Presentation By TTK Healthcare Services Incorporated in March

Presentation By TTK Healthcare Services

Incorporated in March 2002 to provide third party administration Services Our Vision “To be the most preferred third party administrator”

ISO Certified TTK Healthcare Services exudes operational excellence in delivery of customer requirements, through defined quality processes Only TPA to be ISO certified for branches as well as H. O

Role of a TPA

PROVIDERS Desiring less administrative burden, greater autonomy, faster payments, and greater incomes Policy Holders TTK Insurance Co Striving to reduce premiums. Make better policies. Aim at Claims Control Demanding better service, more information, and greater convenience

Pan India Presence Branches • • • • • • Bangalore Manipal Hubli Hyderabad Vizag Chennai Coimbatore Madurai Trivandrum Cochin Ahmedabad Mumbai Pune Jaipur Ludhiana Delhi Patna Jamshedpur Bhopal Kolkota Bhuwaneshwar Sambalpur All branches connected through leased lines Redundant connectivity

CASHLESS APPROVAL Planned Hospitalization & Emergency Hospitalization

Planned Hospitalization • If it is a Pre planned treatment, the cashless request should be sent before a week time • Insurance coordinator in the Network hospital will give assistance & he is the only point of contact in hospital for insurance. • Fill the Pre-Authorizations Form, available with the Network Hospitals upon showing TTK Health Card. This can also be obtained from any of the TTK branch offices or can be downloaded from this site • Submit/Fax the Pre-Authorisation Form at our local branch office 4 days in advance • If your hospitalisation is authorised, then ensure • You pay for non-medical expenses and • Before getting discharge, the final bill should be sent to ttk before a 6 hours time. • Sign the relevant documents including a claim form before leaving the hospital/ getting discharged

Emergency Hospitalization • Insurance coordinator in the Network hospital will give assistance & he is the only point of contact in hospital for insurance. • Get admitted into a network immediately • Please inform your family member /relative to contact the billing dept in the hospital to inform them to intimate TTK • If your hospitalisation is authorised, then ensure • You pay for non-medical expenses and Sign the relevant documents before leaving the hospital/ getting discharged • • If your hospitalisation is rejected, your treatment will be continued at the hospital. After discharge, you can then submit a claim for reimbursement purpose at the TTK Branch office near you. • After sending the fax, the insured person can get confirmation about the fax delivery by contacting the following HELPLINE NUMBERS: 044 -42894444 / 044 -42894445 (24 hrs) & 9884604485(9 am to 6 pm)

Mandatory details to be filled up in Cashless request • Insured name & Patient name with age & sex • TTK ID NUMBER. (If the insured person doesn’t received the TTK ID Number, as an alternate the corporate name & Employee Id should be mentioned in the request). • Mobile Number of the Insured person so that the Confirmation message will be sent once the approval is sanctioned. • Ailment & its duration & plan of treatment. • After sending the fax, the insured person can get confirmation about the fax delivery by contacting the following HELPLINE NUMBERS: • 044 -42894444 / 044 -42894445 (24 hrs) & 9884604485(9 am to 9 pm)

DON’TS WHILE SUBMITTING AS AN CASHLESS • Incompletely filled Cashless form • Sending the Final bill/Enhancement at the time of discharge sharply. • Filling the Patient Name in short (Whatever the name uploaded in the intranet should be filled in the cashless form).

MEDICAL REIMBURSEMENT Non - Cashless Hospitalization

MEDICAL REIMBURSEMENT Claim form 1 st & 2 nd page (Available in the Internet ). Medical Certificate duly filled by the Treating consultant with Hospital Seal (Available in the Internet). DISCHARGE SUMMARY : Discharge summary (Detailed) in Original With Hospital Seal & Treating consultant’s sign (Should be in Hospital Letter head). Date of admission & Discharge with time. Detailed explanation about the treatment undergone. Duration of the ailment. Advice On discharge (Which contains Prescription). Brief description about the investigation undergone. IN CASE OF MATERNITY: Obstetric Score/History (Number of live children) should be mentioned in the Discharge summary.

LAB REPORTS (DO’S WHILE SUBMITTING AS AN MEDICAL REIMBURSEMENT) Lab Reports in Original with Dr. prescription. Lab bills (If not mentioned in Main Bill ). IN CASE OF FRACTURE : X-Ray report with Film IN CASE OF ACCIDENT : FIR Copy/MLC/AR Entry. [MLC: Medical Legal Certificate, AR : Accident Registration Entry]

BILLS (DO’S WHILE SUBMITTING AS AN MEDICAL REIMBURSEMENT) Consolidated Main bill with detailed breakup. Numbered Payment Receipt for the Payment made. NUMBERED PAYMENT RECEIPT Numbered payment receipt is different from the cash bill, even if the cash bill is submitted, numbered payment receipt is necessary for the claims to process. If in case, the hospital doesn’t have a option of providing numbered payment receipt the alternate document insured person can provide is a payment receipt in the hospital letter head with the revenue stamp pasted & sign & seal on it. Consultant bill/Surgeon bill. Pharmacy bills with prescription. (The above mentioned are only the basic documents required for processing, once the claim is scrutinized, . If necessary, medical queries will be raised for further processing)

Pre & Post Hospitalization • Up to 30’days prior to the date of admission any treatment related expenses for pharmacy, lab, consultation charges is payable. • Up to 60’days the post hospitalization treatment related expenses for pharmacy, lab, consultation charges is payable.

General Exclusions • Injury or disease directly or indirectly caused by or arising from or attributable to War or War-like situations Injury or disease caused directly or indirectly by nuclear weapons • Circumcision unless necessary for treatment of disease • Dental treatment of any kind unless requiring hospitalisation • Congenital external diseases or defects / anomalies • HIV and AIDS or treatment for Venereal diseases • Hospitalisation for convalescence, general debility, intentional self-injury, use of intoxicating drugs/ alcohol. • Naturopathy - including spas, therapeutic massages etc…. • Any non-medical expenses like registration fees, admission fees, charges for medical records, cafeteria charges, telephone charges, etc • Cost of spectacles, contact lenses, hearing aids • Any cosmetic or plastic surgery except for correction of injury • Hospitalisation for diagnostic tests only • Vitamins and tonics unless used for treatment of injury or disease • Infertility treatment • Voluntary termination of pregnancy during first 12 weeks (MTP) • Natural calamities / acts of God – floods, storms, earthquakes etc….

DON’TS WHILE SUBMITTING AS AN MEDICAL REIMBURSEMET • Submitting the claim documents after 30 days from the discharge date. If in case of submitting after 30 days, the letter from the insurance company to be enclosed for processing. (Letter from insurance should contain a valid reason for the late submission. Insured person can request to the New India Assurance for the above mentioned letter. • Photocopies of the documents are strictly not applicable as per the policy.

ORIGINAL DOCUMENTS RETURN • If the insured person needs the original documents back for the further treatment, It will be provided by submitting a request letter signed by the insured person. • Discharge summary & Bills will not be returned at any cost. • Request for the original documents is applicable, only if the claim is settled. • Original documents will be returned to the insured person within 20 working days from the requested date.

PROCESS

Provider Network 4749 Hospitals / Nursing Homes in 390 cities and 3536 Diagnostic Centers in 31 locations.

Network – Empanelment Extensive Service Provider Network Delhi NCR, HP, Uttaranchal 269 Uttar Pradesh 390 Locations Goa 12 Madhya Pradesh 101 Gujarat 340 Maharashtra Daman and Diu 966 West Zone 1419 201 4749 Rajasthan & Jammu& Kashmir 124 Punjab & Haryana 266 North Zone 860 Assam & Orissa 734 Andhra Pradesh 545 Tamil Nadu &Pondy 693 South India 164 18 Jharkand & hattisgharh 42 Karnataka Kerala West Bengal Bihar Network Strength in India Pondichery Hospitals 13 209 2194 East Zone 92 316

Network – Empanelment Extensive Diagnostic Center Network Delhi NCR, HP, Uttaranchal 115 Uttar Pradesh 31 Locations Goa 13 Madhya Pradesh 92 Gujarat 283 Maharashtra Daman and Diu 509 West Zone 897 3536 Diagnostic centers 311 Rajasthan & Jammu& Kashmir 140 Punjab & Haryana 212 North Zone 778 Bihar Network Strength in India 106 20 Jharkand & hattisgharh 34 Assam & Orissa Karnataka 585 Andhra Pradesh 397 Tamil Nadu &Pondy 341 Kerala 268 South India West Bengal 1591 East Zone 69 229

Misuse and Fraud Prevention Investigations Department • Verification of hospitalization records • Validation of Medical Records • Case Selection based on Past Data Analysis. • 10% of All Claims Investigated. • Investigations Team Visits for all high Value Cases • Visits as a WELL-WISHER • Carries a Get Well Soon Card!

Geared for Customer Convenience

E Alerts 098452 48885 SMS Facility: Give us your mobile number in the preauthorization form and you will get an • SMS sent when request received. • SMS sent when authorization processed Email Notification: Give us your employees email id in the proposal form and you will get an email when • pre auth request is received. • Pre authorization request is processed • claims notification

HELPLINE NUMBERS GENERAL HELPLINE NUMBERS CHENNAI: 044 -42894444 1800 -425 -7575 Chennai Fax: 044 -42183300 044 -42024343 CORPORATE PRIORITY CALL CENTER NUMBER: 044 -42894445 & 9884604485 (9 AM TO 9 PM) CALLS HANDLED BY CALL CENTER AGENTS

CONNECT TTK TOLL FREE NOS. TTK HO CALL CENTER 1800 425 8885 TTK HO CALL CENTER 1800 425 7878 TTK CHENNAI CALL CENTER 1800 425 7575 TTK MUM CALL CENTER 1800 22 1717 TTK COCHIN CALL CENTER 1800 425 6264 TTK HYD CALL CENTER 1800 345 4051 ICICI CALL CENTER 1800 229 CITI BANK TOLL FREE NO. 1800 425 4448 TTK KOL CALL CENTER 1800 345 7069 ZERO COST TO CONSUMER * Airtel subscribers only TOLL FREE FAX NOS. TTK HO FAX NO. 1800 425 2626 MUMBAI FAX NO. 1800 22 1919 COCHIN FAX NO. 1800 425 6262 CHENNAI FAX. NO. 1800 425 7474 FIRST TPA IN INDIA to introduce New Toll free number Reachable from mobile* 1800 -102 -1234 CITY SPECIFIC TOLL-FREE NUMBERS UNIQUE TO TTK ONLY.

24/7 Call center 24 hour toll free helpline to provide assistance with • • • Hospitalization-Pre-authorization related queries – approval status, reason for partial rejection etc Policy Scope and Coverage related queries Enrollment ID Card queries Information on Network hospitals Claim Related queries

Online Features Claims • Online enrollment by Corporate – real time process, easy to access, no fear of misplacing documents/details, fewer errors • Online MIS for Corporate – All details available a click away • Online Authorization facility at top hospitals, for faster processing and convenient ( paper free) • ONLINE PAYMENT OF SETTLED CLAIMS DIRECTLY TO CUSTOMERS ACCOUNT

All forms available online Self Access Medical Information Medical second opinion Visit us at www. ttkhealthcareservices. com

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Extended Value for our clients Medical Information section on website Information adapted for Indian scenario and available in small, easy to digest pieces with simple language and illustrative diagrams More Facts about Cataract 1. What is cataract? Cataract is clouding of natural lens in the eye which is responsible for focusing light and produc 2. Who is Prone to getting cataracts? Cataracts are leading cause of vision loss among adults aged 55 years and above. They can also r 3. What are the symptoms of cataracts? The most common signs of cataract development are blurred of fuzzy vision (Picture) and sensit 4. What are the treatment Options? The only treatment currently available for cataracts is surgery. In cataract surgery the clouded le

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