FAQs
FAQ
Q1: What are the services available to me
Answer
A: You can avail of the following services :
from the TPA?
e-Card aga inst your policy, which would give you
access to our TPA services.
authorized by Mediclaim / Hos pitalization Insura nce
-network
hospita ls
hr access to our Ca ll Center t hrough our Toll Free line a nd
IVR and location spoc.
docume nts
Q2: When I call Vipul MedCor p TPA's Call
Center/IVR/Office, ho w will you identify
me?
Q3: What if I do n’t remember my Card
Number and my Policy Number and I am in
an emergency situation? Can I use my
employee ID no .?
Q4: Ho w do I avail o f Cash Less Facility?
A: Please mention your Vipul e-Card Number to the Ca ll Center
Executive, IVR, locat ion SPOC.
The executive may verify other details like your Date of Birth,
Employer Details etc. O n establishing your ident ity, we will be
happy to a nswer your queries.
A: In case you are in a n e mergency sit uation, we ca n search
your details through our website
(http://www.vipulmedcorp.com/niit/Index.aspx) based on your
company na me and Emp ID. Also, you can spea k to our location
spoc to he lp you.
Cash Less facility is availa ble only in network hospitals
To avail cashless facility, the me mber has to visit a ny of the
network hos pita l (network hospital list available on Vipul MedCorp
website)
Insured has to produce his TPA card at the recept ion/TPA desk.
He will have to fill a pre-authorization re quest form The preauthorizat ion form will be duly signed by the treating doctor and
will be faxed/e mailed to Vipul by the hospital
Vipul doctor will process t he documents based on e ligibility/policy
condition and send a fina l a uthorization to hospital. There may be
some deduct ions of non-payable ite ms like registration fees,
personal ite ms etc. for which the hos pita l may insist on a
refundable nominal deposit.
Q5: What documents do I need to send for
processing claims if the treatment has been
done in a non-net work hospital / In a
network hospital where cash less fac ility
was not granted / availed ?
Q5A . Where do I submit my cla ims
On the date of discharge, hospita l will fax/e ma il the f inal bill and
discha rge summary to TPA and patie nt/depe ndents of patie nt
needs to sign a ll origina l documents, which will be retaine d by the
hospita l for onward submission to TPA. Pat ient should retain
Xerox of a ll docume nts for future reference.
A: Following documents are re quired for processing your claims
on re imburse me nt basis:
a.
b.
Online C laim Form to be filled thru Se lf Care Portal.
c.
d.
e.
f.
All original documents pertaining to the illness
Discharge Summary from the hospital(in case of
hospita lisat ion)
Main Hospital Bill.
Payme nt Rece ipt.
Relevant reports/films of diagnost ics tests.
A A: you can submit the cla ims to the Vipul He lp Desk Execut ive
along with print out of the online cla im form
1
Q6: When will my claim be reimbursed?
A: The cla im will be re imbursed within - 15 days after receipt of
complete documentation from the client / Corp HR.
Q7: What documents should we obtain
before discharge from the hospital in case of
A: All bills in origina l and a discharge cert ificate are to be left with
the hospital prov iding cashless treat ment. The pat ient has to
countersign all bills and fill the cla im form and a lso leave the
sa me with the hospital at the time of discharge.
A copy of t he bills & Discharge Summary can be carrie d by the
patient for his records and for submission along with Pre & Post
Hospitalization bills.
cash less facility availed?
Q8: Is there any exclusio n in the po licy
A: Yes.
Q9: Can I get the salient features of our
Policy coverage
A: The salient features of the policy can be viewe d by visit ing the
Vipul MedCorp we bsite
(http://www.vipulmedcorp.com/niit/Index.aspx )
Q10: Can Vipul MedCorp TPA reject my
claim? Do I have any remedy?
A: Yes, the TPA can reject / deny your claim based on t heir
evaluation / ana lysis on justif iable grounds. The reject ion letter
will cover the reasons for rejection of the cla im.
Remedy :- In case you are not satisfied by the reasons for
rejection, you can represe nt to the insurer/TPA within 15 days of
As per policy T & Cs
such denial.
Q11: Ho w do I get a list of network
A: The list of hos pitals is available on the Vipul MedCorp we bsite
hospitals of Vipul MedCorp TPA Pvt. Ltd.?
under the "Hospita l Network" sect ion
Q12: Can I lodge more than one claim for
the same disease?
A: Yes, your mediclaim policy covers 30 days Pre-hospita lizat ion
expense reimburse ment and 60 days Post-hospitalization
expenses. You may lodge your Pre-hospitalization claim along
with hospitalization cla im. The Post-hospita lizat ion claim may be
lodge d after 60 days of the hospitalization. However, please
quote your Vipul ID Number for easy referra l and sort ing.
Q13: Ho w will you keep track of my claim?
A: You may lodge your claim online with us and submit the cla im
through our Helpdesk and it should be ma pped with t he checklist
and the claim status can be v iewed online t hrough se lf care
portal.
Q14: In case I require my original medica l
papers back for future reference, what
should I do ?
A: Please carry a complete set of photocopie d documents when
you lodge your cla im. The relevant origina l documents will be
returned to you after verificat ion. We will however sta mp the
origina l documents [Vipul Me dCorp TPA - C laim Processed on
Xeroxed copy ]. Please note t hat norma lly, the origina l doctor
prescription, medicine bills and discharge summary a long with the
hospita l bills will be retained by us. Only X -ray films, ECG, other
me dical records will be returned to you as a spe cia l case after
verification / approval of our me dica l tea m.
Q15: During the course of my treatment,
can I change the hospitals?
A: Yes it is possible to shift to anot her hospital for reasons of
require ment of better medical procedure. However, this will be
evaluated on the merits of the case and as per policy terms a nd
conditions.
Q16: Can I get outpatient treatment using
my TPA Card?
A: No. The TPA Card is issued to you against your me dicla im
policy which only covers hospitalization expenses. The outpat ient
expenses pertaining to the treat ment of disease which is the
cause of hospitalization is however covered in Pre & Post
Hospitalization be nefits.
Q17: I have received my e-Card but there
are mistakes. What should I do ?
A: For any changes, please contact your People Enga ge ment
Q18: I am not happy with the services of
Vipul MedCorp T PA or if I have a query.
A: You can access our online Query module through se lf care and
we sha ll resolve your queries within 48 hours. In case you face
Manager or raise your queries through ASSIST.
What should I do?
any service issues , please e scalate to your HR SPOC or to Vipul
SPOC/Esca lation Matrix contacts
Q19: I went to one o f your net work
hospitals and they did not entertain me.
Ho w should I proceed?
A: You may immediately call our location spoc, giv ing details of
such hospitals/med ica l providers. O ur network depart ment will
immediate ly contact the concerned medica l provider and sort out
the matter.
Q20: I am not keen to avail of Cash Less
facility. Can I go in for reimbursement?
A: Yes. Under the Mediclaim Policy, you ca n opt for Cash Less as
well as Reimburse ment. We would adv ise that in case you are
taking treat me nt from a network hospital, then you should avail
of the Cash Less facility. This will give you t he financial
advantage of not paying for your hospital treat ment and also
gives you more cushion to meet your post-hospita lizat ion
expenses, as we have pa ckage /discounted rates with the network
hospita ls.
Q21: In case the child after birth s uffers
from any disease is the expense covered. If
yes, how will the enro lment be done when
the child has not been named?
Q22: If the member suffers from any
complication due to her maternity, is it
covered and up to what limit?
Q23: Ho w do I access the
relationship/escalation matrix?
Q24: If a net work hospital does not cooperate with me, what recourse do I have?
Q25: What do you mean by pre-existing
coverage?
Q26: What is floater cover?
Q27: What do you mean with the term
hospitalization?
Q28: Can I go to any hospital or clinic for
taking treatment?
Q29: What is called maternity benefits?
A: The ne w born is covered from day 1 in case of hospita lizat ion
(Subje ct to free slot availability) and justified treat ment is
administered. In case of cashless, the hospital needs to prepare
bills and send cashless request in the na me of “B/o <mother’s
na me>” for processing. For re imburse ment, the child has to be
enrolled with Vipul first in order to process the claim t hrough our
enrollme nt module. Conge nital a ilments are not covered.
A: The complicat ions arising out of maternity are covered under
the maternity benef its and upto the limit of the maternity sum
insure d.
A: Please refer to t he Se lf care module to view the Relationship
matrix.
A: Employees are advised to contact the Vipul representatives in
case the hospital does not co-operate.
A: Any disease exist ing prior to the inception of policy
A: Fa mily floater of maximum 4 me mbers (inclusive of e mployee).
Sum Insured can collect ively be ut ilized by any me mber in the
family.
A: The durat ion of indoor stay in the hospital should be more
than 24 Hrs. However, this time limit will not a pply for spe cific
treatments i.e. dialysis, che motherapy, radiotherapy, eye surgery,
lithotripsy, tonsillectomy, D&C, etc.
A: Yes, but please ensure t hat the hospital is we ll equipped to
handle me dical e merge ncies.
A: Any expense re lated to maternity expenses re lated to
hospita lizat ion only. These expenses are payable only if insured
has less than 2 living childre n. Postnata l & prenatal expenses are
not covered.
Q30:Will claims pr ior to 1st Feb 2014 be
settled under cashless scheme by Vipul?
A: Cashless facility is ava ilable for admissions on or after 1 s t Feb
2014. Admission prior to this pe riod will go thru existing
reimburse me nt process.
Q31: Will I get the entire amount of the
claim always?
A: The insurance compa ny will pay the entire a mount of the cla im
if it is re lated with the medical treat ment and is supported by
proper documentations a nd wit hin the limits. Howev er, all the
claims should stand testimony to medica l professional jurisdiction.
Failing this only that part of the cla im that is justif ied will be
payable. There is 10% co-pay applicable on ea ch and every cla im
of parents/siblings. Non payable ite m list can be referred through
self care module.
A: The a mount will not be carried for ward to subseque nt periods
Q32: If I have not utilized my permissible
eligibility amount in a particular po licy
period will I get any benefits like carry
forward for the next period if I renew the
policy?
Q33: In case of employee transfer to another
location in there any procedure involved to
continue the scheme?
Q34: Will the change in names in bet ween
policy period matters?
A: Change of location , within India does not affect the coverage
as your policy coverage is PAN India a nd Vipul Me dCorp provides
cashless facility on PAN India basis
A: Yes. According to insura nce compa ny the cla im will not be
settled (unless prior intimation to TPA and the Insurance
company) if there is any a lterations in the na me a nd in
bills/reports (docume nts) submitted by me mber/hospital
Q35: Can I c hange or add my dependents
name in bet ween the policy period?
Q36: In case of part settlement of claims,
can the member claim for the ba lance by
producing the required doc uments?
A: As of now it is not a llowed however you may get in touch with
your HR spoc for such a facility.
A: Yes. But only e ligible a mount as per the terms and condit ions
of the policy sha ll be pa id. Original settle me nt letter and attested
copies of the claim document from the other Service provider is
require d as per policy norms.
Q37: What about dental treatment?
A: All expenses related to dental treat ment shall not be covered
under the group hos pita lization policy unless it is an a ccidental
case.
A: This will be covered under the hospita lizat ion limits. But only if
done on the advice of a qualified doctor and on account of
me dical reasons. Expenses arising out of voluntary terminat ion of
pregnancy are not covered. However, medical expenses arising
out of terminat ion of pre gnancy (commonly termed as
miscarriage ) will be covered, within maternity sum insured.
A: Expenses of ne wborn child is covered under the policy in case
a justif ied hospitalization has bee n administered. A separate bill
and discharge summary would be issued for the baby by the
hospita l a nd stay in the hospital should be as per the policy terms
and conditions.
Q38: What about termination of pregnancy?
Q39: What happens when a ne wborn c hild
has to undergo treatment in the nursery?
Q40: What happens when I have to undergo
a treatment like dialysis when I an
discharged on the same day?
Q41: Do we require any photo ID Proo f in
cashless facility? What is the purpose of
photo ID proof?
Q42: In case of no n availability of photo ID
proof, what should we do? Also, please
advise on children if they get hospitalized?
A: When treat ment such as dia lysis, che mot herapy, and
radiotherapy etc. is taken in t he hospital/nursing home and the
insure d person-pat ient is discharge d on the sa me day, the
treatment will be considered to be take n under hos pitalization
benefit
A: Vipul will issue a la minated Photo ID card to a ll the covered
me mbers and If you are not carrying the Vipul la minated card
and are seeking cashless through ecard, we nee d a valid photo
ID proof, which may be, Pan Card, Driving License, Rat ion Card,
etc. It is to validate the ident ity of the patie nt
A: You can contact Vipul SPOC in your area and give your
Employee ID or Inform the Hos pital that you are covered under
Vipul service and they can ment ion the Employee ID and Vipul
SPOC will provide the Vipul ID no .
For childre n, school ID proof is admissible or Parents ID is a lso
admissible
Q43: In case if I need or iginal reports /films ,
can I retain the same for further treatment
and can I get the claim o n submissio n of
Xerox reports ?
A: Yes, you may reta in t he origina l films and retain a Xerox of
the reports, but the bills have to be submitted in originals along
with original bills, discharge summary a nd origina l reports . In
case there is a nee d to retain the original reports also , then you
may show the original reports to the claims pick up executive
and submit a Xerox of the sa me along wit h the claim Docket
Q44: What if my bill exceeds the covered
amount / sum insured?
Q45: In ho w many hospitals Vipul has
packages and where can I see the list of
such hospitals?
A: Vipul shall a uthorise the cashless / reimburse ment cla im upto
the sum insure d a nd deduct ions would be ma de as per policy
sublimits /co pay ment cla use/Non payable ite ms. A mount
exceeding the settled a mount/Sum Insured , has to be be borne
by the e mployee.
A: Vipul has packa ge rates with 1000+ hos pitals and the hos pita l
list can be v iewed as PPN LIST on www.vipulmedcorp.com
Q46: Will Vipul Packages with hospitals
affect the quality of the treatment/
implants?
Q47: If the employee does not opt for
packages , will he get the cashless /
reimbursement on open billing amount?
A: The qua lity of treat ment / impla nts will not be affected due to
packages.
Q48: Can the employee get advance
payment in case the hospital is not on
A: Vipul cannot ma ke t he advance pay me nt, but you may draw
an advance from your e mployer compa ny and Vipul will
A: We would a lways advise to go for packages as this will he lp
you in gett ing more be nefits in your future claims for pre & post
hospita lizat ion, however you are free to go in for open billing
also.
network of Vipul?
reimburse t he sa me to the Employer Company
Q49: Do we have provision o f discounts in
pharmacy of hospitals or open pharmacy /
diagnostic centers?
We have discounts in Stand a lone pharma cy and diagnost ic
centers as available in the we llness portal, which is updated by
us on real time basis.
Some of the hospitals do give discounts in their in house
pharmacy /OPD a nd t he list would be viewe d from the Vipul
Wellness portal
Q50: What if any new joinee who is not yet
enrolled needs a cashless, ho w will he avail
the cashless benefit?
A: After validat ion through locat ion HR, Vipul shall authorise
cashless, out of syste m to the hospital for the ne w joinee as per
policy terms and conditions in network hospital. If such a
situation arises , please get in touch with Vipul SPOC
Q51: Will the resigned employees get the
continuity benefit of the po licy?
A: If they take the policy from t he current Insure r , then they
can get a continuity benefit subje ct to the agree me nt with the
Insurance Co . In such a case the existing Corporate GMC card
would be ca ncelled and Vipul will issue a new cards , on rece ipt
of the ne w policy
Q52: Will the family members of employees
travelling or working overseas get the
medical benefit?
A: If the e mployees are listed in your policy and he /she is on
oversees posting , a nd their fa mily me mbers are residing in
India, the n the fa mily me mbers can avail the benef it of the
policy. If the e ntire fa mily a long with the e mployee are residing
overseas then t hey may be covered in a separate Overseas
Medicla im Policy.
Q53: Can the employee view the c laim
documents on vipul portal?
A: Yes, the e mployee ca n vie w the sca n documents through se lf
care porta l
Q54: Will I get discount in medical checkup
through Vipul Wellness?
A: Yes, you can book through Vipul Wellness for me dical checkup
and ca n avail a discount ra nging from 25% to 40%. The details
of various packages would be uploaded on Vipul We llness
package
A: You can book your Executive Health che ck /MedHealth Check
from Vipul Porta l , which is be ing offered to you on a discount of
25 to 40% on t he market rates. You can avail of First Me dica l
Opinion ( FMO ) , Doctor on C hat, Electronic Medica l Recors
Manage ment (EMR M) on a FOC basis
Q55: What are the services, we can get
from Vipul Wellness portal . Will it be on
FOC basis ?
Q56: Since you have package rates with
hospitals under 3 categories viz , Single
room , Semi Private and Ward , ca n We opt
for any room category
Q57: Since when Vipul ID Card is applicable?
Will I get cards for my dependents too?
Q58: Do I have to provide photographs for
all of my dependents?
Q59: Can Enrollment of the dependents be
done any time in the policy year?
Q60: In Self care portal is pass word c hange
mandatory?
Q61: Can I c hange the sum insured dur ing
the course of the policy?
Q62: What is a TPA Desk in the hospital?
Q63: Is there any time frame for submitting
The room category option will de pend on your Sum Insured. SI
upto 1.5 la khs can opt for Ward and those between 1.5 to 3
lakhs ca n opt for Se mi Private/Twin Share room and those with
SI > 3 la khs can opt for Single room
A: Vipul ID Cards is applicable from 01.02.2014, from the policy
incept ion date, and Vipul sha ll prov ide ID cards for a ll your
dependents as per the policy
A: Yes, as per your policy, you need to prov ide us the
photographs to us for issuing the Vipul ID Cards.
A: Enrollment can be done only once in a policy year, also it is
restricted to a t ime period as specif ied by your HR. Newly ma rried
spouse, ne w born baby ca n be adde d during the policy year ,
subject to free slot availab ility. Please get in touch with your HR
SPOC for such additions
A: Yes, for se curity purpose of your data, we have made it
ma ndatory to cha nge the password.
A: No, you cannot change the sum insured during the policy
period . you may get in touch with the HR SPOC for such a
require ment
A: TPA Desk is a he lp desk provide d by the network hospital in
their pre mises to facilitate communicat ion with t he TPA for
availing cashless benefit in the hospital.
A: Yes, it is advisable that cla im documents are submitted within
the documents?
21 days of discharge and for Post hospitalization claims , wit hin
21 days of complet ion of treat me nt or 60 days , which ever is a
early period .
Q64: Do I get to kno w about my ROOM rent
eligibility?
A: Yes t hrough se lf care porta l you may raise a querry or your
room rent e ligibility or for t hat matter on a ny other matters
relating to your policy
Q65: What is theme based event in health
camps?
A: The me based events relate to the hea lth ca mps / events
organise d making base as t he the me which may be woman ’s day,
world ca ncer day, etc.
Q66: Ho w to confirm discount for diagnostic
centers and pharmacy?
A: One ca n confirm the discounts through Vipul We llness portal.
Coverage:
Salie nt features of NIIT Policy coverage
All me mbers including new joinees are covered from day one
subject to inclusion in the policy or by way of endorse ment and
payme nt of pre mium.
Family & eligible members:
Addition/Deletion & Substitutio n/Swapping:
The term Fa mily ca n be defined a s Employee + 3 dependants i.e.
(1+3). Fa mily me mbers Eligible for coverage: a) Spouse b)
Children, c) Pare nts/Parents in law d) Brother e) Sister f)
Grandpa rents / and any dependent re lative.
Employee may cover the ir extra De pendants (other than
employee + 3 de pende nts) with additional sum insured on
individual basis as per indiv idua l medicla im policy which shall
attract addit iona l pre mium. Maximum e ntry age is 80 years.
(Persons above the age of 50 years will have to submit the report
of Blood Sugar, ECG, KF T,LFT, TMT & Lipid profile)
Any Addit ion/De letion & Subst itution/Swapping of de pende nts
allowed only in case of new child birth, marria ge, divorce and
death, subject to availability of slot. Fresh midterm inclusion of
parents not allowed in the policy.
Other then the a bove me ntioned no midterm add ition would be
accepted and pre mium will be charged on pro-rata basis.
Specia l Coverage:
Pre Ex isting disease (Clause 4.1):
1st 30 days Coverage (Clause 4.2):
1st Year Exclusio n:
Maternity Benefit :
Baby coverage:
PED is covered only for e mployee, Spouse a nd Children only.
Parents are not covered for any Pre exist ing ailme nt until 3 years
from the date of joining subject to continuous coverage.
For Employee , spouse and Children all pres existing a ilments are
covered irrespect ive of a 3 year wait ing period , while for Parents
, pre existing disease are not payable in the first 3 years of their
joining in t he sche me. IN case they cont inue in the sche me for 3
yrs , then in the 4th year , the cla ims arising out of t heir pre
existing ailme nts would be payable
Waived Off. This means that a ll admissions within the f irst 30
days of the fresh coverage ( Ne w joinees ) is a lso a dmissible
The treat ment of disease such as Cataract, Benign Prostatic
Hypertrophy, Hysterectomy for Menorrhagia or F ibromyoma,
Hernia, Hydrocele, Congenital internal disease, fistula in a nus,
piles, Sinusitis and related disorders, Ga ll Bladder Stone re moval,
Gout & Rheumatism, Calculus Diseases are not covered during
first year of insurance however this exclusion is wa ived off for
self/e mployee, spouse & child only.
Maternity Covered from Day 1. INR 35,000 for Normal Delivery &
INR 50,000 for Cesarean.
Baby covers from day one, if free slot is available. Declaration for
enrolment in the policy from e mployee should be within 60 days
of birth.
Room Rent Capping:
Room Re nt is restricted to 2% of the various Sum Insured Limits
or Rs.2000/- whichever is higher. Other Increases expenses due
to higher room rent need to be borne by e mployee. ICU charges
will be paid as per actual.
Co Pay :
10% co-pay ment on all cla ims will a pply on each and every claim;
except cla ims for Self, Spouse a nd C hildren.
Disease Capping:
Cataract – INR 30,000 per eye,
Stone, Hernia (bilatera l a nd unilatera l) – INR 75,000,
Hysterectomy -INR 1,00,000/-