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Name of the Organization : Vidal Health TPA Pvt Ltd (vidalhealthtpa.com)
Type of Facility : How to Get TTK Health Card & Check Status Online?
Location : Bangalore

Website : http://www.vidalhealthtpa.com/home/

TTK Health Card :
Vidal Health TPA Pvt. Ltd. is an ISO 9001–2008 certified Third Party Administrator (TPA) services company. Vidal Health TPA Pvt. Ltd. manages a wide network of Healthcare Service providers comprising of multi-specialty hospitals, nursing homes and diagnostic centers across the country. Our services include cashless hospitalization at our Network hospitals and nursing homes and speedy & direct settlement in case of reimbursement claims. Customers are supported aptly with a comprehensive claim management service. We have a Customer Care Centre to assist customers with their queries round the clock. All these services are pivoted around a unique Health Card which enables the customer to avail the health insurance benefits at our wide network of empanelled service provider network.

Cashless Hospitalisation :
** Health Insurance earlier entailed the complete settlement of the health care services bill by the individual to the hospital, followed by a reimbursement claim filed with the Insurance Company. The Insurance Regulatory Development Authority in India initiated the Cashless Hospitalization Process through Third Party Administration services for Health Insurance claims from 2002.
** Once you are covered under a Health Insurance Policy administered by us, you will be issued a Vidal Health TPA ID card. If your health insurance cover is issued through your employer, you may not be issued a physical ID card but you may have a E-card. This card will facilitate you to avail CASHLESS facility at the Networked Hospitals.
** Cashless hospitalization can be availed only at our network hospitals. The essence of cashless hospitalization is that the insured individual need not make an upfront payment to the hospital at the time of admission.
** Cashless is only a facility extended by the Third Party Administrators to the Insured persons through their Network of Hospitals who have agreed to certain terms and conditions.
** Cashless cannot be claimed as a matter of right and denial of a pre-authorization request is in no way to be construed as denial of treatment or denial of coverage or denial of your right to prefer reimbursement claim. You can go ahead with the treatment, settle the hospital bills and submit the claim for a possible reimbursement.
** If the policy covering you is subject to the GIPSA PPN arrangement, please check for the nearest hospital that is in the GIPSA PPN Package Agreement. Cashless facility for such policies will be available only in those hospitals who are under the GIPSA PPN Arrangement.

Process for availing Cashless Hospitalisation Facility :
** Plan admissions only in such hospitals that are in our Network. If your policy is subject to GIPSA PPN Network, please get admitted only in such hospital that is in the GIPSA PPN Network. Your admission elsewhere will lead to denial of the cashless facility and even reimbursement of the expenses will be subject to the limits as per the GIPSA PPN Tariff.
** Produce the ID Card issued by us at the Hospital Help Desk – along with any other ID Proof like DL/ Voter’s ID/ Passport etc in respect of THE PATIENT.
** Obtain the Pre-authorisation Form from the Hospital Help Desk, complete the Patient Information and resubmit to the Hospital Help Desk.
** Please indicate our ID Card Number without fail. In case the policy is taken by your employer you may also furnish the Employee Number.
** The Treating Doctor will complete the hospitalisation/ treatment information and the hospital will fill up expected cost of treatment.
** This form is submitted to us either online or by fax.
** We will process the request and call for additional documents/ clarifications if the information furnished is inadequate.
** Once all the details are furnished, we will process the request as per the terms and conditions as well as the exclusions therein and either approve or reject the request based on the merits of the case.

Important:
1.Once the request is received, it is processed. Our medical team will determine whether the condition requires admission and the treatment plan is covered by your Health Insurance Policy. They will also check with all the other terms and conditions of your Insurance Policy.
2.In case coverage is available, we will issue an approval to the hospital for a specified amount depending on the disease, treatment, sum insured available etc. We will send the Approval Letter for Cashless Facility by fax and e-mail (if available) to the Hospital. This approval is called “Pre-authorisation”. This pre-authorisation entitles you to avail the treatment at the hospital without paying for the medical expenses up to the authorised limit.
3.At the time of discharge, in case the amount authorized by us is not sufficient to cover the hospitalization expenses, the hospital will make a second/ final request on your behalf for sanction of additional amount. We will process this request and sanction of an additional amount will be made subject to terms and conditions of your health insurance policy.
4.Your policy may be subject to ‘Co-pay’. This is the compulsory amount that you need to bear in respect of each and every hospitalisation claim. Please check for this information. You are required to pay to the hospital the amount equal to the co-pay and obtain the necessary Bill & receipt. The hospital has to submit the proof for having collected this amount from you. If the hospital is not able to produce the requisite proof in respect of collection of co-pay from you, twice the amount of co-pay will be deducted as a penalty from the amount payable to the hospital.
5.Please verify your policy benefits to check your eligibility for Room Charges etc. An admission to a ward higher than your entitlement would cost your claim as the amount payable will be reduced in proportion the eligible ward charges bear to the higher ward charges billed.
6.Once final sanction has been received by the hospital, please make sure that you check and sign the original bills and Discharge Summary. Please carry home a copy of the signed bill and the Discharge Summary and all your investigation reports. This is for your reference and will also be useful during your future healthcare needs.
7.The hospital will ask you to pay for all the Non-admissible Expenses in your bill. You have to make this payment before discharge. You may check for the items disallowed against the Annexure IV of the ‘Standard List of Excluded Expenses in Hospitalization Indemnity policies’ of Exposure Draft – Health Insurance’ by IRDA in the website.
8.In case, for whatever reason, the pre-authorisation request cannot be approved, a letter denying preauthorization will be sent to the hospital. We may deny the Pre-authorisation without assigning any reason. We may not be able issue Pre-authorisation probably due to insufficient information either from the service provider or the Insurer. In such case, you will have to settle the hospital bill in full by yourself.
9.Please note that denial of a Pre-authorization request is in no way to be construed as denial of treatment or denial of coverage. You can go ahead with the treatment, settle the hospital bills and submit the claim for a possible reimbursement.

Comprehensive Claim Management :
Reimbursement of the hospitalization expenses can be claimed where Cashless Hospitalisation facility is not availed or treatment is availed in a Non-network Hospital. You will have to settle the hospital bill, collect all original hospitalisation documents and submit the documents to our office for their scrutinizing the same in terms of the policy and check the admissibility or otherwise of the claim/ expenses.

Reimbursement claims may be filed in the following circumstances:
a. Hospitalization at a non-network hospital
b. Post-hospitalization and pre-hospitalization expenses
c. Denial of preauthorization on application for cashless facility at a network hospital

Reimbursement claims can be submitted to us through registered post / courier or can be handed over at any of our Branches.

One of the very basic requirements of insurance is ‘Claim Intimation’. It simply means intimating us or the Insurance Company about the hospitalisation. Some of the policies indicate a time frame of 24 hours or 7 days from the date of admission, most of the policies require that intimation has to be lodged immediately on admission. Non-compliance to this may make your claim inadmissible.

The documents that you need to submit for a hospitalization reimbursement claim are :
a. Original hospital final bill
b. Pre-Numbered / Printed Receipts for payments made to the hospital
c. Complete break-up of the hospital bill
d. Original Detailed Discharge Summary
e. All Investigation reports
f. All medicine bills with relevant prescriptions
g. Operation Theatre Notes in the event of a surgery performed
h. Sticker for the Implant, if any, used during surgery
i. A copy of the Invoice for the implant, if any, used during surgery performed
j. Original duly completed and signed claim form
k. Duly completed and signed Medical Practitioner’s Form
l. Copy of our ID card or current policy copy and previous years’ policy copies if any
m. Company Employee ID card if you and your family are insured through your employer
n. Documents for National Electronic Fund Transfer (NEFT)
i. NEFT Format giving details of the Bank Account where you need the claim amount to be transferred
ii. A copy of the page of the Bank Pass Book containing the Account Number & the Name/ Address of the Account Holder.
iii. A cancelled Cheque for the above Account in to which the claim amount has to be transferred
o. Covering letter stating your complete current address, contact address if available and the list of documents attached.

The documents that you need to submit for a Post-hospitalization or a Pre-hospitalization claim are :
a. Copy of the discharge summary of the corresponding hospitalization
b. All relevant doctors’ prescriptions for investigations and medication
c. All bills for investigations done with the respective reports
d. All bills for medicines supported by relevant prescriptions
e. NEFT Documents as above. (If you have furnished the NEFT Documents for the main hospitalisation claim earlier, you want the amount be transferred to the same Bank Account, Please furnish the Claim Particulars for us to pick up NEFT Details there from.)

Important:
** Once the reimbursement claim is received, it is processed. Our medical team will determine whether the condition requiring admission and the treatment are covered by your health insurance policy. They will also check with all the other terms and conditions of your insurance policy. All Non-admissible Expenses will be disallowed.
** The policies stipulate a period from the Date of Discharge within which the claim documents have to be submitted. Submission of claim papers after the stipulated period could lead to denial of the claim. Normally it is 7 days from the date of discharge for hospitalisation claim and for Post-hospitalisation it is 7 days from the date of completion of the post-hospitalisation treatment. Please check for the time frame for submission of the claim papers. In case the claim papers are submitted beyond 7 days from the date of discharge the claim is liable to be denied as per the policy terms. Hence, ensure compliance to the time frame without fail.
** Based on the processing of the claim, a denial or approval is executed. In case of approval, settlement is made by transferring the approved amount to your Bank Account. We will also send you the settlement particulars along with the computation sheet to the address mentioned in your health insurance policy. In case you have been insured through your Company, the cheque will be dispatched to the address based on instructions received from your company.
** In case we require additional documents we may send you a Shortfall Letter. Kindly comply with the requirements within the stipulated time. In case you do not submit the required documents within the stipulated time, after 2 reminders we will reject the claim and send the Denial Letter. Once the claim is denied as above, you will forfeit your right to the claim.
** In case your claim is denied, the denial letter is sent to you by courier / post quoting the reason for denial of your claim. In case you have been insured through your Company, the denial letter will be dispatched based on instructions received from your company.
** In the event you are aggrieved with the settlement or the denial of the claim, you may kindly represent your case to our Grievance Cell. You may also refer the matter to your Insurer’s Grievance Cell.
** If you are not satisfied with the redressal of your grievance either through our Grievance Cell or that of the Insurer, you may present your case before the Insurance Ombudsman.

Download Forms Here : http://www.vidalhealthtpa.com/home/Forms

Application Status :
You can login to your account in our web portal or you can call our call center to check the claim status.

Login Here : http://www.vidalhealthtpa.com/home/

Note :
You will be intimated on your claim status to your updated email id from our database.

Procedure to Download Vidal Health TPA card :
You can login to your account in Vidal Health TPA web portal and download E Card or call the call center and place the request.

Note :
The TTK Health card both Physical and E-cards will still be valid at all network hospitals for Cashless Hospitalization. All the hospitals are informed to accept TTK cards also.

Contact Us :
All the contact details have been updated in the website. Please note that our e-mail will now read name@vidalhealthtpa.com instead of name@ttkhealthcareservices.com