TPA / MEDICLAIM

  1. Home

TPA / Mediclaim


DO's

  • Jabalpur Hospital TPA/Insurance Cell is in Basement Old Wing Phase-I, Room No.11 which is open from Monday to Saturday from 10 am to 6 pm. Please contact.
  • Mediclaim Policy Holders should submit a copy of current Mediclaim Policy / TPA – ID Card after admission in hospital, so that pre-authorization request may be sent to TPA within 24 hours.
  • In case of the planned surgery / planned admission, please submit a copy of policy / TPA – ID Card to Basement Room No.11 three days prior to your admission along with a prescription of Doctor and copies of all previous investigation reports.
  • Our TPA/Insurance Cell will send a pre-authorization request on your behalf to TPA for obtaining cashless facilities. Please wait for TPA response.
  • Pre-authorisation request sends by the hospital is assessed by TPA team where TPA doctors are also available to assess the essentiality of hospitalization and preexisting disease. After assessment of pre-authorisation request, TPA may send acceptance for the cashless treatment facility. TPA may deny cashless services and you may be advised to make payment of hospital bill and then submit your claim to TPA for settlement. In this way Hospital Authorities are not responsible for obtaining cashless access; acceptance of pre-authorisation request totally depend on TPA team. Please cooperate.
  • You can avail cashless treatment at the hospital only after receipt of written authorization from TPA. Please note.
  • Please leave back all the original documents/investigation reports/prescriptions / discharge card and duly signed claim form with the Discharge Counter of the hospital at the time of discharge.
  • Mediclaim Policy Holder has to bear the expenses which are not covered under the terms and conditions of the policy.


DONT's

  • Don´t insist upon admission at the hospital merely for investigations, evaluation or Health Check up as these are not approved by TPAs.
  • Don´t carry back any original documents at the time of discharge from the hospital if your cashless request is accepted by the TPA.
  • Don´t forget to sign the claim form.


CGHS / CSMA Patients

This hospital is rendering health care services to the Central Govt. Employees covered under CGHS Jabalpur & pensioners since 1993. CSMA beneficiaries, mostly from Ordnance Factories i.e. O.F.K., G.C.F., V.F.J. & G.I.F. are taking treatment and reimbursement facilities from this hospital.

DO's For CGHS Patients

  • Serving Central Govt. Employees & Central Govt. Pensioners covered under CGHS Jabalpur should contact their concerned CGHS Dispensary for OPD treatment and according to their official referral letter beneficiaries may avail investigation facilities from this hospital.
  • In case of any Medical / Surgical emergency CGHS Card Holder should contact hospital for direct admission.
  • For planned admission / planned surgery please obtain permission from concerned CGHS Dispensary.
  • Serving Central Govt. Employees should apply for medical advance to meet expenses of hospitalization, amount paid as medical advance will be adjusted in final settlement of Medical Claim to be submitted to parent department.
  • Central Govt. Pensioners may avail treatment on credit basis as per their ward entitlement.
  • Central Govt. Pensioner should submit photocopies of CGHS card at Reimbursement Cell (Basement of Hospital) so that letter of emergency admission may be send to CGHS office within 24 hours of admission. So please submit copy of your valid CGHS card positively.
  • In case the CGHS Disp. Refer the pensioner for particular treatment, please submit referral letter at reception counter in time of admission.
  • Please pay charges for the facilities availed over and above of your entitlement.
  • Freedom fighters are also covered in CGHS. Please intimate us in advance to enable us to make appropriate arrangements for their comfort.



DONT's For CGHS Patients

  • Don´t use invalid CGHS card.
  • Don´t insist upon admission if the condition of patient is not emergent.
  • Don´t insist your doctor to provide you such treatment facilities which are not advised in CGHS referral instructions.
  • Be aware of your ward entitlement and don´t insist to provide higher ward facilities.



DO's For CSMA Patients

  • Take prior permission of Head of Department for Hospitalization.
  • If you are residing within 8 km of your factory and availing facilities from Factory Estate Hospital, please get necessary referral from your hospital before admission.
  • If you are residing beyond 8 km of your factory and not availing facilities from Factory Estate Hospital, please get necessary referral from your AMA before admission.
  • If you are hospitalized, please obtain certificate of Estimated Cost of treatment from our Reimbursement Cell Basement Office, which works from Monday to Saturday from 10:30am to 6:00pm.
  • Please apply for availing medical advance from you parent department as per rules and submit the cheque of medical advance before discharge. Please make the full payment of hospital bills and medicine bills before discharge and collect the receipts and bills as advised by our reception counter.
  • Collect hospital bills and medicine bills submit the essentiality form on prescribed Govt. format for certification.



DONT's For CSMA Patients

  • Please don’t take admission without prior permission of your HOD/Estate Hospital/AMA.
  • In case of any medical emergency please don’t forget to inform Head of Department of parent department.
  • Don’t avoid furnishing application medical advance.
  • Don’t insist your doctor to extend your hospital stay for no reason.
  • Don’t wait for medical advance if your doctor advised discharge. Make the full payment of hospital bill and get the same reimbursed from your department.
  • Don’t insist to provide facilities of higher ward for which you are not entitled.

List Of Our Authorised TPA / Insurance Companies


List

  • 1. Alankit Health Care Ltd.
  • 2. Apollo Munich
  • 3. Bajaj Allianz General Insurance Co. Ltd.
  • 4. Dedicated Health Care Services (1) Pvt.Ltd
  • 5. Genin India Ltd.
  • 6. Good Health Plan Ltd.
  • 7. HDFC ERGO General Insurance Limited
  • 8. Heritage Health TPA Pvt. Ltd.
  • 9. ICICI Prudential Life Insurance Co. Ltd.
  • 10. IFFCO Tokio
  • 11. Max Bupa Health Insurance Company Limited
  • 12. Med Save Health Care
  • 13. Mediassist India TPA Pvt. Ltd.
  • 14. Medicare TPA Services (I) Pvt. Ltd.
  • 15. Paramount Health Service Pvt. Ltd.
  • 16. Parekh Health Management Pvt. Ltd.
  • 17. Reliance General Insurance
  • 18. Universal Sompo
  • 19. Vidal Health TPA Private Limited
  • 20. Vipul Medcorp. Pvt. Ltd.
  • 21. MD India Health Insurance TPA Pvt. Ltd
  • 22. Vision Solution Insurance


LINKS