Health Insurance Orientation

Module

Future Generali Health

 Introduction

 Future Generali is an insurance joint venture between the Italy-based

Generali Group and the India-based Future Group.

 Future Generali operates Life and Non-Life insurance businesses through ‘Future
Generali India Life Insurance Co. Ltd.’ and ‘Future Generali India Insurance Co. Ltd.’

 Future Group holds 74% each in both the companies.

 Future Generali received license from the Insurance Regulatory Development

Authority (IRDA) in Sept 2007 and launched operations from Nov 2007.

Future Generali Health

 Introducing

For your Health Needs

Future Generali Health

How we are different:

• Future Generali Health (FGH) is an internal unit of Future Generali India

Insurance.

• No Third Party Administrator (TPA) involved between the insurer and FGH.

• Claim settlement is faster due to single point clearance – no exchange of

claim documents between insurer and TPA.

• Preferred services extended as FGH provides service only to clients insured

by Future Generali.

Future Generali Health

Future Generali Health
An In-house Health Management Team of Future Generali India Insurance Co. Ltd.

Internal units of (FGH) Future Generali Health Team

Call Centre 24 X 7 Helpline to cater to customer queries

Enrolment For card issuance and member data management

Cashless Management 24 X 7 services with 2 hours Turn Around Time (TAT)**

Claims Processing Average TAT of 14 working days**

Provider Management 1800 hospitals and 200 diagnostic centers network

Research and Analysis Analysis, Feedback & monitoring

Pre Policy For retail medical underwriting

Underwriting Centralized Group / Retail Underwriting at hubs

**All TAT’s subject to availability of complete documentation

Future Generali Health

Your New Wellness Card

• Your New card entitles you to a host of

healthcare benefits.

• Photo identification is necessary whenever

you use this card.

• This card does not entitle you to avail

cashless without pre-authorization.

• This is NOT a credit card.

Future Generali Health

Member Enrolment
Key Function: For card issuance and member data management

 Within how many days will I get my Wellness Card?

• You will receive health cards via courier or e-mail within 7 days after your details
are received by FGH from your organization.

 What if there is an error on my Wellness Card?

• For any error in cards or correction required, you can immediately report to your
HR.

 What is the use of the Wellness Card?

• You will get a Wellness Card to utilize the Cashless facility at Network Hospitals.

• This card helps only in your identification as a Future Generali Health member.

• Availability of Cashless and any other benefit is subject to policy terms.

Future Generali Health

Claim Process: Cashless
If you are going for a Planned Hospitalization:

1. Carry your ID cards and authorization letter when you go to the hospital for admission

2. Get the Pre-authorization done in at least 7 days before hospitalization

3. Pre-authorization is done to determine whether cashless facility can be granted based on

all medical information about your ailment and coverage

4. Pre-authorization forms are available at NETWORK hospitals. You can also obtain it from
our call centre by e-mail or Fax

5. Your treating doctor has to fill the form and sign it

6. You will also have to sign the Pre Authorization form and provide your mobile number

7. The hospital will fax this form to our Call Centre to get an authorization

Future Generali Health

Claim Process: Cashless Continued….
If you are going for Planned hospitalization:

8. Our doctors will examine the form and decide on cashless availability

9. If cashless is granted, we will send an Authorization Letter to the hospital. You

can also get a copy of the Authorization Letter from our Call Centre by e-mail

10. If cashless is denied, we will send a Denial Letter to the hospital and inform you

11. If cashless has been denied, you will have to pay the hospital bill and then send

the claim to us

Future Generali Health

 Customer approaches FGH Toll Free
Cashless for Cashless Treatment. Future Generali coordinates
with hospital for preauthorization
Process
Hospital verifies customer details and sends
pre-auth by fax to FGH (Pune)

FGH verifies pre-auth details with

policy benefits and sends the response by
Fax to Hospital

Network Hospital

Approved Query Denial

Authorization Letter sent by Query Letter sent by Denial Letter sent by

FGH FGH FGH

Hospital admits the patient Hospital faxes the reply for

Hospital admits the patient as
without any deposit and queries asked by
Cash Patient and patient pays the Bill
provides cashless treatment FGH doctors

Future Generali Health

Cashless Process FAQs
1. What is a Network Hospital? How do I know the hospital is on
the network?

 FGH has tied up with specific hospitals and nursing homes to provide preferred services
to its customers . These hospitals are termed as “Network” hospitals.

 You can find out the details of Network hospitals in your city from our Call Centre on
phone or by e-mail. The details are also available in the Health Insurance Guide sent
along with your Wellness Card.

 Hospitals are added and removed from the network at regular intervals. You are advised
to check with our Call Centre for the updated status of any hospital.

Future Generali Health

Cashless Process FAQs
2.How does the Hospital verify that the cardholder is genuine?
Since the Card issued is not a photo id card, you are required to submit a photo id to
verify the genuinity of identity at the Admission Desk of the Hospital. The photo id can
be your Organization Identity Card, Driving License or any other such card which will
help the hospital to establish the genuinity of the patient.

3.What is a Preauthorization Request?

This is a Request for Cashless Hospitalization. The same has to be duly filled up, signed
and stamped by the Hospital Authorities. Thereafter it has to be sent by fax / e-mail to
FGH. The Contact details of FGH is available in the hospital.

Future Generali Health

Cashless Process FAQs
4.Where do I procure the Preauthorization Request from?
The Preauthorization Form template is available with the Network Hospitals or also
enclosed with the Health Insurance Guide. It can also be obtained from FGH Call Centre
on phone or by e-mail.

5.How to fill the Preauthorization form?

It must be filled by the Treating Doctor.
Information required are :
ID No. as printed on the Card, Signs and Symptoms of the present aliment, duration of
the aliment, diagnosis, pre existing conditions if any, proposed line of treatment,
expected date of admission, duration of stay and estimated cost of hospitalization.

Future Generali Health

Cashless Process FAQs
6.Where do I send the Preauthorization form?
The Preauthorization Request for Cashless Hospitalization can either be faxed to
24 x 7 Toll Free Fax-line 1800 103 9998 or mailed to fgh@futuregenerali.in
7.What is an Authorization Letter ?
Authorization Letter is the communication ascertaining the Admissibility or Acceptance
of the Cashless Service. The same is issued by FGH subject to admissibility of the claim
and availability of balance sum insured for the member.
8.Is the entire amount requested by hospital authorized by
FGH?
FGH would release a part or the entire amount depending on the ailment and related
expenses. In case a part amount has been approved by FGH, then the hospital would
ask for additional authorization when necessary.

Future Generali Health

Cashless Process FAQs
8.How do I know whether my Claim has been approved for
Cashless or not?

Authorization Letter or Denial Letter shall be faxed directly to the Hospital with

intimation to you.

A Query letter shall be faxed to the hospital if in case FGH wants some additional

information to decide upon the admissibility.

Future Generali Health

Cashless Process FAQs

9. What are the circumstances under which a Request for

Cashless Hospitalization shall be denied?

1. If the information contained in the Request is insufficient for FGH to arrive at

a decision and further information is not available for whatever reasons.

2. The ailment for which hospitalization is sought is not covered under the

particular insurance policy or is a part of an Exclusion under the policy

guidelines.

3. The insured has already exhausted his insurance coverage for the year.

Future Generali Health

Claim Process
If there is an EMERGENCY

• Contact our call centre and inform them about the nature of emergency

• If possible, always go to a network hospital

• If not, then go to the nearest hospital

• In a network hospital, the patient can be admitted by showing the FGH Wellness

Card only

• After admission, the pre authorization has to be done

Future Generali Health

Claim Process
If there is an EMERGENCY

• Our doctors will inform you and the hospital if cashless can be given

• The hospital will ask you for a deposit if we deny cashless

• If you have gone to a non – network hospital, keep our call centre informed

Future Generali Health

Remember

Cashless facility is always subject to the broader policy guidelines and relevant

terms and conditions.

Important

Please note that decline of a request for Cashless Hospitalization is only denial of

Cashless Service and is in no way to be treated as denial of treatment or claim. The

insured retains the right to get treated and submit the bills to FGH for subsequent

Reimbursement.

Future Generali Health

 Preliminary scrutiny of claim &
verification :
- Policy Benefit Claim documents received from
- Date of Loss Insured member
- Mandatory Documents

Deficient
Repudiated Approved
(Some Document required
(Not falling with policy conditions) (Admissible under policy)
For Admissibility)

Intimation of the Repudiation letter Payment cheque

Deficiency sent to client sent to client
is sent to the client

Reply received along Reply not Subsequent reminders

with all received sent at fixed intervals
deficient documents

Documents
not received

Reimbursement
Claim closed
Claims Process without payment

Future Generali Health

Reimbursement Claim Process - FAQs
In case of Non Cashless Claims, what would be an appropriate plan
of action to ensure timely reimbursement of the claim?

If cashless facility is not availed, pre-authorization is denied or treatment is availed at a non-

network hospital, the insured will have to settle the bills directly with the hospital and

subsequently claim reimbursement by submitting the following documents to FGH:

1. First Prescription / consultation note from the Doctor

2. The Claim Form duly signed by the claimant or family member
3. The Original Hospital Discharge Card
4. The Original Hospital Bill giving detailed break up of all expense heads mentioned in the
bill

Future Generali Health

Reimbursement Claim Process - FAQs

5. The Money Receipt duly signed with a Revenue Stamp.

6. All Original Laboratory & Diagnostic Test Reports. E.g. X-Ray, E.C.G, USG, MRI Scan,
Haemogram etc
7. If you have purchased medicines in cash and if this has not been reflected in the hospital
bill, please enclose a prescription from the doctor and the supporting medicine bill from
the Chemist
8. If you have paid cash for Diagnostic or Radiology tests and it has not been reflected in
the hospital bill, please enclose a prescription from the doctor advising the tests, the
actual test reports and the bill from the diagnostic centre for the tests.

Future Generali Health

Reimbursement Claim Process - FAQs

What are the norms for Intimation on Claims ?

Preliminary notice of claim with particulars relating to Name of the Insured

Person / Claimant, Nature of illness / injury and Name and Address of the

attending Medical Practitioner / Hospital / Nursing home should be given to

FGH. Intimation can be sent by e-mail or Fax to our Call Centre.

Future Generali Health

Reimbursement Claim Process - FAQs
Are there any norms related to the Hospital where treatment is sought
which are mandatory for admissibility of claims?
Please ensure that the hospital / nursing home where you are contemplating treatment
fulfills these criteria.
1. It has at least 15 inpatient beds;
2. It has a Doctor who is in attendance 24 hours per day;
3. It maintains daily medical records for each of its patients,
4. It is registered and licensed as a hospital or nursing home with the appropriate local
authorities. Always instruct the hospital authority to mention the Attending Doctor’s and
Hospital Registration No. in the hospital papers or demand for a separate certificate on
the same
5. The hospital provides a proper discharge summary, numbered bill and receipt for
hospitalization expenses at the time of discharge

Future Generali Health

Reimbursement Claim Process - FAQs
Where do I send my claim documents?
You can handover claim documents at the Help Desk in your office

All claims will be managed by the Claims Team located in Pune.

Claims Team
Future Generali Health
2nd Floor, Kant Helix Tower, Bhoir Colony, Opp Tata Motors, Chinchwad,
Pune – 411033 (Maharashtra)
All claim payments advice shall be made within 14 working days from the date of receipt of
COMPLETE documents.
FGH may ask for the additional documents from the claimant if the submitted documents
are not sufficient to decide the admissibility of the claim.

Future Generali Health

Reimbursement Claim Process - FAQs
What does FGH do with my claim documents?
 Your claim is assessed by our expert team and doctors who verify the documents and bills

 If all requirements are complete and the claim is admissible, the claim is approved and the
cheque is sent to you or your corporate

 If the claim is not admissible, then a Repudiation Letter is sent to you / corporate by e-mail
/ courier

 If our team requires additional documents to process the claim, then a Document
Recovery letter will be sent to you / corporate by e-mail / courier

 FGH will send one intimation and two reminders at intervals of 15 days

 If additional documents are not received after the second reminder from FGH, the
claim is assessed with the available documents. This could lead to part payment or no
payment at all.

Future Generali Health

Your Contact Points
For any claim related query, hospital information, grievance, feedback or
appreciation, please contact us on the following:

Toll Free Phone No 1800 103 8889

Toll Free Fax No 1800 103 9998

Email fgh@futuregenerali.in

Future Generali Health

 Future Generali Health Insurance
2nd Floor, Kant Helix Tower, Bhoir Colony, Opp Tata Motors, Chinchwad,
Pune – 411033 (Maharashtra)

Future Generali Health