Q1: How can I get my insurance e-card?
You can instantly download your e-card from the Medi Assist member portal at https://mediassisttpa.in/download-ecard/.
Log in using your MAID (Member ID) or Employee Number along with your date of birth, then click “Download e-Card” to receive the PDF. Alternatively, you may send a “Hi” message from your registered mobile number to our official WhatsApp line at +91 7026669449. After successful verification, we will assist you in retrieving your e-card.
If you prefer, you may share your MAID (or Employee Number) and the exact name registered under your policy with us, and we will email the e-card to you after verification.
Q2: I need help filling out the PA (Pre-Authorisation) form.
We’re here to help. Please reach out to the hospital helpdesk and we will guide you step-by-step on how to complete it.
Q3: What does my policy cover?
Insurance policies include several key components that define your coverage:
• Sum Insured: This is the maximum your insurer will pay in a policy year. For example, if your sum insured is ₹5 lakhs, the insurer covers up to ₹5 lakhs of hospital bills in that year; any excess is your responsibility.
• Room Rent: The daily limit your policy covers for your hospital room. If you choose a room that costs more than this limit, you’ll pay the extra amount—and the insurer may proportionally reduce coverage of other medical expenses.
• Co-payment (Copay): A fixed percentage you pay on the payable amount.
• Non-Medical Expenses (NMEs): Items not covered by health policies, such as hospital registration fees, attendant food, or consumables like gloves and tissues. These costs are deducted from your claim.
*Some policies cover NMEs, refer to members policy to know more
• Sublimit: A cap on specific treatments regardless of your overall sum insured. E.g., a ₹1 lakh sublimit for cataract surgery within a ₹5 lakh sum insured means the insurer pays at most ₹1 lakh for that surgery or the final bill of the hospital whichever is lower.
• Pre- and Post-Hospitalisation Expenses:
- Pre-hospitalisation: Expenses for tests, consultations or medicines before admission related to the ailment or treatment availed during hospitalisation. The limit of duration is defined in your policy.
- Post-hospitalisation: Costs for follow-up visits, medicines or tests after discharge related to the ailment or treatment availed during hospitalization. The limit of duration is defined in your policy.
Please refer to your specific policy document for accurate and detailed information.
Q4: What is Proportionate Deduction?
Proportionate deduction means your insurance company may reduce your claim amount because you choose a room that costs more than what your policy allows.
For example:
If your policy allows ₹3,000 per day for room rent, but you stay in a ₹6,000 room, it’s not just the extra ₹3,000 you pay—other related charges like doctor fees, surgery, and investigations may also be reduced in the same proportion. This is because many hospital charges are linked to the room category.
Q5: We have two policies. Which one has better coverage?
If both policies are administered by Medi Assist, we can compare them for you. We’ll examine sum insured, room rent limits, co-pay, sublimits, and other conditions to help you determine which policy provides more comprehensive coverage for your current treatment.
Q6: Can I claim my outpatient expenses (consultation, investigations, medicines, etc.)?
Outpatient (OPD) expenses such as doctor visits, lab tests, and medications without hospitalization may be covered, depending on your policy. We will check your specific policy terms to determine whether OPD claims are permitted and inform you of any applicable limits or exclusions.
Q7: Can I claim my health check-up expenses?
Some policies offer preventive health check-up benefits, either annually or once every few years. We will review your policy to confirm whether you are eligible to claim these expenses, and inform you of any applicable frequency limits, caps, and documentation requirements.
Q8: What is the status of my cashless claim?
To check the status of your cashless claim, please provide your Claim ID or MAID. Once verified, we will provide an update on whether your claim is under review, approved, or if any additional information or documents are pending.
Q9: Why is my initial approved amount so low?
The initial approved amount is a provisional authorization to begin your treatment. It is not the final approval. The final amount will be determined at the time of discharge after reviewing the full hospital bill and documents, in accordance with the terms and conditions of your policy.
Q10: Why has an IR (Information Request) been raised on my claim?
An IR (Information Request) is issued when additional documents or clarification are required to process your claim.
- For cashless claims, the hospital will be notified to submit the requested documents.
- For reimbursement claims, you or your representative will need to submit the required items.
This is a standard process to ensure claim completeness.
Q11: The deductions in my final approval are very high. Can you explain why?
Final deductions are made based on your policy’s terms and may include:
- Non-medical items not covered under your policy
- Excess charges beyond your room rent eligibility
- Treatment sublimits or package restrictions
- Co-pay requirements
- Charges outside of insurer-approved tariffs
We will help break down each deduction and explain what was covered and what was excluded.
Q12: How do I file a reimbursement claim?
You can submit a reimbursement claim through the MAven app:
- Download the MAven app from the Play Store or App Store.
- Log in using your registered mobile number or email ID.
- Tap the “+” button and select “Submit Claim.”
- Choose the relevant member and enter hospitalisation details.
- Upload required documents, including bills, reports, and a cancelled cheque.
- Complete your KYC by uploading your Aadhaar or PAN card.
- Submit the claim.
You will receive timely updates on your claim status via SMS and email.
Q13: Can you update me on my reimbursement claim status?
Please share your Claim ID or MAID. After verifying your details, we will provide the current status of your reimbursement claim, including whether it is under review, approved, or pending any documents or clarification.
Q14: I need to buy a new policy. Can you guide me on the best one?
Our hospital help desk is not authorized to recommend or sell insurance policies. For policy comparisons or purchases, please visit official insurance provider websites, trusted aggregators or consult your employer’s HR department for corporate policy options.
Q15: There are incorrect details in my approval letter—like the wrong room type. What should I do?
If you notice any incorrect information in your approval letter—such as wrong room type, member name, or admission details—please notify us immediately. We will review and escalate the issue for correction and reprocessing if necessary.
Q16: How can I check my available balance (sum insured left)? Do I have a co-pay in my policy? Is a specific treatment capped?
Please share your MAID, employee code, or registered email ID. We will review your policy and let you know your available balance and applicable terms such as co-pay percentage, sublimits, or caps on specific treatments.
You can also view this information anytime by logging into the MAven app, available on the Play Store or App Store.
Q17: Will implants used in surgery be covered?
Coverage for implants such as stents, lenses, or prosthetics depends on your policy. We will check whether implants are fully covered, partially covered under a sublimit, or excluded, and inform you accordingly.
If you have any further questions, please contact us via our member portal or WhatsApp helpline.
