Universal Sompo General Insurance Company Ltd In House

Universal Sompo General Insurance Company Ltd In House Claims Management- Overview

Over View In- house Claims setup � Started In House Health Claim Management in the year 2015 � Operation – Centralized � Location – Noida � Support – 365 days (9 AM to 9 PM) � � Cashless Management � Claim Reimbursement � Card Issuance � Claim Payment- In house Claims Dedicated Team available from 9 AM to 9 PM 365 days � Medical team for Cashless and Reimbursement claims � Customer Care & Grievance Management � Enrollment & Cards � Investigation & Audit � Dedicated Toll free Help line No – 24 X 7 365 days � Robust Application for Health Policy Administration- HPAS

Demographic Pan India Presence. Network Hospitals - 3827 • 1044 • 863 • 1584 North Zone South Zone West Zone East Zone • 336

State wise- Network Hospitals State No of Hospitals ANDHRA PRADESH 194 MADHYA PRADESH 106 ASSAM 24 MAHARASHTRA 528 BIHAR 35 CHANDIGARH 13 CHHATTISGARH 24 DELHI 179 GOA 6 GUJARAT 199 HARYANA 177 MANIPUR 1 ODISHA 55 PONDICHERRY 8 PUNJAB 144 RAJASTHAN 153 TAMIL NADU 502 271 HIMACHAL PRADESH 7 TELANGANA JAMMU AND KASHMIR 3 TRIPURA JHARKHAND 26 UTTAR PRADESH 329 KARNATAKA 448 UTTARAKHAND 39 KERALA 161 WEST BENGAL 193 2

Service Overview Member Enrollment & Card Issuance Cashless Management Reimburseme nt Claims Customer Support Services Grievance Management Claims Payment Claims Audit & Investigation Provider Management MIS

Cashless Process Receive Fax document & Segregrate Attach Card No /Claim No Intimate Claim Update Cashless Request Form Cashless Process by doctor and recommened to Coommittee Committee takes final decision on case Issue Authrization Letter /Rejection letter /raise Query Inform Hospital thru Fax & Email Cashless case Close Hospital sends Original Claim dcoument for Payment

Claim Reimbursement Process Receipt of Claim Document from Insured and Hospital Capture Information in Inward Module and Segregate and tag document tpe Intimate the Claim and update claim form information Scanning of Documents Enter Hospital bills details Claim Process by Doctors and recommend for approval Claim approved /reject /raised query by committee Payment advice note send to accounts Amount paid to Insured /hoispital thru NEFT details updated in the system and mark claim as paid claim Claim file sent to Store for Storage.

Application Overview- HPAS � � � In built Document Digitization module � Fax Server/ Mail Server � Inward & Outward Management � Document Management System Integrated Alert Management for real time update � Integrated with SMS � Auto mailer Hospital Management through Application � � Tariff & Discount Update � Facilities update � Hospital Empanelment Process Integrated Policy Administration System � Insured Policy enrollment and card issuance � Addition and deletion of members � Policy benefit Management

Application Overview- HPAS � � � Cashless & Claim Management � Request through Fax/Mail / Inward & Outward Module � Update through SMS & Email to Insured for claims update � Integrated with Policy Benefits & Hospital Tariff � Online Cashless & Claim document view Claim Payment � Electronic Fund transfer for Claim payment � Update through SMS & Email to Insured for claims update � Bank interface for claim payment Inward & Outward � Document collection though Inward module � Acknowledgement of Claim documents � Dispatch of Claim documents through Outward Module Contd. .

Support Services 24 X 7 365 Days � Toll free Health Helpline Number : � Toll Free Fax Number � Health Direct No � Single ID support for all queries related to Health Claims & Cards � Single ID Support : 1800 200 5142 : 1800 200 9134 : 022 -39635200 Healthserve@universalsompo. com � Auto mailer & SMS update at each stage to Insured � Hospital Address details through SMS � Real time update through SMS with link to download letter

Web Portal – Health Portal Web Portal for Real time access for - Claim Tracking & E-Card � Employee � Corporate HR � Member Login � Bank Partners � Broker /Agents/Web Aggregator through IMD login � USGI Branch Office � Sales Manager

Claim Document Submission Universal Sompo General Insurance Co Ltd Health Department 5 th Floor Assotech One, C-20/1 A, Block- C, Sector-62, Noida, Uttar Pradesh - 201309

Web Login Access Login Option User Type User ID Broker /Agent Broker HO IMD CODE Broker Branch Office SUB -IMD CODE Individual Agents IMD CODE Web Aggregators IMD CODE Bank HO IMD CODE Bank Branch Office Bank Branch Code Sales Manager Banca Assurance Executive Primary Manager Code USGIC Office USGICL Branch Office USGI Branch Code Member Individual Insured Health Serve Card Number Corporate Employee Code/Health Card No. Corporate HR Corporate Code Bank Partners

Features of Web Portal � View & Download E-Card � Track Claims Status � View & Download Communication letters Claim Intimation Letter � Cashless Authorization Letter � Claims Query Letter � Claims Settlement Letter � � Search Network Provider � Download Forms Claim Form � Cashless Request Form � Electronic Fund transfer Form � Reimbursement Claim Form � Feed back form � � Cashless & Reimbursement Claims Process � Contact Details

Service Standards � Claims � Card Settlement TAT 7 days Issuance � Physical Card Issuance 7 days � E Cards 24 hrs � Customer � Claim Query response Payment � Cashless 24 hrs 48 hrs Authorization Response Time � Fresh cashless request 60 mins � Query reply cases 45 mins � Discharge cases 60 mins

Value Added Services � Fortnightly � Real Claims MIS to Corporate time Web portal access to Corporate � Single ID support for employees & HR for prompt response. � Discounted � Outbound �E Coupons for Employees call support to employees for Query Cases -Card on SMS � Corporate � Web Guide Book portal Manuals for Employees & HR

Discounted Diagnostic Centre Network for USGI Cardholders Provider Name No Centers Discount offered 18 20% discount on routine Pathology & Radiology test Apollo Health& Lifestyle 56 • 10% discount on In House Diagnostics • 15% discount on Standard Health Check ups Express Clinic 18 30% discount on routine Pathology Tests PAN India Discounted Packages for USGICL Policy Holders SRL Limited Thyrocare

Key Differentiators � Direct Connect with Insured’s- Reduce response time � Faster Claim Settlement to Insured & Hospitals � Direct payment to hospitals – better hospital discounts � Robust Health Claims Application-minimize cost of operation & Improve Processing TAT � 100% Digitization of claims documents � Real time update on claims tracking through SMS and Auto mailer � Link on SMS to download E-card & Communication letter � Quality network of hospitals and diagnostic centers � 100% electronic fund transfer for all payments

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