Medikoe Health Insurance and Healthcare services

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No Documentation

No
Pre-Medicals

Treatment in Single Private Room

Free Health Checkup

OPD
Benefits

  • Calculate your Premium Calculate your Premium
  • For any Claim related Info, please contact on our Helpline Number : 1800 103 1033

    Click for Corporate Health Insurance







Why choose MEDIKOE Health Insurance ?

Medikoe is pleased to offer Health Insurance, exclusively for its registered clients. With affordable premiums, simple processing, unique plan benefits and tax exemption on premium paid under section 80D. This Health Insurance is designed to ensure a safe and healthy time for you and your family.

Medikoe Health Insurance is a Group Health Insurance Plan underwritten by Aditya Birla Health Insurance.

No Documentation, No Medicals

Being a valued Medikoe Health Insurance client, you can purchase the Group Health Insurance without providing for any kind of documentation.

OPD Benefits

Claim back your OPD expenses which includes Doctor consultation, Medical bills, blood test etc which does not require hospitalisation.

Free Health Check Up

A FREE Health Check-Up would be available once a policy year.

Worldwide Emergency Assistance

We will provide Emergency Medical Assistance worldwide as described below when an Insured Person, during the Policy Period, is travelling 150 K.M. away from his/her residential address.

100% Reload of Sum Insured

Once in the Policy Year, We will provide for a 100% reload of the Sum Insured, in case the available Sum Insured is utilised for another illness/person within that policy year.

All Major Hospitals in Network

Cashless Hospitalisation & Day-care procedures in the best hospitals in your city. Refer our Hospital Network List.

No Room Rent Capping

Single private room shall be made available for all eligible policy holders without any room rent capping.

No Co-Pay

Our Group Health Insurance Plans come with NO CoPay which essentially means you as a client do not have to pay anything towards any medical costs claimed for.

Sec 80(D) Tax Benefit

You are allowed to claim a deduction up to Rs. 25,000 per budgetary year for medical insurance premium installments.

FAQ

Your Possible Questions about
MEDIKOE HEALTH INSURANCE is answered here

Pre-Auth and Cashless

Initial / Enhancement Approval or Query Within 2 Hours From receipt of Documents from Hospital
Final Approval Within 2 Hours From receipt of complete Discharge Documents from Hospital
Pre-Auth Denial Within 2 Hours From receipt of complete Discharge Documents from Hospital

Reimbursement

Acknowledgement & Registration of the Claim Documents 1 Working Day From receipt of documents or intimation from Insured
Deficiency to be raised for short fall of claim documents (if any) 3 Working Days From receipt of Initial documents or intimation
First, Second & Final Reminders 10 Days interval From 1st Query generation date
Closure / Repudiation for non-receipt of claim documents 45 Working Days 7 Days after final reminder
Acknowledgement for receipt of Deficiency or any documents 2 Working Days From receipt of Deficiency or any documents
Re-deficiency (if New Queries arises from the submitted documents) 2 Working Days From receipt of Deficiency or any documents
Claim Payment to Insured or Network Hospital 7 Working Days From receipt of complete set of claim documents
Re-imbursement Claim Repudiation 7 Working Days From receipt of complete set of claim documents
Claims Investigation 15 Working Days From date of assigning the claim for investigation.
  • Q: What are the branch addresses, in case i have any query where i can contact ?

    Answer: 
     1. Office no 403, Laxmi Commercial Premises Society Senapati Bapat Marg, Dadar Station Road Dadar West Mumbai -400028
     2. 104, BABA House, Bajaj Road Off M V Road next to WEH Metro Station Andheri (East), Mumbai -400093
     3. HB Twin Towers, Office No. 104, Above starbucks Netaji Subhash Place New Delhi -110034
     4. Office No 6, Pradeep Chambers Bhandarkar Road, Pune -411004
     5. Gr Floor Rain Tree Palace, Mc Nicholas Road, Chetpet, Chennai -60003
     6. 1st Floor, 19/4 above Axis Bank Sairbagh, Cunningham Road Bangalore Karnataka -56005
     7. Apeejay House 3rd Floor, C block, 15 Park Street, Kolkata -700016
     8. Flat No 209, Block II, White House, Begumpet, Hyderabad 500016
     9. Unit No. 1&2, 1st Floor. Parmesh Corporate Tower, Plot no.13, Karkardooma Community Centre, Delhi -110092

  • Q: If the customer has taken OPD optional benefit, can the customer claim for skin related opd expenses?

    Answer:  Skin related OPD expenses can be payable under OPD benefit if opted.

  • Q: If customer taken an enhanced policy with a sum insured of 10 lacs. In his 1st claim he claims for Rs 1 lakh for dengue, in the same year he again undergoes hospitalisation and has one claim of Rs 15 lakhs so how much can he claim...?

    Answer:  First Claim - Rs 1 lakh for dengue we pay the claim, Second claim - Rs - 15 lakhs wherein hospitalisation is for some other reason other than dengue we do a reload of 10 lakhs and settle the claim of Rs 15 lakhs.

  • Q: Need to know the list of cosmetic treatments which are covered and not covered?

    Answer:  We do not not cover cosmetic treatments.

  • Q: Is bariatric surgery covered in ABHI policies?

    Answer:  No its not covered in ABHI policy as it’s a part of permanent exclusion.

  • Q: Do we cover Robotic surgery in our ABHI activ health plan?

    Answer:  Robotic sugery is covered under policy however claim admissibility will be subject to final diagnosis and policy clause for Reasonable & customary charges

  • Q: With respect to the Pre-Authorisation Process, is the customer provided with the Pre-Authorisation Form where he fills in the required details?

    Answer:  Pre authorization forms are available on Hospital TPA desk as well as on website. Same needs to be filled by treating doctor & signed customer. Hospital will then send this Pre-auth form to Insurance company.

  • Q: Is there any deadline for the customers to claim for his bills for pre an post hospitalization?

    Answer:  Within 30 days after the post hospitalization.

  • Q: What is turnaround time for reimbursement claims to be settled?

    Answer:  7 working days.

  • Q: If a customer has opted Single Pvt Room at the time of opting for the plan. At the time of hospitalisation, neither Single Pvt Room nor lower category room is available & the hospital puts the customer in a higher category room. Will the company bear the total cost of claim?

    Answer:  Yes, customer can get into higher room but Co-payment for treatment in Higher room category will be applicable.

  • Q: In case of day care procedure what if doctor suggested to stay for more than a day or two. So will we consider that claim?

    Answer:  It will be decided case to case basis after checking whether need for further hospitalization is justified or not.

  • Q: Customer has Activ health plan without maternity cover and there is any complications during pregnancy, will that be covered in policy? Eg: Cutting the tube Pullipian tube Ectopic pregnancy surgery?

    Answer:  Any complication related to pregnancy will not be covered under policy however Ectopic pregnancy will be covered.

  • Q: For claim cases in non-network, we need to intimate within 48hours but customer may be unconscious and family may not know about any insurance policy. So in this case how do we tackle?

    Answer:  If the claim is not notified to Us, then We shall be provided the reasons for the delay in writing. We will condone such delay on merits where the delay has been proved to be for reasons beyond the claimant’s control.

  • Q: Why any hospital charges different packages to different insurance co. Eg Jupiter hospital charges 1.49 lac for ICICI, 1.25 lac for New India and 1.40 lac for Max Bupa for once particular treatment why such differentiation?

    Answer:  Every insurance company have their negotiated rates with hospital which they agreed upon.

  • Q: What is the TAT for Pre-auth?

    Answer:  2 hours.

  • Q: Would Physiotherapy be covered in post hospitalization if client gets admitted for “Chikangunya”. If yes then any limitation as to number of days or amount?

    Answer:  Yes, if prescribed & required, number of days as specified in policy.

  • Q: Would Physiotherapy be covered in post hospitalization if client gets admitted for “Chikangunya”. If yes then any limitation as to number of days or amount?

    Answer:  Yes, if prescribed & required, number of days as specified in policy.

  • Q: If a customer is doing cycling in his daily activity and met with in an accident while cycling do we cover him for the same in our policy

    Answer:  Yes, same will be covered.

  • Q: Will we pay claim for abdomen endoscopy?

    Answer:  Diagnostic endoscopy treatment will not be covered under policy however endoscopy along with treatment procedure (for e.g. biopsy) done will be covered in case of hospitalization subject to admissibility of claim.

  • Q: How does our 'Reload' feature works plz revert along with two examples.

    Answer:  Eg 1 : Mr. A has a policy of Rs. 10 lac SI and he gets hospitalized due to a road traffic accident. The bill comes to Rs 15 lac. The reload feature does not apply to first claim in a policy year, EXCEPT in case of a road traffic accident. Therefore, in this case, Rs 10 lac will paid from SI & the rest 5 lac will be paid from Reloading of SI. Eg 2: Mr. A has a policy of 10 lac SI. He gets hospitalized due to a heart-related ailment and his total claim is for Rs 9 lac, which is paid from his SI. In the same year, he gets hospitalized again for the heart-related ailment, for which his bills come to Rs 5 lacs. His remaining SI of 1 Lac is insufficeint to cover the claim. However, Reload will NOT apply, because, both the claim are for the same illness. Reload does not apply for same person, same illness during a policy year.

  • Q: Can we get some scenarios where reload is applicable and where it is not applicable?

    Answer:  Eg 1 : Mr. A has a policy of Rs. 10 lac SI and he gets hospitalized due to a road traffic accident. The bill comes to Rs 15 lac. The reload feature does not apply to first claim in a policy year, EXCEPT in case of a road traffic accident. Therefore, in this case, Rs 10 lac will paid from SI & the rest 5 lac will be paid from Reloading of SI. Eg 2: Mr. A has a policy of 10 lac SI. He gets hospitalized due to a heart-related ailment and his total claim is for Rs 9 lac, which is paid from his SI. In the same year, he gets hospitalized again for the heart-related ailment, for which his bills come to Rs 5 lacs. His remaining SI of 1 Lac is insufficeint to cover the claim. However, Reload will NOT apply, because, both the claim are for the same illness. Reload does not apply for same person, same illness during a policy year.

  • Q: Reloaded SI shall not apply to the first claim (except in case of an accident). Will it be applied from second claim onwards? For example, a customer has 5L. He made a claim of Rs.3L for accident. After a few months, he has to undergo By-Pass which costs him 4L. Can he now claim 2L from the base SI and 2L from the reloaded SI?

    Answer:  Yes, reloaded SI shall not apply to the first claim (except in case of an road accident) and from second claim onwards it will apply.

  • Q: In organ donor benefit is reload applicable

    Answer:  The receiver i.e. the Insured person can use the ‘reloaded sum insured’ for claim as it’s an In-patient claim, but we will not pay for the organ donors expenses from reloaded Sum Insured.

  • Q: If the client is admitted for heart attack for 1st claim (SI 10 lacs) the bill is 6lacs now for the 2nd claim is for organ transplant 7 lacs needed including organ donor expenses 3 lacs will reload apply?

    Answer:  In this case reload will not apply.

  • Q: Customer purchased policy on 1st Jan for 10 lac SI he had a 1st Claim in Apr month for heart attack (8lac) , 2nd claim in July for brain haemorrhage (3lac) now 3rd claim in sept for heart attack will my reload get trigger?

    Answer:  In this scenario, this person will not be able to use the reloaded SI as it is for the same/related illness.

  • Q: Is there any list of 527 day care procedures that are covered.

    Answer:  It's there in policy terms & condition annexure

  • Q: Can we cover Physiotherapy in day care procedure?

    Answer:  Physiotherapy is a supportive procedure which is performed after the discharge. So if the treating doctor suggest to perform that proceedure then it will be consider under post hospitalisation no matter whether actual surgery is performed under IPD or day care procedure.

  • Q: Do we cover pre and post hospitalization in organ donar?

    Answer:  Not covered.

  • Q: In Day care reload will trigger?

    Answer:  Yes.

  • Q: It's mentioned in Policy wordings domiciliary cover will not covered for diabetic mellitus

    Answer:  Yes, it will not be covered.

  • Q: Health check-up reports where he can see?

    Answer:  Vendor system will automatically send the reports to client’s registered Email ID, after 7 days of medicals.

  • Q: For free health check-ups, in the policy wordings it is mentioned “Network Providers”. When the customer is calling up the customer care number to fix an appointment, they are been provided with the list of diagnostic centres where they can go for the test. What if the customer wants to go to one of our network hospitals to carry out the same, will the free health check-up still be done?

    Answer:  The Annual Health Check up will be done with our empanelled Diagnostic centres only and not in the network Hospitals.

  • Q: Who all are eligible for annual health check up?

    Answer:  Each insured person above the age of 18yrs is eligible.

  • Q: Do we have any specific list of countries in where we provide medical assistance under worldwide emergency assistance.

    Answer:  Our partner Assist America Provides services globally (worldwide) and do not have any such country where they don’t give the services. So no geographical exclusions. Hence all the countries are covered for providing our medical  emergency assistance.

  • Q: In medical emergency for evacuation, do we contact Assist America directly or call our customer care and if we use the evacuation facility, does it eat our SI?

    Answer:  We need to call our customer care number (18001031033) an they will do warm transfer to Assist America and evacuation facility it will not take away our SI it is over and above on SI.

  • Q: If insured has only his reload amount left, can he avail the free service for worldwide emergency assistance if required?

    Answer:  This is a service feature provided by a third party and is not related to Sum Insured.

  • Q: In worldwide emergency assistance service, what happens when insured is travelling for more than 90 days, is he/she not eligible for this service?

    Answer:  As per T&C Trips exceeding 90 days from residential address without prior notification to Us are excluded. Therefore for a trip more than 90 days an intimation should be made to Us for acceptability.

  • Q: In worldwide emergency assistance service, the condition of period of less than 90 days would be in one travel or throughout the year?

    Answer:  One travel.

  • Q: What is the customer care email id?

    Answer:  customercare.abh@adityabirla.com

Disclaimer

This Group Health Insurance policy is underwritten by Aditya Birla Health Insurance Company Limited (ABHIC) (Insurer registered with IRDAI through license no. 153). Vesaan Technologies Pvt. Ltd (Medikoe.com) is a Master Policy Holder (Master policy no. 61-17-00003-00-00 dated 02/08/2017) providing add on service of group health insurance policy to its registered customers only and collecting premium on their behalf. All Claims under the policy will be solely decided upon by ABHIC subject to terms and conditions of the policy.