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RAKSHA HEALTH INSURANCE TPA PVT LTD
Stay healthier with us
An ISO 9001:2008 companyAn ISO 9001:2008 company
GMC Conditions for IIT Indore
RAKSHA TPA PVT. LTD.IRDA Licensed Company (license no.15)
Board Members :
▪ Ms. Natasha Nanda (Chairperson)
(A young turk and promising industrialist)
▪ Mr. Pawan Kumar Bhalla (Managing Director)
(An icon in Insurance Industry)
▪ Dr. Naresh Trehan (Director)
(Chief Thoracic and Vascular Surgeon of International Fame)
▪ Mr. Prabodh Chander (Director)
(Former executive director of the Indian insurance regulator)
CORPORATE CAMPUS 80,000 SQ.MTR.
TOTAL DECENTRALIZED OPERATIONS(Competitive Advantage)
1. Faridabad (corporate office)
2. Jaipur
3. Jodhpur
4. Mumbai
5. Bangalore
6. Mangalore
7. Kochi
8. Hubli
9. Lucknow
10. Kanpur
11. Ludhiana
12. Dehradun
13. Pune
14. Chandigarh
15. Chennai
16. Kolkata
17. Indore
18. Raipur
19. Hyderabad
20. Bhopal
21. Guwahati
22. Ahmedabad
23. Vadodara
24. Bhubaneswar
25. Patna
25 Decentralised operations In all major cities
83 Service Locations
PRESENCE…
FOOT - PRINTS
▪ The New India Assurance Co. Ltd.
▪ Oriental Insurance Co. Ltd.
▪ United India Insurance Co. Ltd.
▪ National Insurance Co. Ltd.
▪ Life Insurance Company of India
▪ IFFCO-TOKIO General Ins. Co. Ltd
▪ Apollo Munich Health Insurance Co. Ltd
▪ Bharti Axa General Insurance Company Ltd
▪ HDFC ERGO General Ins. Co. Ltd
▪ Universal Sompo General Insurance Co. Ltd
▪ L&T General Insurance Ltd
▪ Reliance General Insurance Co Ltd
▪ Religare Health Insurance Company Ltd
▪ Royal Sundaram Alliance Ins. Co. Ltd
▪ Future Generali India Insurance
▪ Tata AIA Life Insurance Company
▪ Star Union Dai-chi Life Insurance
▪ Max Bupa Health Insurance
▪ SBI General Insurance Company Limited
Public Sector Companies Private Sector Companies
OUR PROUD ASSOCIATIONS…
▪ In House
Enrollment
Team
▪ E-Cards
within 24 hrs
ENROLLMENT
OUR PERFORMANCE PARAMETERS…
▪ Physical
Cards
within 7
days
18 years of operational excellence in TPA industry licensed by IRDA
More than 8000 Hospital in network
Servicing for all Public & Pvt Insurers
Dealing more than 5000 corporates
OUR PERFORMANCE PARAMETERS…
Presentation of TPA Services
Silent features of policy
Indian Institute Of Technology Indore
Policy Parameter
➢ Insurer New India Mediclaim Policy
➢ TPA Raksha TPA Pvt Ltd
➢Policy Start Date 24 July 2020
➢ Policy End Date 23 July 2021
➢ Coverage TypeTAILOR MADE FLOATER
GROUP MEDICLAIM POLICY
Benefits / Extensions Coverage
➢Cashless facility • Yes
➢ Pre existing diseases • Covered
➢ Waiver for 2 & 4 year
exclusion disease • Covered
➢ Waiver yes 1st 30 days
excl.•.Covered
Benefits / Extensions Coverage
➢Room Limit 2%
➢ICU 2% of SI ( pro rata is applicable if opted higher room category)
➢Ambulance max. Rs 2000/- (home to hospital in ICU)
Pre and Post Hospitalization 30 & 60 days
POLICY FEATURES
Radiotherapy Chemotherapy Cataract
Coronary
angiography Dialysis
Some procedures in which 24 hours hospitalization is not applicable
DAY CARE PROCEDURE
HOSPITAL / NURSING HOME
The Hospital should have the following:
▪ Minimum 15 in-patient beds in town and 10 beds in village population
▪ Fully equipped OT
▪ Fully qualified nursing staff round the clock
▪ Fully qualified & registered doctors round the clock
❑ OPD treatment
❑ Dental Treatment other than arising due to Accident requiring
hospitalization
❑ Intentional Self Injury, Intoxicating Drugs, Alcohol, Congenital External
Disease, sterility etc
❑ Hospitalization meant for Oral Medication, primary Investigation is non
Payable
❑ Vitamins And Tonics unless part of treatment
❑ Hospitalization Less than 24 hrs other than day care treatments
❑ Treatment related to infertility is not covered
❑ Cosmetic Treatment until unless required due to accident
❑ Psychiatric and psychosomatic disorder is not covered and Psychosomatic
disorder is not covered
FEW EXCLUSIONS UNDER THE POLICY
Procedure To Avail Cashless
Hospitalization
CASHLESS SERVICES
Emergency
Identification via UHID Cards
Approach Network Hospital
Planned
Pre-authorization request to Raksha
TPA from Provider
Raksha TPA Pvt Ltd
Verified by Doctor
Authorization Issued Pre – Authorization Request DeniedQueries Raised for further Clarification
CASHLESS TAT
Our Deliverable
▪ Cashless TAT: 30 min - 1 hrs – Our Commitment
▪ For Planned Admissions Pre-auth Form to reach 2 to 3 days in advance.
▪ For Emergency Admissions Pre-auth to reach within 24 hrs of admission.
The Oriental insurance Company Ltd, has implemented the process of INTIMATION OF
HOSPITALISATION IN CASE OF NON NETWORK HOSPITALIZATION.
All Hospitalization must be intimated to Raksha TPA (P) Ltd with details of Name of the
hospital, name of the Patient, Date of Admission to the hospital and Diagnosis.
Intimation must be given to us with in 24 hrs of the Date of admission.
Claim Document must be submitted in TPA office with in 15 days after Date of Discharge
Intimation can be made through following
Telephonic - 0731-4003652 / 4967535
Email - [email protected]
Mobile - 9109972901
INTIMATION AND CLAIM SUBMITION
REIMBURSEMENT HOSPITALISATION SERVICES
Maximum Turn Around Time is 2 Days
Claim Passed / Rejected
Claim is Processed
Claim Folder Is Sent To Raksha TPA
Insured Gets Hospitalised In Non-network Hospital
If Documents Are Insufficient ImmediatelyIntimated To Employee
Intimation should reach us via
mail or telephonic within 24
hours
REIMBURSEMENT CLAIM -SETTLEMENT
Our Deliverable
▪ TAT for settlement : 7 to 10 Working Days after receipt of all claim documents
▪ No. of query reminder : 2 times
▪ Frequency of query reminders : After every 15 days
▪ Closure of claim after 45 days if reply not received
OUR APP………..
MOBILE APPS
Benefits:
Real time Update of Cashless and Claims
Easy download of E-cards
Address are mapped through GPS for locations
Claim Intimations
MOBILE APPS
Supporting Platforms
• Android
• IOS
• Windows
• Blackberry
MOBILE APPS
MOBILE APPS
MOBILE APPS
MOBILE APPS
WEB ENABLED SERVICES…
Communication Support…
✓ Providing information directly from servers (www.rakshatpa.com):- Claim Status- Cashless Status - ID Card Status - Information on Network Hospitals - Claim intimation- Customer Care
www.rakshatpa.com
Click here
Either enter policy no. (incase you don’t know your
Raksha member id) or enter Raksha member id.
Click here when you have entered your member id
Than click here
Than click here
Now you can take the printout of this e-card.
Raksha TPA
4U
36
Digital Platform
DOCUMENTS REQUIRED FOR REIMBURSEMENT
i. Photocopy of Raksha Member ID Card.
ii. Address & Photo ID proof of the insured (Insured)
iii. Claim Form (A part fill by Insured and B part fill by Hospital) with Insured
signature
iv. Intimation Copy.
v. First Prescription/Consultation Letter of Treating Doctor.
vi. Original detailed Discharge Summary
vii. Originals Final Hospital Bill with Proper Break-up.
viii. Original Payment Receipt against hospital Bill.
ix. All Original Medicine Prescriptions.
x. All Original Medicine Bills.
xi. All Original Investigation Reports with film.
xii. Copy of Complete set of Indoor case papers and vital charting.
xiii. Package breakup (if applicable)
xiv. Original IOL sticker (in case of cataract)
Note: All bills in originals has to be submit within `15 days from the date of discharge from the
hospital to Raksha TPA.
Toll Free No. 18001801444
Email [email protected],
cashless [email protected]
Telephone No. Faridabad Head
Office
129-4289999, 8090046594 &
8090046595
SPOC contact details
Shivkumar Baghel
Mob- 9109972901
0731-4003652; 4967535
CONTACT DETAILS
Ways for Customer Connect
• Via Web : www.rakshatpa.com
• Via Mobile Application : https://goo.gl/3L1jpO
• Via What’s app Application : 9029070051
• Direct SPOC Shiv Kumar Baghel - 9109972901
• Via Landline Number : 0731-4003652, 4967535
• Via Call IVR : 0129-4289999
THANK YOU....