»  I have an I-card issued by your company. What are the benefits of this card ?
This is mediclaim health card issued by us as we have been appointed by your Insurance Company as third Party Administrator to service your claim.This card entitles you to get the hospitalization claim processed to us as per the policy terms & conditions. You to avail cashless services in any of the hospitals in our network. The process for availing the facility and the list of hospitals are detailed in the User manual sent to you along with the card. The network list is also available on our website. You may make any enquiry on our toll free number using the unique identification number (card number) issued to you on this card.

» What is the process of availing cashless facility in the hospital?
In case of a planned / Emergency hospitalization you need to inform us seven days in advance by uploading the the pre-authorization form (form on website)completely filled & signed by the treating Consultant and Insured. Please refer to cashless claim procedure available on our website for details.
At the Time of Discharge , Patient needs to Pay for the Non Payable Amount, as per IRDA list, deduction made as per policy terms & conditions including for Co-payment if any as per IRDA list & NON Payable Items to the Hospital and get the Receipt of payment from Hospital.

» What are the formalities that need to be done at the time of discharge in case of a cashless facility?
Patient needs to Sign the Original Discharge Summary, Hospital Bill , Claim Form and leave all the Documents including Investigation reports and Films with the Hospital to be Forwarded to AITL for receiving the Cashless Payment in respect of the Insured Patient from Insurers directly within 3 days from the Date of Discharge. Insured to get the payment receipt of items mentioned in previous question from the hospital.

» What are the documents required for availing hospitalisation claim by me?
List of documents required for availing hospitalisation claim are:-
Original documents are required :-
1- Completed claim form duly signed by insured.
2- Discharge summary
3- Hospital bill with break up
4- Investigaion reports with films
5- Pharmacy bills
6- Payment receipt including Advance Payment.
7- Facility Certificate of Non Networking Hospitals/N.Home Clearly mentioning No. of Beds,OT Facility,No, Round the Clock RMO &Nurses With Contact No.
8- Intimation Letter
9- AITL Health Card Copy
10- Cancelled Cheque having Name of insured, IFSC Code, Account No./ passbook copy having details as mentioned
11- One photo Id card (self attested)
12- If claim amount is above 1 Lakh, self attested pan card copy

» How to avail cashless service at network hospital?
Please refer to our website for details.

» What does discharge summary means and the Information required in it?
Discharge summary means the discharge card issued to the patients at the time of discharge having all patients treatment details during hospitalisation.
Information required in it is as follows :-
A. Patients Name
B. Telephone No./Mobile No.
C. IPD No.
D. Admission No.
E. Treating Consultant Name, Contact No, Department / Specialty.
F. Date And Time of Admission.
G. Date and Time of Discharge
H. MLC No./FIR No with Copy
I. Provisional Diagnosis at the time of Admission
J. Final Diagnosis at the time of Discharge
K. ICD – 10 codes or any other Code recommended by Authority for Final Diagnosis.
L. Presenting Complaints with Duration and Reason for Admission.
M. Summary of presenting illness.
N. Key Findings on Physical Examination at the time of Admission.
O. H/o of ALCOHOLISM, TOBACCO or SUBSTANCE abuse if any.
P. Significant PAST MEDICAL and SURGICAL History, if any
Q. Family H/o if Relevant/Significant to the Diagnosis or Treatment
R. Summary of KEY Investigation during Hospitalization.
S. Course in Hospital including Complication if any.
T. Advice on Discharge.
U. Name & Signature of Treating Consultant/Authorized Team Doctor.
V. Name & Signature of Patient/Attendant.
» If I avail cashless facility for my hospitalization, how will I claim for my post Hospitalization expenses?
You can file a claim for reimbursement of your Pre & Post hospitalization expenses (30/15 days before date of admission and 60/30 days from the date of discharge depending upon the nature of Policy Coverage ) to ALANKIT INSURANCE TPA LTD. .It should be accompanied with Completely Filled Claim Form duly Signed, All Prescriptions, Investigation Reports with Films if any, Medicine Bills, Receipts of Payment ALL in ORIGINAL along with a Cancelled Cheque having Insured Name, IFS CODE, ACCOUNT NUMBER OR PHOTOCOPY of FIRST PAGE of PASSBOOK for receiving direct Payment from the Insurance Company.

» What are my rights and duties as a hospitalization policyholder?
As a hospitalization policy holder you have certain rights and duties enumerated as under:-
Rights: You have a right to be treated in any PPN NETWOKING hospital of your choice. You have a right to know the status of your claim and if your claim has been found admissible you have a right to be paid. You have a right to represent to us or to the insurance company in case you disagree on any matter.
Duties: Your duty is to 1. Inform Alankit in case of an admission: (Intimate your claim,), 2. Provide complete and correct information as required by your treating doctor who would in turn provide the same to Alankit. Send all relevant documents to AITL as mentioned. Please quote your policy number/card Number in case of any query to AITL.

» Where do I lodge my claim if I get treated in a non-network hospital?
You can lodge your claim at our office at 4E/2,Alankit House ,Jhandewalan extension, New Delhi – 110055.Please note the List Documents to be Submitted as enumerated in Reimbursement Process on our web-site to AITL If your claim is found admissible it shall be forwarded to the Insurers by AITL for direct Payment in your Account.

» What does my mediclaim policy cover?
Your Policy covers the hospitalization expenses incurred by you once admitted in a Hospital subject to hospitalization being for a minimum period of 24 hours (with exceptions where 24 Hrs Hospitalization is not required ) and exclusions as mentioned in your Policy Documents

» What is an exclusion?
Certain diseases that are not covered under the policy for a Particular time period after the Inception and few diseases are never covered as mentioned in the exclusion clauses of the Policy are called exclusions.

» What is a thirty-day exclusion?
As per the exclusion clause 4.2 of the policy any disease contracted by the insured person within the first thirty days from the commencement date of policy is not payable (except in case of accident) unless proved by the panel of doctors that the insured could not have known of the disease before the commencement of the policy.

» What is a Pre-existing Disease exclusion?
All diseases which are Present before the inception of Policy Cover are known as Pre-existing diseases. Any Complications arising from Pre-existing ailment/diseases/injuries will be considered as a part of Pre-existing health condition/disease. Commonly Diabetes, Hypertension OR both and its Complications whether known or Unknown are not covered in first 48 months of Policy coverage. In a standard mediclaim policy these gets Covered after 48 months of Continues Coverage if there has been No claim reported during last 48 months .i.e. these diseases are payable after a 48 month of continuous cover, i.e in Fifth Year of Policy with no break in Policy.

»  What is a one-year exclusion?
In a standard mediclaim policy certain diseases are not payable in the first year of insurance cover. These diseases are payable after a 12 month of continuous cover, i.e in second Year of Policy with no break in Policy. These diseases are :-
Benign ENT Disorders, Tonsillectomy / Adenoidectomy/Mastoidectomy / Tympanoplasty (see Product type).

» What is a Two-year exclusion?
In a standard mediclaim policy certain diseases are not payable for first year of insurance cover. These diseases are payable after a 24 month of continuous cover, i.e in third Year of Policy with no break in Policy. These diseases are :-
Cataract, Benign Prostatic hypertrophy, Hysterectomy for menorrhegia or fibromioma, hernia, hydrocele, Hypertension & related Complications, Diabetes & related Complications, congenital internal diseases, fistula in anus,pilonidal sinus, piles, Calculus diseases,sinusitis and related disorders. Surgery of Gall Bladder & Genito-Urinary System excluding Malignancy,Surgery of Prolapsed Intra-vertibral Disc unless Arising from Accident, Surgery of Varicose Vein,polycystic ovarian disease, on Infective Arthritis,Gout & rheumatism (see Product type).

» What is a Four-year exclusion?
In a standard mediclaim policy certain diseases are not payable for first four year of insurance cover. These diseases are payable after a 48 month of continuous cover with No claim reported during last 48 months, i.e in fifth Year of Policy with no break in Policy. These diseases are :-
Treatment for Joint replacement due to degenerative conditions, age related Osteoarthritis and Osteoporosis.

» Is dental treatment covered?
No, dental treatment of any kind is not covered unless arising from Accident requiring hospitalization

» My wife’s EDD is on 29.12.15. My policy commenced on 12.5.15. Is her delivery covered?
No, treatment arising from or traceable to pregnancy or childbirth including cesarean section is not covered in a standard individual mediclaim policy and Pariwar policy.

» Whether treatment for HIV,AIDS ,STD is covered?
No, expense arising out of any condition directly or indirectly attributable to any syndrome or condition commonly called HIV, AIDS,STD are not covered.

» Whether charges for diagnostic test etc. are also covered?
Charges for diagnostic test consistent with or incidental to the diagnosis and treatment of the positive existence or presence of any ailment, sickness or injury are payable only as a part of pre & post hospitalisation claim. It is not payable as OPD pateints where there is no hospitalisation

» On hospitalization, what is the time frame for intimation to the TPA or the Insurance Company?
You are required to intimate the TPA or your insurer 7 days prior to Planned Hospitalization and within 24 hours of emergency hospitalization in a Network Provider/PPN in case of Cashless Hospitalization . In case of Reimbursement: - In Planned Hospitalization it is 72 hours before Admission and within 24 hours of emergency hospitalization.

» What is the time frame for submitting your reimbursement claim after getting discharge from the hospital?
You are required to submit your reimbursement claim within 15 days from the date of discharge from Hospital . In case of Post Hospitalisation Expences Reimbursement, it is 15 days from the Completion of Post Hospitalisation Treatment in Standard Individual policy or maximum 15 days of 60/30 days period as per the terms & conditions of the mediclaim policy which ever is earlier.

» Whether treatment for General Debility, Congenital External anomaly is covered?
No. General debility, run down condition or rest cure, congenital disease or defects are not covered. in the policy.

»  Whether treatment for Sterlity, infertility, assisted conception is covered?
No. these Procedures are not covered.

» Whether treatment for Refractive error, Obesity is covered?
No . Surgery for correction of eyesight due to refractive error is not covered.
Treatment of obesity or conditions aising thereof (including morbid obesity) or any weight control and management programe /services/supplies or treatment is not covered

» Whether treatment for Psychiatric disorder, intentional self injury is covered?
No all forms of Psychiatric and Psycho-somatic disorders, intentional self inflicted injury attempted suicide are not covered in the Policy