STUDENT’S MEDICAL INSURANCE

     

1. What is Pan India Cashless Medical Insurance Scheme (PICMIS) for students?

Answer: In order to avail the medical reimbursements towards the expenses of hospitalization treatment (IPD), the Institute has chosen a “Pan India Cashless Medical Insurance Scheme (PICMIS)” offered by an Insurer. This is the PICMIS of the Institute.

 

2. Who are covered under PICMIS?

Answer: All the registered regular students are covered under this policy.

 

3. What is the coverage value/sum insured under PICMIS?

Answer: The basic sum insured is Rs. 1,00,000/- per student.

 

4. Is PICMIS useful for OPD?

Answer: Yes. In case, any student is referred to an outside specialist doctor for consultation or a pathology test, the expenditure thereon shall also be eligible for re-imbursement under this policy limited to the cover of Rs. 10,000/- for 100 cases.

 

5. Is there any waiting period?

Answer: There is no waiting period for any disease/treatment covered under the PICMIS.

Current Policy is effective from 01.08.2020-31.07.2021. Further, all pre-existing diseases are covered.

 

6. Is there any upper limit for the reimbursement?

Answer: The upper limit is the sum insured (basic + buffer subject to the availability).

 

7. On top of treatment cost, what are the other expenses reimbursable under PICMIS?

Answer: The treatment cost including doctor’s fee and required drugs and investigation expenses are reimbursable as per Insurers norms.

 

8. Who will process the reimbursement claims?

Answer: The Insurer shall engage an agency called Third Party Administrator (TPA) through which the reimbursement claims will be processed.

 

9. How does the Insurer/TPA recognize a member of PICMIS?

Answer: The ID-Card may be downloaded from RAKSHA TPA website under the link ‘https://www.rakshatpa.com/log_main_new.jsp?id=policy.’ The ID-Card along with Institute ID Card /Adhaar Card shall be used for any hospitalization and reimbursements.

 

10. What is the claim procedure?

Answer: The hospitalization of members which is duly informed/pre-authorized to/by TPA are eligible for reimbursement. For which, the member shall submit a duly filled claim form (in the prescribed format) to TPA along with the original documents.

 

11. Should anyone be informed about any hospitalization?

Answer: Yes, TPA shall be informed regarding any hospitalization for which reimbursements are expected. In case of planned hospitalization, Raksha Health Insurance TPA Pvt. Ltd., 807, 8th Floor Cyber Height, Vibhuti Khand, Gomti Nagar, Lucknow – 226 010, Toll free no. – 18001801444,

Contact No. 8090046595 / 8090046594,

Cashless – 08881673411 / 011-66173411 / 011-45823411

Website : http://www.rakshatpa.com/

Email: This email address is being protected from spambots. You need JavaScript enabled to view it. , This email address is being protected from spambots. You need JavaScript enabled to view it.

The student residing in campus will have to seek referral from Health Centre, IIT Kanpur for all planned hospitalization cases. However, in case of any emergency, the patient can be taken directly to the hospital and post referral must be taken from the Health Centre, IIT Kanpur within 24 hours of admission in Hospital.

The student while on vacation/leave may avail facility directly from the hospital where they are residing after seeking advice / referral from their treating doctor & intimate the same to Health Centre, IIT Kanpur attaching the advice / referral of treating doctor within 3 days of hospitalization but before discharge. Also inform to RAKSHA TPA through the contact details as given.

 

12. Is there any restriction on the hospitals to get the treatment? What about empaneled hospitals?

Answer:  No. Any Institution in India established for indoor care and treatment of sickness and injuries and which has been registered either as hospital or nursing home with the local authorities and is under the supervision of a registered and qualified medical practitioner will be considered.

 

13. What are network hospitals and their advantages?

Answer: The Insurer/TPA has tie-up with some hospitals across the country called the network hospitals. The members of PICMIS can have cashless treatment in the network hospitals. The Insurer/TPA shall directly pay the entitled medical expenses to the network hospitals. In case of treatment in a hospital which is not empanelled ‘OR’ in case of any emergency where networked hospitals are not available ‘OR’ for all government hospitals, the claim will be reimbursed as per entitlement on submission of all documents. All reimbursement claims will be routed through Health Centre, IIT Kanpur for verification of referral. On receipt approved of the amount of against the claim from the insurance company, the said amount will be transferred to the account of the claimant. If claim is not submitted (and also verified to the concern hospital and doctor along with RAKSHA TPA claim form which is available on RAKSHA TPA website www.rakshatpa.com) within 30 days from the  date of discharge the same will not be processed for reimbursement by the TPA / Insurance Company / Institution.

 

14. How to contact the TPA?

Answer: TPA can be contacted on the phone numbers given on RAKSHA website/Toll Free Number. The TPA shall provide a helpdesk at the Institute on regular basis. At present, the helpdesk is opened twice a week on Tuesday and Friday (from 3.00 PM to 5.00 PM) at Health Centre, IIT Kanpur.

 

15. In case of any difficulty whom to contact in the Institute?

Answer: Health Centre has established an Insurance Cell for resolving various pre and post hospitalization reimbursement problems of the policy during office hours / working days. In case of hospitalization beneficiary has to contact to RAKSHA TPA.

 

16. I approached a network (or even a non-network) hospital for a medical emergency. The hospital kept me in observation for a while and after some diagnosis, they observed that the hospitalization is not required. Will these expenses be paid/reimbursed by PICMIS?

Answer: Yes.

 

17. Presence of TPA?

Answer: It is the same across the country. The Insurer/TPA shall have their offices in all major cities to deal with the cases.

 

18. What is the role of beneficiary in case of non-cash less hospitalization?

Answer: Beneficiary’s responsibility is to collect all original bills from the hospital (bills, report, discharge summary and card, if any etc.) and also get these verified from the concern hospital and doctor along with RAKSHA TPA claim form which is available on RAKSHA TPA website www.rakshatpa.com

 

19. What is the role of all beneficiaries for pre and post hospitalization?

Answer: All medical expenses relating to pre hospitalization (30 days) and post hospitalization (60 days) shall have to be claimed from M/s New India Assurance Company / Raksha TPA. Bills, prescription and investigation reports in original along with claim form need to be submitted for payment. Institute shall not reimburse the Pre (30 days) & Post (60 days) hospitalization bills. Bills have to be submitted within 30 days from the date of discharge positively failing which no reimbursement will be available.

 

20. Should all the papers be obtained from hospital before discharge?

Answer: YES!!

 

21. What to do in case insurance card is not available?

Answer: Insurance card is already available on the web page of RAKSHA TPA https://www.rakshatpa.com/log_main_new.jsp?id=policy. If it is still not there please contact the TPA. All the data had been uploaded. Even otherwise, the Institute Photo ID card along with Adhaar Card and Policy No. is sufficient to avail facilities all over India on Cashless basis. In case of non-cashless, Adhaar is sufficient and bill will be reimbursed as per norms. Emergency hospitalization Admit to the nearest suitable hospital Contact TPA desk at the hospital, if available If TPA desk is not available, contact TPA officials on toll free no. or email & explain the emergency. If you want cashless facility, find a network hospital from the website of RAKSHA TPA. Planned hospitalization Obtain pre-authorization from RAKSHA TPA through email or Toll free number as mentioned.

 

22. Whom should I contact for any other queries related to Medical Insurance?

Answer: You may write to < This email address is being protected from spambots. You need JavaScript enabled to view it. > or contact at telephone numbers 0512-2597224 to Mr. Gaurav Gupta.

 

23. Most of the students shall be studying from their home towns/other places in online mode in the coming semester due to Covid-19. In these cases, how the treatment of ailments including COVID-19 will be taken care of?

Answer: Student (any registered student) is covered under the GMC Policy whether in campus or off campus. Only criterion to be member of the policy is a registered/ enrolled student of the institute.

 

24. The insurance (cashless) policy through The New India Assurance Co. Ltd. (Raksha TPA) for employess of IIT Kanpur, includes the provision of dedicated COVID-care ambulance for hospitalization, Hospitalization and Testing of COVID-19 patients at the below mentioned two empanelled hospitals:

  • Rama Hospital & Research Centre, Rama City, Near Mandhana Railway Station, GT Road, Kanpur (UP)-209217.

  • Naraina Hospital & Research Centre, Gangaganj, Panki, Kanpur-208020

What are the provisions in cases of students who will be residing in the campus?

Answer: Students can avail the similar facilities as offered by the M/s Raksha TPA.

 

25. What is the coverage policy in COVID-19 cases?

Answer: The policy covers only Active Line of Treatment following Hospitalization and does not cover admission only for isolation/ Quarantine.