7- Family Floater Coverage - Parivar Mediclaim (National Insurance Prospectus) |
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Source: Website of National Insurance Company Limited |
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11. |
Contribution Clause: |
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If the proposer is having more than one health insurance policies he should mention it to the underwriter so that there is a reference of the additional policy No. on both policies and that in case of a claim, underwriters will ensure that both the policies would contribute proportionately. |
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Procedure for availing Cashless Access Services in Network Hospital / Nursing Home. |
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Claims in respect of Cashless Access Services will be through the list of the network of Hospitals/Nursing Homes and is subject to pre admission authorization. The TPA shall, upon getting the related medical information from the insured persons/ network provider, verify that the person is eligible to claim under the policy and after satisfying itself will issue a pre-authorisation letter/ guarantee of payment letter to the Hospital/Nursing Home mentioning the sum guaranteed as payable, also the ailment for which the person is seeking to be admitted as a patient. |
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The TPA reserves the right to deny pre-authorisation in case the insured person is unable to provide the relevant medical details as required by the TPA. The TPA will make it clear to the insured person that denial of Cashless Access is in no way construed to be denial of treatment. The insured person may obtain the treatment as per his/her treating doctor’s advice and later on submit the full claim papers to the TPA for reimbursement subject to admissibility of claim as per terms and conditions of policy. |
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The TPA may repudiate the claim, giving reasons, if not covered under the terms of the policy. The insured person shall have right of appeal to the insurance company if he/she feels that the claim is payable. The insurance company’s decision in this regard will be final and binding on TPA. |
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The prospectus shall form part of your proposal form hence please sign as you have noted the contents of this prospectus |
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Signature of the Proposer: |
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Name: |
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Place & Date: |