputs. Your feedback is valuable for us.

You can rate the service parameters as:-

Excellent :
Good :
Average :
Area of Improvement :

Service Parameters Area of

Excellent Good Average
Improvement
1. Quality of Services Provided
2. Response to the queries or doubts raised
3. Insurance Experience
4. Grievance Resolution
5. Rating of the services provided
a) Experience during Authorization
b) Experience during Reimbursement
c) Support received from MDIndia Local Branch / Help
Desk
6. Please rate the experience during authorization
a) Experience at the Hospital
b) Turnaround time for Pre-Authorization
c) EFiciency of MDIndia in managing and processing the
Authorization request
d) Overall experience while exiting the hospital regarding
documents, final clearance, time taken etc.

7. Please rate the experience during reimbursement

claim
a) Turnaround time for claim processing
b) Turnaround time for claim payment
c) Support from TPA and follow up during deficiency in
mandatory documents
8. Please rate the overall experience with MDIndia
Health Insurance TPA Pvt. Ltd.
Any Suggestions / Comments / Appreciations:

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