GUIDE BOOK
Genins India TPA Ltd. is a Third Party Administrator in health Insurance. Licensed by IRDA to administer health policies issued by Insurance Companies.
We have been selected by your insurer to provide you with value added services, such as:
i) Cashless Hospitalization.
ii) Expeditious settlement of claim.
iii) 24 hour help-line to provide you assistance and answer your queries.
How to utilize the services of Genins India TPA Ltd., in case of illness At Network Hospital
Step 1: The Genins cardholder visits any of the network hospital listed in the guidebook and establishes his/her identity to the hospital by producing the card.
Step 2: The network hospital sends request to Genins for preauthorization.
Step 3: Genins cardholder’s treatment shall commence after authorization from Genins, in case of planned hospitalization.
Step 4: Authorization should be obtained prior to hospitalization, but in case of emergency, authorization can be obtained after hospitalization, within 24 hrs of admission.
Step 5: Hospital will not charge the card holder for any expenses except the deductibles like extra bed, phone charges etc. as per the terms & conditions of the policy.
Step 6: Before discharge, the card holder should correctly fill up insurance claim form and sign it.
Step 7: No original documents should be collected from the hospital by the card holder to facilitate direct payment to hospital, in case of cashless treatment.
Step 8: The validity period of authorization is 3 days from the date of issue or date of hospitalization, whichever is later.
Step 9: For expenses pertaining to pre and post hospitalization, the card holder will submit documents containing prescriptions, cash memos, investigation report etc., to Genins directly for reimbursement.
At Non-Network Hospital
The card holder will have to intimate to Genins within 24 hrs. of hospitalization, through a letter, fax, e-mail at gil@geninsindia.com or do online claim intimation on our website www.geninsindia.com.
The card holder will pay the total expenses directly to the hospital.
The card holder will claim for the reimbursement from Genins after discharge from the hospital.
How to claim: After getting the intimation letter, Genins will send claim form, which the card holder will fill up properly. The claim form can also be downloaded from our website www.geninsindia.com. Documents to be enclosed with the claim form are:
1 : Photocopy of registration certificate of hospital. If unregistered, a certificate from the hospital, about the facilities including:
a) No. of beds
b) Availability of In-house Operation Theater
c) 24 hours doctor on duty
2 : Pre hospitalization documents : Prescription, Chemist Bills and Investigation reports.
3 : Hospitalization documents : Discharge summary, investigation reports, hospital bill, receipts of payment, break-up of each heads of hospital bill separately, prescriptions and cash memo, incurred during hospitalization period, both supplied by the hospital and purchased from outside hospital.
4 : Post hospitalization documents : Prescriptions, chemist bills and investigation reports.
5 : The policyholder will have to deposit the above documents at Genins India TPA Ltd.
DONT'S
1) Do not get admitted to hospital for health check-up, investigation or evaluation only. These are not payable if existence of disease is not diagnosed.
2) Do not take original documents related to treatment from a network hospital.
3) When treatment is taken at non-network hospital, send all documents at one go with duly completed claim form. Do not send them in piece meal.
The policy of insurance covers hospitalization expenses for any disease, which is not excluded, as per policy terms and conditions of the policy. For detailed exclusions, please refer to the policy document.
Important Note : -
In case sufficient information in the prescribed pre-authorization format is not given or in case of vague symptoms, where medical team of Genins India TPA Ltd. is not sure of eligibility of coverage under the policy, due to inadequate medical information, pe-authorization for cashless can be denied.
The denial of cashless facility does not mean denial of treatment and does not prevent you from seeking necessary medical attention in hospital. The claim can be considered for payment in accordance with terms & conditions of policy as a reimbursement claim.
Genins offices