Individual / Corporate Queries
What is the difference between GHPL and any Insurance company?
GHPL is a Third Party Administrator actively engaged in facilitating Health Care services to the medicliam policy holders of any insurance company. It facilitates better and cost effective medical care to the mediclaim policy holders through its wide spread Network of Hospitals, Cashless treatment at SMH, tariff negotiations with the hospitals, Medical opinion services, strict scrutiny of bills in claim processing and 24-hours support to the member.
Who can avail the facilities of GHPL?
The facilities provided by GHPL can be availed of by Individuals / corporate. For this the individual should have the medicalim policy of the Insurance Company who has empanelled GHPL to act as their TPA.
In case of Corporate, the corporate should have the Group Mediclaim policy of Insurance Company or should have some self funded corpus which can be managed by GHPL to provide cost-effective better medical care.
What are the services offered by GHPL?
GHPL offers the following basic services to individuals / Corporate:
- Network Hospital base of more than 1000 Hospitals spread throughout India
- Issuance of ID Cards to all members
- Assistance in selection of Hospital
- Cashless treatment at SMH
- Case management (at admission, Treatment and Discharge stages)
- Claim Management
- 24 Hours Helpline
GHPL offers the following additional services to the Corporate:
- Designing of new need based Health Plans
- Cost containment of Medical expenditure
- By Tariff negotiations with SMH
- Pre-Authorization of the Admission
- Document Verification
- Medical Scrutiny
- Medical & Physical audit
- Preventing Churning
- MIS for a better analysis & Review
- Personalized Client Services
- Organizing Health camps like Vaccination camps, Eye –checkup camps
- Dental checkup-camps etc
- Discounted General Health Checkups
- Organizing talks on preventive medicine
Where can be the treatment availed by the member?
The member can avail the treatment under the cashless Hospitalization facility at any of the GHPL ‘Select Member Hospital’. Location of the member does not act as a barrier for availing treatment.
The treatment can also be availed at any other hospital not in GHPL’s network. In such case the member needs to make the payment to the Hospital / Nursing Home directly and then apply for reimbursement to GHPL.
On being transferred to a different location, can a member still avail the services of GHPL?
GHPL has a strong network of Hospitals to facilitate its members. The SMH are widespread with country wide coverage. Therefore our facility can be availed of irrespective of your location (due to transfer or for any other reason) anywhere in India.
However our services cease to exist in case of expiry of the insurance term or in case the member leaves the company / corporate (in case of Group Insurance policy)
In case of Cashless Hospitalization facility, who will submit the bills and the claim form?
The SMH will directly submit the claim form (signed by the member) to GHPL along with all original bills and original reports. The payment on claim settlement will be released to the SMH directly.
The member should not ask for any original documents while discharge.
In case of Treatment in a Non-SMH, who will submit the bills and the claim form?
In this case the member will make the payment to the Hospital. Afterwards, the member will submit the claim form (signed by the member) to GHPL along with all original bills and original reports, for reimbursements. The payment on claim settlement will be released to the member.
The member should collect all original documents from the hospital on discharge.
What are the chances of Claim Rejection?
If the member utilizes the services of SMH for his treatment, the pre-Authorization letter issued by GHPL Medical team will take care that whether the ailment is covered under the terms and conditions of the package, the amount of treatment is within the available limit, any other exclusion specific to that particular policy and so their will be no chances of rejection.
Denial of Authorization letter by GHPL medical team will mean, that the treatment is not covered under the policy and so the charges of treatment has to be collected from the member/patient directly.
However even if the facilities are availed outside the network and then bills are submitted for reimbursement, the same will be subjected to the same check as in case Pre-Authorized cases. Only Eligible amount will be reimbursed.
Therefore it’s always advisable to approach a SMH for treatment.
What are the documents that need to accompany the claim form for reimbursement?
- Copy of GHPL member ID Card
- Copy of Pre-Authorization Letter ( if any)
- Original Detailed Discharge Summary
- Original Consolidated bill along with all bill-breakup’s
- Original investigation requests and reports
- Original Prescriptions and Pharmacy bills
- OT Bills with Breakup
The member should retain a copy of all these documents and original should be submitted to GHPL.
What is the procedure to be followed in case of emergencies?
Please refer member guide book for details.