Faq On Group Mediclaim Policy: Cavinkare Private Limited

FAQ ON GROUP
MEDICLAIM POLICY
CAVINKARE PRIVATE LIMITED

What is Group Mediclaim Policy ?
GMC Policy is taken for mediclaim coverage for employees and their
families in the event of hospitalisation.
Following points are essential for coverage : -
• Minimum Coverage of 24 hours hospitalization.
• Treatment should be availed only in registered hospital / nursing

home under the supervision of a registered & qualified medical
practitioner
• Hospital should have the following:
- Minimum 20 in-patient beds (in metros) 15 in non-metros
- Fully equipped OT
- Fully qualified nursing staff round the clock
- Fully qualified & registered doctors round the clock
Who is our Insurer & TPA?
• We have our policy with National Insurance Company Limited,
Chennai
• TTK Healthcare Services, Chennai is our TPA.

• Contact Details of TTK in-charge – Ms. Anitha - ani
tha.rani@ttkhealthcareservices.com / 98840 94544
TOLL FREE NOS. OF TTK

TOLL FREE FAX NOS. OF TTK
TTK HO CALL CENTER 1800 425 8885
TTK HO CALL CENTER 1800 425 7878
TTK CHENNAI CALL CENTER 1800 425 7575 TTK HO FAX NO. 1800 425 2626
TTK MUM CALL CENTER 1800 22 1717 MUMBAI FAX NO. 1800 22 1919
TTK COCHIN CALL CENTER 1800 425 6264 COCHIN FAX NO. 1800 425 6262
TTK HYD CALL CENTER 1800 345 4051 CHENNAI FAX.NO. 1800 425 7474
TTK KOL CALL CENTER 1800 345 7069
TPA stands for Third Party Agency

What is Policy period & Who are
all covered under the policy?
• CavinKare Group Mediclaim Policy period commences on
22nd August of every year, and closes by 21st August of
next year.
• Employees and their dependents are covered under the

policy.
• Dependents includes Self, Spouse, Parents & Children,

subject to max. of 6 members in a family including
employee. ( 1 + 5 coverage )
What are the features
of CK Mediclaim policy ?
• Pre-existing diseases covered
• Waiver of 1st year exclusion
• Waiver of 30 days waiting period
• Coverage till 80 years
• Inclusion of maternity benefit ( Pre & post
maternity charges not covered )
• Baby coverage from Day 1
• Floater made policy
• Coverage for 1 + 5 dependents
• Cashless scheme - network with 3500 hospitals
through out India
What is my claim eligibility ?
We have a graded coverage for our
employees –
• MN3 & Above Rs.85,000 pa
• MN4 & MN 5 Rs.50,000 pa
• O1 & O2 Rs.40,000 pa
• O3 & O4 Rs.30,000 pa
Eligibility amount is per member in a family.
What is floater made policy ?
• Under floater scheme the sum insured for the
individual family members will be added and the total
insured amount will be treated as sum insured for
family members.
• If an employee in MN4 grade has 4 members in his

family, total SI for his family is Rs. 2.0 lacs
• 50000/- * 4 = 200000 /- Sum Insured
• Sum Insured amount can be used within the family,

and there is no restriction on the same.
What is cashless facility ?
• ID cards are provided to employees &

their dependants.
• With the use of id card, they may get

admitted in any of the network
hospitals through out India and need
not pay any cash during hospitalisation.
How does Cashless access for
Hospitalization works ?
Cashless access for Hospitalization

Hospital faxes
Pre Authorisation to
TTK on Toll Free
Number
Patient approaches Request received at TTK

Network hospital Based on Pre Auth dept thru
recommendation Dedicated Fax Machines
of physician
CYCLE TIME
SAME DAY.
Claims Dept checks

for coverage and
Authorisation eligibility
faxed to Hospital
Medical Dept checks for Use Toll

Treatment & Applies Free Nos.
Negotiated Tariffs
Online HelpDesk at Select Hospitals :Authorisation & Billing

Will my claim be covered under
reimbursement scheme ?
• Yes. If the hospital is not covered
under cashless scheme, employee may
get admitted to any nearest hospital.
The amount incurred by the member

towards hospitalization shall be
reimbursed.
What are the documents to be
submitted for reimbursement claim ?
• Original Discharge Summary
• Medical investigation / diagnostic test Bills must be

accompanied by photocopies of the Reports
• Medical bills and prescriptions
• Lab reports, x-ray / scan reports etc.
• Claim to be submitted to HRD.

In case of reimbursement claim
submitted by me, why full amount
doesn’t get reimbursed from TPA ?
• Following charges / expenses incurred by member is disallowed as per
Mediclaim conditions : -
– Admission fee
– Registration Charges
– Diet & Canteen charges
– Telephone calls
– Service charges
– Miscellaneous Expenses
– Purchase of diapers, napkins, child food like Nestum
• This is applicable for both cashless & reimbursement claims.

Will maternity claim for 3rd child
be covered ?
• Only 2 live births are covered. i.e, if the claimant has
2 children, then the 3rd baby delivery charges are
not payable even if he/she has not claimed for the 1st
and 2nd children
• Similarly, Medical/voluntary termination of pregnancy

– unless necessitated by medical advice where
fetal/maternal life is endangered is not covered
under Mediclaim
What are the other coverage
excluded from policy ?
• Domiciliary Hospitalization
• Treatment for sterility / infertility.
• Family planning operations
• Naturopathy treatment
• Admissions for evaluation / purely for
investigation
• Congenital external disease or defects
• AIDS
OTHER FREQUENTLY
RAISED QUERIES
QUERIES REPLIES REMARKS
Will Cataract be Yes However, cost towards
covered? lens shall not be
reimbursed
Will Dental treatment No Dental treatment arising
be covered? out of accident shall be
covered
Will Cosmetic surgery No --
be covered?
Will Outpatient No --
treatment be covered?
ADDITIONS & DELETIONS
• Employees presume that by sending their
wedding invitation to HR, their spouse shall be
covered automatically.
• Nomination form should be filled in by employee,

giving details of their nominee, DOB and duly
signed form should reach HR for adding their
dependents.
• Similarly, any deletion in the family to be

informed by giving a nomination form to HR.
Otherwise, Company will continue to pay the
premium for that member unncessarily.
Where do I get mediclaim
related forms ?
• For your convenience, forms ( claim
reimbursement & nomination form ) are
made online available in
http://my.cavinkare.com
• All you need to do is, login with your emp

id, click the DOWNLOAD FORMS link, and
can take the print out of the forms.
Whom should I contact in HR for
further information on Mediclaim ?
• You may contact Mr. Kalaiselvan,

kalaiselvan@cavinkare.com ( 044–24317749 )
or
• Ms. Kayal, kayal@cavinkare.com ( 044 –
24317751 ) for further details on Mediclaim
policy.
THANK YOU !

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FAQ ON GROUP

CAVINKARE PRIVATE LIMITED

• Minimum Coverage of 24 hours hospitalization.

• Treatment should be availed only in registered hospital / nursing

• TTK Healthcare Services, Chennai is our TPA.

TOLL FREE NOS. OF TTK

TTK KOL CALL CENTER 1800 345 7069

TPA stands for Third Party Agency

• Employees and their dependents are covered under the

• Dependents includes Self, Spouse, Parents & Children,

• If an employee in MN4 grade has 4 members in his

• Sum Insured amount can be used within the family,

• ID cards are provided to employees &

• With the use of id card, they may get

Cashless access for Hospitalization

Patient approaches Request received at TTK

Claims Dept checks

Medical Dept checks for Use Toll

Online HelpDesk at Select Hospitals :Authorisation & Billing

The amount incurred by the member

• Original Discharge Summary

• Medical investigation / diagnostic test Bills must be

• Medical bills and prescriptions

• Lab reports, x-ray / scan reports etc.

• Claim to be submitted to HRD.

• This is applicable for both cashless & reimbursement claims.

• Similarly, Medical/voluntary termination of pregnancy

• Nomination form should be filled in by employee,

• Similarly, any deletion in the family to be

• All you need to do is, login with your emp

• You may contact Mr. Kalaiselvan,

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