Frequently asked Questions
Q. What are the treatments that are covered under day care hospitalization?
A.
  •    Dialysis
  •    Chemotherapy, Radiotherapy
  •    Eye Surgery
  •    Lithotripsy (Kidney Stone removal)
  •    Tonsillectomy
  •    Any other procedure that can be done on day care basis due to advancement of medical technology (check with the TPA for the complete list)
Q. What do you mean by pre and post natal expenses?
A. Expenses arising before delivery are known as prenatal expenses and those arising after delivery are known as post natal expenses.
Q. Which are the other expenses that are excluded apart from those mentioned under general exclusion?
A.
  •   Registration Fees, File opening fees
  •   Telephone, Internet charges
  •   Food and refreshments supplied to visitors and attendants
  •   Television charges
  •   Any other expenses not related to treatment of illness
  •    Charges paid to organ donors
Q. If I have recently got married how do I get coverage for my spouse?
A. You would need to register your spouse. Coverage for that person becomes effective on the date of intimation.
Q. How do I get coverage for my new born child?
A. You would need to register your child. Coverage for the child becomes effective from day one.
Q. What is an ID card?
A. It is an identification card, which will entitle you to credit towards hospitalisation and any other negotiated benefits at hospitals on the panel of TPA on pre-authorization. These healthcare providers could be hospitals, nursing homes, diagnostic centers etc. Information on this is available with the TPA customer service. Please remember that the ID card is not a credit card. The card does not entitle you to credit towards out patient treatment. To avoid any misuse of your card, the hospitals may ask you to furnish some identification card (like Voter ID, Photo Credit card etc)
Q. How do I get an ID card?
A. You can download your e-card from paramount website (www.paramounttpa.com)
Q. What do I do if I lose my ID card?
A. In case you lose your ID card, please inform the HR immediately.
Q. Suppose the hospital does not accept my ID card?
A. Please call up the TPA helpline immediately for assistance. Also, note down the name of the staff-refusing acceptance of the ID card and revert back to the TPA as soon as possible.
Q. What are network hospitals?
A. These are hospitals where TPA has a tie up for the cashless hospitalization
Q. What should I do when I reach the hospital (NETWORK)?
A. Please show your ID card for identification. TPA will also send a letter of credit (on pre-authorization) to the hospital to make sure that they extend credit facility. You will not need to pay any cash except for non-medical expenditure as explained under the Benefits Manual. If the pre-authorization is not done, you must collect all reports and discharge card when you get discharged. Please make sure that you sign the hospital bill before leaving the hospital. You can then submit the claim along with all the necessary supporting documents to TPA.
Q. What if I go to a non- network hospital?
A. It is still advisable to fill the preauthorization form (use the copy attached with the Benefits Manual). Please fill the claim form, attach the relevant documents and send it to TPA office for reimbursement.
Q. What happens if I forget to bring my Medical Card at the network hospital?
A. If it is planned hospitalisation, show your letter or ID card to the hospital and call TPA helpline for assistance. If it is an emergency hospitalisation, please inform the hospital you are on the stated program and you will be required to make cash payment upfront at the panel clinic. You must submit the bills with the claim form attached with this manual.
Q. What are claim reimbursements?
A. In the event where cashless hospitalisation in not availed, you need to submit all the original bills along with the claim form to the insurance company/TPA within 7 days of discharge and the hospitalization expenses will be reimbursed to you.
Q. How can I claim my pre & post hospitalisation expenses?
A. The policy covers pre-hospitalisation expenses made prior to 30 days of hospitalization and incurred towards the same illness/ disease due to which hospitalization happens. It also covers all medical expenses for up to 60 days post discharge as advised by the Medical Practitioner. All the bills with summary have to be sent to TPA.
Q. Is pre authorization necessary?
A.
  •   Yes. This will help you in the following ways: You will be informed in advance regarding the coverage for your treatment so that your claim does not get rejected at a later stage and you do not end up paying out of pocket
  •   It will help you ensure that the treatment cost is appropriate and not inflated.
  •   This will also help TPA in planning your hospitalisation expenditure such that you do not run out of the cover that you are entitled to.
  •   It will help TPA in registering the impending claim with the insurer.
Q. Can I continue the insurance coverage if I resign from the company?
A. The insurance contract is arranged by your employer for the benefit of the employees. Employees who resigned will not be able to continue enjoying these benefits.
Q. What are incremental Charges?
A. A proportionate increase in procedural / treatment charges, if employees (inclusive of dependents) are opting for a room with higher Room rent than the maximum limit given above, he / she have to pay for the differentials in the Room rent and the differential in the Procedural & other related medical charges also.

Ex: - A patient gets admitted in Fortis Hospital, Noida for Lap- Cholecystectomy. Hospital having the categorization of their tariff schedules (Procedure Packages charges) based on the room category adopted by patient. In general ward the package charges would be Rs.35000/- if you will choose the twin sharing the cost will increase by 15%, if you will choose the single room cost will increase by 30%, Deluxe increase by 45-50%.

So, it is always advisable to select room category for treatment rather to go for luxury after all it directly effects to your SUM INSURED.

(Please refer to the list of Preferred Provider Network where we have did further negotiation and get more discounts) For any further questions, not covered here, you may contact PARAMOUNT HEALTH SERVICES PVT (TPA) LTD. for assistance.
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