Q:  I have recently taken a mediclaim policy. Can I avail of Vipul MedCorp Insurance TPA's services ?
A:  Please check if Vipul MedCorp Insurance TPA is the authorized TPA, appointed by the insurer for administration of your policy. If yes, then you can avail of our services.

Q:  What are the services available to me from the TPA ?
A:  You can avail of the following services :

Enrollment Card against your policy, which would give you access to our TPA services.

Cash Less service facilitation at network hospitals up to limit authorized by Mediclaim / Hospitalization Insurance

Claims Processing and Reimbursement for non-network hospitals

24hr access to our Call Center through our Toll Free line

Online assistance during hospitalization and filing of claim documents

Other services as defined by your Employer / Insurer

Q:  When I call Vipul MedCorp Insurance TPA's Call Center / Office, how will you identify me ?
A:  Please mention your Policy Number or your Health Card Number to the Call Center Executive.
The executive may verify other details like your Address, Insurer, Date of Birth, Employer Details etc. On establishing your identity, we will be happy to answer your queries.

Q:  What if I dont remember my Card Number and my Policy Number and I am in an emergency situation ?
A:  In case you are in an emergency situation, we can search your details through our software based on the following:

Name, Address, Date of Birth

Insurer

Underwriting Office Code

Q:  What is a Mediclaim Policy and the benefits thereof ?
A:  For a detailed explanation regarding mediclaim policies Click Here

Q:  How do I avail of Cash Less Facility ?
A:  Cash Less facility is available only in network hospitals. In case the patient wants to be referred to a network hospital, please do so, but we need to obtain the following documents from the patient before we can issue a preadmission authorization for cash less facility :

1. Original first prescription of the doctor referring the hospitalization, complete with details of symptoms and diagnosis on his/her prescription letter head.
2. Hospitalization Form in the given format
3. Details of previous policies : if the details are not already available with us except in case of accidents

In case information is not complete in the hospitalization form or if the history of the disease is not confirmed, we cannot issue a preadmission authorization for cash less facility. In such a case, if the patient is admitted in a network hospital, treatment will be same as in the case of a non-network hospital.

IT IS ESSENTIAL THAT WE REQUEST THE PATIENT FOR ALL THE ABOVE DOCUMENTS. The doctor must mention in the history sheet - the record of history of the disease, relation to preexisting diseases like hypertension, diabetes etc if any and history of the same.

Q:  What documents do I need to send for processing claims if the treatment has been done in a non-network hospital / In a network hospital where cash less facility was not granted / availed ?
A:  Following documents are required for processing your claims on reimbursement basis:

1. Claim Form propoerly filled and signed by the claimant
2. Discharge Certificate from the hospital
3. All documents pertaining to the illness starting from the date it was first detected i.e. Doctor's consultation reports/history
   1. Bills, Receipts
   2. Cash Memos from hospital supported by proper prescription
   3. Receipt and diagnostic test report supported by a note from the attending medical practitioner/surgeon justifying such diagnostics. Surgeon's certificate stating the nature of the operation performed and surgeon's bill and receipt
   4. Attending doctor's / consultant's / specialist's / anesthetist's bill and receipt, and certificate regarding diagnosis
   5. Certificate from the attending medical practitioner / surgeon that the patient is fully cured
4. Details of previous policies : if the details are not already with us except in the case of accidents

Q:  When will my claim be reimbursed ?
A:  The claim will be reimbursed within 15 days after receipt of complete documentation from the client

Q:  What documents should we obtain before discharge from the hospital in case of cash less facility availed ?
A: All bills in original and a discharge certificate are to be left with the hospital providing cashless treatment. The patient has to countersign all bills and fill the claim form and also leave the same with the hospital at the time of discharge.
A copy of the bills & Discharge Summary can be carried by the patient for his records and for submission along with Pre & Post Hospitalization bills.

Q:  Can I get Cash Less facility / Reimbursement in the case of pre-existing diseases.
A:  Pre-Existing disease are excluded in Mediclaim Policy (Exclusion No 4.1). Our doctor panel will verify / check the inception of disease based on your medical records and in case the disease has an origin before the inception of the policy, then your claim is not payable, as per the policy

Q:  Can I get Cash Less facility / Reimbursement within 30 days of policy commencement ?
A:  Mediclaim policies have a waiting period of 30 days. Only accidents if occurred during the first 30 days of the policy are covered. Any other disease is not payable.

Q:  Is there any exclusion in the first year ?
A:  Yes. mediclaim policy does not cover a few disease which have occurred within one year of policy commencement.
Diseases which are not payable during the first year of the operation of insurance cover are :

1. Cataract Benign Prosthetic Hypertrophy
2. Hysterectomy for Menorhegia or Fibromioma
3. Hernia, Hydrocele
4. Congenital, Internal Diseases
5. Fistula in anus, Piles, Sinusitis

Q:  Can I get the salient features of mediclaim policy ?
A:  Yes, you can download the proposal form from our website. To go to the downloads section Click Here.

Q:  Can Vipul MedCorp Insurance TPA reject my claim ? Do I have any remedy ?
A:  Yes, the TPA can reject / deny your claim based on their evaluation / analysis. The rejection letter will cover the reasons for rejection of the claim.
Remedy :-  In case you are not satisfied by the reasons for rejection, you can represent to the insurer within 15 days of such denial

Q:  If I lose my ID Card, can I get a duplicate card issued ?
A:  Yes, you may send a request letter along with a cheque of Rs.50/- [per card] favouring Vipul MedCorp Insurance TPA Pvt. Ltd. The duplicate ID Card will be dispatched to you within 7 days of clearance of your cheque.

Q:  How do I get a list of network hospitals of Vipul MedCorp Insurance TPA Pvt. Ltd. ?
A:  Along with your ID Card, you will get a kit comprising of a Guide Book and List of Network Hospitals.
You can also download the list from our website from the "Hospital Network" section.

Q:  My mediclaim is expiring next month. How do I renew the same and will I get a renewal card from Vipul MedCorp Insurance TPA ?
A:  You may approach the Insurance Company for your policy renewal. The ID Card issued to you by Vipul MedCorp Insurance TPA does not have a validity date and as such you can continue using the same card. After every renewal, your data will be sent to us by the Insurance Company, and the same will be updated in our records.

Q:  I want to increase my Sum Insured and also add another family member to the policy. Please Advise.
A:  You will need to contact your Insurance Company for any addition / deletion of the above type. Once we get a notification from them, we will update our records similarly.

Q:  Can I lodge more than one claim for the same disease ?
A:  Yes. your mediclaim policy covers 30 days Pre-hospitalization expense reimbursement and 60 days Post-hospitalization expenses. You may lodge your Pre-hospitalization claim along with hospitalization claim. The Post-hospitalization claim may be lodged after 60 days of the hospitalization. However, please quote your Claim Number for easy referral and sorting.

Q:  How will you keep track of my claim ?
A:  You may lodge your claim at any of our offices personally or you can send the same by courier / post etc. On receipt of your claim documents, an acknowledgement letter will be issued to you, which will carry your claim number also. We will identify / track your claim based on the above number.
The claim will be put in a folder and after assessment will be stored in our record room. We will have online access to your claim details based on the assigned claim number

Q:  In case I require my original medical papers back for future reference, what should I do ?
A:  Please carry a complete set of photocopied documents when you lodge your claim. The relevant original documents will be returned to you after verification. We will however stamp the original documents [ Vipul MedCorp Insurance TPA - Claim Processed on Xeroxed copy ]. Please note that normally, the original doctor prescription, medicine bills and discharge summary along with the hospital bills will be retained by us. Only X-ray films, ECG, other medical records will be returned to you as a special case after verification / approval of our medical team.

Q:  During the course of my treatment, can I change the hospitals ?
A:  Yes it is possible to shift to another hospital for reasons of requirement of better medical procedure. However, this will be evaluated on the merits of the case and as per policy terms and conditions.

Q:  Can I get outpatient teatment using my TPA Card ?
A:  No. The TPA Card is issued to you against your mediclaim policy which only covers hospitalization expenses. The outpatient / domicillary expenses pertaining to the treatment of disease which is the cause of hospitalization is however covered (Please see Pre & Post Hospitalization benefits)

Q:  I have received my policy, however, I have not yet received my ID Card. Please advise.
A:  There could be a chance that the Insurance Company has still not forwarded your details to us. Also there is a possibility that your card has been dispatched and you have not received the same.
You can call our call center and they will giude you suitably. Alternatively, you can enter the policy number at our website (vipulmedcorp.com) and you can get your card status.

Q:  I have received my ID Card but there are mistakes. What should I do ?
A:  You may please send your ID Card back to us, mentioning the mistakes along with the rectification required. The corrected card will be dispatched to you within 7 days without any additional cost.

Q:  I am not happy with the services of Vipul MedCorp Insurance TPA. What should I do ?
A:  You may write/email to our grievance department (grievance@vipulmedcorp.com), giving details of your grievance. We assure you that our grievance department will address the issue within 48 hours.

Q:  I went to one of your network hospitals and they did not entertain me. How should I proceed ?
A:  You may immediately call our call center, giving details of such hospitals/medcal providers. Our network department will immediately contact the concerned medical provider and sort out the matter.

Q:  I am not keen to avail of Cash Less facility. Can I go in for reimbursement ?
A:  Yes. Under the Mediclaim Policy, you can opt for Cash Less as well as Reimbursement. We would advise that in case you are taking treatment from a network hospital, then you should avail of the Cash Less facility. This will give you the financial advantage of not paying for your hospital treatment and also gives you more cushion to meet your post-hospitalization expenses.

Q:  I have taken Mediclaim from Insurance at Delhi and I have been posted to Mumbai. can I still avail of Vipul MedCorp Insurance TPA's service ?
A:  Yes. The TPA service is of All-India nature. you can access any of our offices and in the event of a hospitalization, use the services of any network hospital spread across the country.

Q:  How do you credential your hospitals and can I get access to your findings ?
A:  In order to know more about Hospital Accredition, please click here.

If you have any further queries, you can email us at info@vipulmedcorp.com

or call us at +91-0124-4699600,2438270-75