Aslamah Rahman recently spoke to Chairman of Council of Wardens (CCW), Prof.K. Sethupathi, about the revised health insurance framework. In this article, she details the procedure for claiming health insurance, and all conditions that are applicable to the circumstances of the claim.
Every year, students of IIT Madras pay an amount of Rs 967/- as premium for the Student Medical Insurance, to cover up for any medical expenses that they might incur during their stay in the campus. Usually, the institute hospital takes care of all the medical diagnosis, treatment and cost of prescription of students. But this is often inadequate in the case of a more serious health problem, when the need of hospitalization outside the campus may arise. With a focus on well-being of the students, CCW has introduced a revised health insurance scheme in collaboration with United India Insurance Company Ltd. and Vidal Health TPA (P) Ltd., to cover medical expenses in such a case.
According to the revised framework, from the academic year 2015-2016 on wards, all registered students of IIT Madras will be eligible for the Student Medical Insurance, abbreviated as SMI. The scheme was initiated in 2005, with a maximum reimbursement amount of Rs. 50,000/- allotted to each student per annum for hospitalization expenses. This year on wards, the amount has been expanded to Rs. 75,000/- per student, and will be available only if the student receives treatment in select hospitals listed by Vidal Health TPA ( please refer to this link for more information ). The list is exhaustive and covers most hospitals in and around Chennai.
SMI will be available to students under two circumstances – Cashless treatment or Cash reimbursement after the treatment.
Ⅰ. Cashless treatment:
For availing cashless treatment, the procedure will be as follows:
1. The student must inform the Hostel Office / Warden about their hospitalization.
2. The student should be present with the institute ID card and E-Card issued by the insurance company for proof at the respective hospital’s Insurance Section.
Once the records presented by the student are verified by the hospital authorities, all medical expenses, within the stipulated amount of Rs. 75,000/- incurred as a part of their hospitalization will be taken care of by the insurance company. The reimbursement amount will include the medical expenses and the room/ ICU charges.
Conditions applicable:
The following conditions will be applicable on this procedure:
a) Students should note that apart from the upper limit on the insurance amount offered, the insurance scheme will also be subjected to one more condition: the in-patient room rent should not exceed 2% of the insurance amount ( Rs 1500/- per day ) for a normal room and 3% of it ( Rs. 2250/- per day ) for admittance in ICU. The insurance will only cover up for the medical expenses which comes under this criterion.
b) In case if the hospital expenses exceed the insurance amount of Rs, 75,000/-, the additional expenses will have to be paid by the student, However, there will be an opportunity for the student to apply for a Buffer Amount Sanction. This will only be applicable in critical cases, and the student will be eligible for it only on the approval of the Chief Medical Officer of IITM Hospital. Also, the buffer amount sanctioned will be exactly equal to the the additional expenses.
Ⅱ. Cash Reimbursement:
In the second case of cash reimbursement, students can avail treatment at registered hospitals, and be eligible for a reimbursement after that. The procedure for the same will be as follows:
1. The claim form should be downloaded from the website of Vidal Health TPA ( click here ) or can be collected from the Hostel Management Office (Room no, 201, CCW Office )
2. The duly filled claim form, signed by the student and endorsed by the treated / admitted hospital(s) doctors should be submitted at the CCW Office and the Hostel Management Office. The students should also submit the following records: hospital consolidated bill, hospital break up bill, hospital payment receipts, discharge summary, pharmacy bill, doctor’s request for investigation and all original investigation reports. If availed, operation theatre notes, ECG report and all other documents related to hospitalization must also be submitted.
Students must keep in mind that the claim process will take a minimum time period of one month for settlement.
Conditions applicable:
This mode of reimbursement will also be subject to two extra conditions:
a) The hospital in which the student was admitted or received treatment must have a minimum of 15 beds. This will be taken care of if the student chooses a hospital from the list specified by Vidal Health TPA.
b) The minimum time period of hospitalization should be 24 hours.
In case of further queries, students can contact the below set of people:
| United India Insurance Company Limited | Vidal Health TPA (P) LTD (Vidal is a Third Party Assistant between United India Insurance and IIT Madras) |
Office of Hostel Management (OHM), IIT Madras |
|---|---|---|
| Ms. E. Deepa (Asst. Manager) Phone: 9790781392 Email: [email protected] |
Ms. A. Vasanthi (Corporate Executive) Phone: 8939862581 Email: [email protected] |
Mr. R. Narayanamurthy (SMI Office, Room No. 201, OHM), IIT Madras Phone: 9940224304, 9176978382 Email: [email protected] |
| Ms. Pushpalatha Natarajan (Senior Divisional Manager) Phone: 9444282803 Email: [email protected] |
Ms. L. Karthika (Assistant Manager) Phone: 9884094544 Email: [email protected] |
Mr. V. Perumal AR (Students), IIT Madras Phone: 9444008055 Email: [email protected] |
