What is Mediclaim?
Mediclaim is a health insurance to cover hospitalization expenses of an individual. A health insurance policy is a contract between an insurance company and an individual / group in which the insurance company agrees to provide health insurance cover at a premium pre fixed by the insurance company on the basis of the age and medical conditions of the client. The policy is for a period of one year and can be renewed every year after paying the premium. The Insurance company offers cashless as well reimbursement facilities through a Third Party Administrator. A health insurance policy can be taken by an individual for himself and his family. A corporate can also take a group policy for its employees and their family.
What do you mean by floater policy? How does it work?
Floater is a privilege offered to the client only in case he opts for "Group Mediclaim Policy". Unlike the individual policy, where a family (Husband / Wife / children) is covered for the Sum Assured so desired, independent of each other, and pays the premium accordingly, in a Floater - a float amount is shared by the family members Or by the employee families.
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What is a Third Party Administrator (TPA)?
A THIRD PARTY ADMINISTRATOR (TPA) means any Company who has obtained license from IRDA to practice as a third party administrator and is appointed by the Insurance Company for the purpose of servicing their health insurance policies.
What do you mean by Inpatient hospitalization and Daycare hospitalization?
Inpatient hospitalization is the event of hospitalization for treatment where patient stay in the hospital for minimum 24 hrs. Daycare hospitalization is the event of hospitalization for treatment where patient stay is less than 24 hrs.
Note: Policy will not cover the hospitalization of less than 24 hrs, except for daycare diseases as mentioned in policy daycare list
What do you mean by Network / Non-network Hospitalization?
A Hospital, which has an agreement with TPA for providing Cashless treatment, is referred to as a 'Network Hospital'. List of network hospital is available in user guide / TPA website. Cashless facility is provided ONLY at the network hospitals. Non-network hospitals are those who are not empanelled by the TPA and any policyholder seeking treatment in these hospitals will have to pay for the treatment and later claim as per normal procedure.
What is Domiciliary Hospitalization?
Medical treatment exceeding a defined period for such illnesses / diseases / injury which in the normal course would require care and treatment at a hospital/nursing home but actually taken whilst confined at home in India under any of the following circumstances :
The condition of the patient is such that he / she cannot be removed to the hospital / nursing home or
The patient cannot be removed to hospital / nursing home for lack of accommodation therein
This hospitalization will however not cover pre and post hospitalization and treatment for conditions excluded in the policy. For details refer the policy documents.
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What is a Health / Identity Card?
Identity card means the card issued to the Insured Person by the TPA to avail Cashless facility in the Network Hospital. The card may be a Photo identity card or a non photo identity card. It is mandatory for the insured to carry an identity card for the purpose of admission into the hospital.
What are Pre and Post hospitalization expenses?
PRE-HOSPITALIZATION: Relevant medical expenses incurred during the defined period prior to hospitalization on disease / illness / injury sustained will be payable.
POST-HOSPITALIZATION: Relevant medical expenses incurred during the defined after hospitalization on disease / illness / injury sustained will be payable.
Note: Pre & Post Hospitalization expenses are payable only when the main hospitalization claim is admissible.
What is Cashless access?
In the cashless access, TPA will authorize the hospital for the treatment of Insured. The payment shall be made directly by the TPA to the hospital for the amount sanctioned/authorized (subject to Policy Terms, exclusions and Conditions).
How does Cashless access work?
Each person covered under the Policy will be issued a Health / identity card. Whenever there is a need for hospitalization the policyholder should obtain an Authorization Letter from TPA. The authorization letter will indicate the name of the insured/patient, the name of the hospital where treatment is required, the nature of illness / disease for which treatment is required and the monetary limit above which the insured / patient will have to pay. The policyholder will have to submit this authorization letter along with the identity card given by TPA to the admission counter in the hospital.
How does one obtain the Authorization letter?
The policyholder is required to fill the request for pre- authorization letter and send through fax/other means to the nearest TPA office mentioned in the user Guide or TPA web site. TPA will scrutinize the request for authorization letter and send an authorization letter or regret letter. Request for pre-authorization letter are available with TPA office or can be downloaded from TPA website.
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Can a request for Authorization for cashless be declined?
Yes, a request for authorization for cash less access may be declined if,
Inadequate / vague / wrong information is provided and the TPA is unable to get access to additional information.
The ailment / disease for which hospitalization is required is not covered by insurance.
The person does not have adequate insured amount left to cover the hospitalization costs.
This only means that cashless access is declined, AND IS IN NO WAY TO BE CONSTRUED AS DENIAL OF TREATMENT. The policyholder must obtain the treatment as per his/ her treating doctor’s advice.
The denial of pre-authorization letter shall not be construed to mean that the policyholder cannot claim under the terms, exclusions and conditions of the policy. In such cases you are advised to file your claim for reimbursement and TPA will settle the claim as per your policy terms and conditions.
How does hospitalization for Planned Hospitalization work?
The request for Authorization (Pre- Authorization) for planned treatment has to be filled up. This form has to be filled up by the Doctor recommending Hospitalization. The form must be filled fully in Block letters indicating the Doctors Name, Registration Number and Telephone Phone number. Should TPA Medical Officer need any clarification he may contact your doctor before he initiates action on your request.
This request must reach TPA office before hospitalization.
Any change in the date of hospitalization, Hospital, nature of illness or surgeon who is going to perform the procedure will make the authorization invalid. A fresh authorization will have to be taken.
The authorization is valid only for Network Hospitals.
The authorization will be addressed to the hospital and sent to the patients address or faxed to the hospital as desired by the policyholder.
A claim form must be collected from the nearest TPA / Insurance office or you could download the same from the site.
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What are the points one must note while getting hospitalized under cashless access scheme?
In order to secure admission on the appointed day, you are advised to register your name with the hospital well in advance.
Contact the admission desk of the Hospital / TPA Branch office
Show your TPA identity card and the Authorization letter given by TPA. The hospital will check the ID card and authorization letter.
Some network Hospitals may charge you registration fees / admission fees etc. These will have to be paid by the policyholder as these are not reimbursable under the policy.
In case the amount authorized by the TPA is less than the hospital estimate amount, you need to get hospitalized and submit final bill to TPA from hospital for enhancement of the authorization amount. Further TPA will discuss with Hospital.
How does Emergency Hospitalization under cashless access scheme work?
The policyholder is advised to get admitted immediately.
In case of admission to a Network Hospital the hospital will admit the patient as per the procedure of the hospital.
The hospitals will then contact TPA and send a request for authorization. At times the policyholder relative may be required to contact TPA for clarification.
The policyholder / relative must send the pre-authorization request completely filled. TPA will revert on receipt of the request.
If the authorization is given, the policyholder may
Pay for the non-medical expenses before leaving the hospital (non payable expenses- refer the policy documents)
Sign on relevant documents which will be sent to TPA by the hospital
In case cashless access is declined, this is in no way to be construed to be denial of treatment the policyholder must obtain the treatment as per his/ her treating doctor’s advice. The denial of pre-authorization letter shall not be construed to mean that the policyholder cannot claim under the terms and conditions of the policy from TPA.
In such cases you are advised to file your claim for reimbursement and TPA will settle the claim as per your policy terms and conditions.
In case the policyholder gets admitted to a non-network hospital then the hospitalization bills will be reimbursed subject to Terms, exclusions, Conditions and limitations of your Policy.
How does Billing and discharge under cashless access scheme work?
Sign the final bill and check the bill for correctness. TPA reserves its right of recovery of any amount due to it from the insured person for billed services, which are not covered by the policy.
Ensure that all supporting documents are attached to the bill.
You must pay all bills not associated with the condition for which hospitalization was authorized and the amounts in excess of the approved limit.
Retain a copy of the final bill and discharge summary.
Sign a claim form filled in all respects and give it to the hospital along with other authorization letter given by TPA before discharge.
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How does one get Reimbursement for pre and post hospitalization expenses under this scheme?
The Mediclaim Policy allows reimbursement of medical expenses incurred towards the ailment / disease for which hospitalization was necessitated prior to hospitalization and up to a certain number of days after discharge.
This is subject to the limits as described in the policy. The medical expenses incurred prior to Hospitalization are called pre- hospitalization expenses and those incurred subsequent to discharge as post Hospitalization expenses.
Send all bills in original with supporting documents along with a copy of the discharge summary and a copy of the authorization letter to the nearest TPA Office. TPA will scrutinize the claim and settle the bills subject to the overall limit of the policy, provided the main hospitalization claim is admissible. The bills must be sent to TPA within the defined period from the date of completion of treatment.
How does one get Reimbursements in case of treatment in non- network hospitals?
Cashless Hospitalization is available only in Network Hospitals. While it's recommended that you choose a network hospital you are at liberty to choose a non-network hospital also. In case you avail of treatment in a Non Network hospital, TPA will reimburse you the eligible amount of bills subject to the policy taken by the policyholder and claim being admissible.
The Policy Holders attention is drawn to the definition of Hospital in the Mediclaim policy. TPA should be contacted within few days from the time of admission with details of TPA card number, nature of illness, name & address of the Hospital/ Nursing Home/ Clinic, attending Doctor, Bed Number etc. The claim form can be collected from the nearest branch of the Insurance company / TPA office / TPA website. This claim form must be filled fully and sent to the nearest TPA office along with the following documents in original.
Claim Form properly filled in and signed by the claimant. Claim form is available at any of the DHS branches and also can be downloaded (see Download Forms)
Original Discharge Card / Summary from the hospital / nursing home.
Doctor's consultation reports / history.
Hospitalization and other medical Bills, Receipts in original.
Cash Memos from hospital / pharmacies supported by proper prescription.
Diagnostic test reports supported by a note from the attending medical practitioner / surgeon justifying such diagnostics. Surgeon's certificate stating the nature of the operation performed and surgeon's bill and receipt.
Note: Only expenses relating to hospitalization will be reimbursed as per the policy taken. All non-medical expenses will not be reimbursed.
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Can I claim for maternity event?
Individual Mediclaim policy does not cover maternity & related events. Maternity benefits are covered under the Group Mediclaim policy, subject to the payment of additional premium.
What is the maternity coverage limit?
If maternity cover is opted by group, sum insured sublimit for maternity and related events per policy year will be as per policy terms.
Which events are covered under maternity benefit?
Maternity coverage will cover Hospitalization expenses towards delivery (normal / operative) and hospitalization expenses towards complications of maternity during the antenatal & postnatal period. Antenatal and postnatal outpatient expenses are not covered under maternity benefit coverage, unless mentioned in the policy.
What do you mean by the term “MLC Copy”?
MLC Copy, a Medico – Legal certificate is the certificate signed by the policeman and issued by the hospital for medico legal cases (cases where police need to be kept informed). On admission to the hospital, hospital medical staff will identify the cause or nature of illness / disease / accident and if required will inform the police about the case. Policeman will visit the hospital to enquire the cause and sign the MLC Copy.
Tuesday, November 03, 2009
Ford posts surprise profit, sees profit in 2011
DETROIT (Reuters) - Ford Motor Co posted a $1 billion quarterly profit on Monday, defying Wall Street forecasts of a loss, as it cut costs and gained market share, leading it to raise its 2011 outlook to "solidly profitable" from break-even.
Ford's shares surged 8 percent as the surprising profit and increased outlook overshadowed news that the United Auto Workers union rejected a tentative cost-cutting deal with the automaker that would have brought its labor costs in line with U.S. rivals.
The only large U.S. automaker not to file for bankruptcy in 2009, Ford also said later on Monday it is seeking to extend its revolving credit facility from 2011 to 2013 and raise another $3 billion of capital through convertible debt and equity offerings.
The quarterly results provided more evidence that Ford has distanced itself from U.S. rivals General Motors Co and Chrysler, which have struggled to complete restructurings after emerging from government-funded bankruptcies earlier in 2009.
Ford seized North American market share from GM and Chrysler when they halted most production to prepare and execute their bankruptcy cases.
"We're creating a very strong business and we are not taking taxpayer money," Mulally said on a conference call with analysts. "So the advantages clearly outweigh any potential disadvantage."
Ford reported $1.3 billion of positive cash flow in the third quarter, its first positive quarter since the second quarter of 2007, and forecast positive cash flow in the fourth quarter. It burned through $4.7 billion of cash in the first half of 2009.
The company also reported its first quarterly operating profit in North America since the first quarter of 2005.
Ford said it was confident the global economy would be improving by 2011, but it added the near-term growth outlook "remains rather uncertain."
Some analysts believe Ford will be profitable in 2010.
"As the market starts to turn and sales volumes start to recover, Ford should be solidly in the black next year, certainly ahead of schedule," Autoconomy.com analyst Erich Merkle said.
CREDIT ARM'S PROFIT MORE THAN QUADRUPLED
Ford reported a net profit of $997 million, or 29 cents per share, for the third quarter, compared with a net loss of $161 million, or a 7 cents per share, a year earlier. Revenue fell $800 million to $30.9 billion.
Operating profit was 26 cents per share excluding one-time items. On that basis, analysts on average expected a loss of 12 cents per share, according to Thomson Reuters I/B/E/S.
The automaker's results were boosted by Ford Motor Credit Co, which reported that profits rose to $427 million in the third quarter from $95 million a year earlier.
From its automotive business, Ford reported a $446 million pretax operating profit worldwide, including positive results in all four of its regions.
Mulally said he was "cautiously optimistic" and some financial market indicators were returning to levels seen before the Lehman Brothers collapse in September 2008, but consumer confidence and high unemployment remain a drag on the U.S. and UK economies.
"We're just not sure about the strength of the recovery," Mulally said.
Ford posted losses totaling $30 billion from 2006 through 2008 and remains saddled with a much heavier debt load than GM or Chrysler following their bankruptcy reorganizations.
Ford and other automakers are fighting through a plunge in auto sales in North America due to the recession. The company left its 2010 U.S. auto industry sales forecast at 12.5 million vehicles, including medium and heavy trucks, but said it would give an updated outlook early next year.
Until a U.S. economic recovery takes off, cash will remain king for Ford, which borrowed more than $23 billion in late 2006 to finance its turnaround and believes it has enough money to complete its restructuring.
The automaker received $500 million of annual labor cost savings from concessions negotiated with the UAW in February, but said it needed more cuts to align long-term costs with those of GM and Chrysler.
Analysts said the relative health of Ford compared with GM and Chrysler was a key factor in the rejection.
"The positive quarterly results released by Ford this morning are further evidence of the contributions that Ford workers have made," UAW President Ron Gettelfinger said, announcing the rejection of the proposed concessions.
Ford and UAW leaders reached the agreement in mid October, but the vote among some 41,000 Ford UAW workers met stiff opposition over a "no-strike" clause on wages and benefits.
Ford's union workers in Canada ratified a cost-cutting deal over the weekend to preserve most of the Ford jobs in Canada.
Ford shares ended up 58 cents, or 8.3 percent, at $7.58 on the New York Stock Exchange.
Ford's shares surged 8 percent as the surprising profit and increased outlook overshadowed news that the United Auto Workers union rejected a tentative cost-cutting deal with the automaker that would have brought its labor costs in line with U.S. rivals.
The only large U.S. automaker not to file for bankruptcy in 2009, Ford also said later on Monday it is seeking to extend its revolving credit facility from 2011 to 2013 and raise another $3 billion of capital through convertible debt and equity offerings.
The quarterly results provided more evidence that Ford has distanced itself from U.S. rivals General Motors Co and Chrysler, which have struggled to complete restructurings after emerging from government-funded bankruptcies earlier in 2009.
Ford seized North American market share from GM and Chrysler when they halted most production to prepare and execute their bankruptcy cases.
"We're creating a very strong business and we are not taking taxpayer money," Mulally said on a conference call with analysts. "So the advantages clearly outweigh any potential disadvantage."
Ford reported $1.3 billion of positive cash flow in the third quarter, its first positive quarter since the second quarter of 2007, and forecast positive cash flow in the fourth quarter. It burned through $4.7 billion of cash in the first half of 2009.
The company also reported its first quarterly operating profit in North America since the first quarter of 2005.
Ford said it was confident the global economy would be improving by 2011, but it added the near-term growth outlook "remains rather uncertain."
Some analysts believe Ford will be profitable in 2010.
"As the market starts to turn and sales volumes start to recover, Ford should be solidly in the black next year, certainly ahead of schedule," Autoconomy.com analyst Erich Merkle said.
CREDIT ARM'S PROFIT MORE THAN QUADRUPLED
Ford reported a net profit of $997 million, or 29 cents per share, for the third quarter, compared with a net loss of $161 million, or a 7 cents per share, a year earlier. Revenue fell $800 million to $30.9 billion.
Operating profit was 26 cents per share excluding one-time items. On that basis, analysts on average expected a loss of 12 cents per share, according to Thomson Reuters I/B/E/S.
The automaker's results were boosted by Ford Motor Credit Co, which reported that profits rose to $427 million in the third quarter from $95 million a year earlier.
From its automotive business, Ford reported a $446 million pretax operating profit worldwide, including positive results in all four of its regions.
Mulally said he was "cautiously optimistic" and some financial market indicators were returning to levels seen before the Lehman Brothers collapse in September 2008, but consumer confidence and high unemployment remain a drag on the U.S. and UK economies.
"We're just not sure about the strength of the recovery," Mulally said.
Ford posted losses totaling $30 billion from 2006 through 2008 and remains saddled with a much heavier debt load than GM or Chrysler following their bankruptcy reorganizations.
Ford and other automakers are fighting through a plunge in auto sales in North America due to the recession. The company left its 2010 U.S. auto industry sales forecast at 12.5 million vehicles, including medium and heavy trucks, but said it would give an updated outlook early next year.
Until a U.S. economic recovery takes off, cash will remain king for Ford, which borrowed more than $23 billion in late 2006 to finance its turnaround and believes it has enough money to complete its restructuring.
The automaker received $500 million of annual labor cost savings from concessions negotiated with the UAW in February, but said it needed more cuts to align long-term costs with those of GM and Chrysler.
Analysts said the relative health of Ford compared with GM and Chrysler was a key factor in the rejection.
"The positive quarterly results released by Ford this morning are further evidence of the contributions that Ford workers have made," UAW President Ron Gettelfinger said, announcing the rejection of the proposed concessions.
Ford and UAW leaders reached the agreement in mid October, but the vote among some 41,000 Ford UAW workers met stiff opposition over a "no-strike" clause on wages and benefits.
Ford's union workers in Canada ratified a cost-cutting deal over the weekend to preserve most of the Ford jobs in Canada.
Ford shares ended up 58 cents, or 8.3 percent, at $7.58 on the New York Stock Exchange.
Indian gold futures hit new high on IMF sale
MUMBAI (Reuters) - Indian gold futures climbed to a record high on Tuesday as world prices rose on news the International Monetary Fund had sold 200 tonnes of gold to the Reserve Bank of India (RBI).
The December contract on the Multi Commodity Exchange of India Ltd rose to 16,248 rupees ($345.7) per 10 grams, erasing the previous high of 16,173 rupees on Monday.
Kishore Narne, vice president, commodities, at Anand Rathi Commodities in Mumbai, said the IMF sale would keep the sentiment bullish in the near future and could push gold to test its lifetime high of $1,070.4 struck on Oct. 14.
Gold rose half a percent in the spot market to $1,064.55 an ounce. The metal is up 21 percent this year, and will likely keep its record of not having a down year since 2000.
The IMF said on Monday it sold 200 tonnes of gold to the RBI for $6.8 billion, quietly executing half of a long-planned bullion sale that had threatened to slow gold's rally.
This was the first time since 2000 that the IMF sold gold to a central bank.
India, the world's biggest gold market, has imported less gold this year as prices repeatedly made new highs.
Imports by traders between January and Oct. 22 were 157.9 tonnes, down from 383 tonnes bought in the same period a year ago, data from the Bombay Bullion Association showed.
The December contract on the Multi Commodity Exchange of India Ltd rose to 16,248 rupees ($345.7) per 10 grams, erasing the previous high of 16,173 rupees on Monday.
Kishore Narne, vice president, commodities, at Anand Rathi Commodities in Mumbai, said the IMF sale would keep the sentiment bullish in the near future and could push gold to test its lifetime high of $1,070.4 struck on Oct. 14.
Gold rose half a percent in the spot market to $1,064.55 an ounce. The metal is up 21 percent this year, and will likely keep its record of not having a down year since 2000.
The IMF said on Monday it sold 200 tonnes of gold to the RBI for $6.8 billion, quietly executing half of a long-planned bullion sale that had threatened to slow gold's rally.
This was the first time since 2000 that the IMF sold gold to a central bank.
India, the world's biggest gold market, has imported less gold this year as prices repeatedly made new highs.
Imports by traders between January and Oct. 22 were 157.9 tonnes, down from 383 tonnes bought in the same period a year ago, data from the Bombay Bullion Association showed.
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