Dear all, Our name has changed from Family Health Plan TPA Ltd. to Family Health Plan Insurance TPA Ltd.

Integration of best technology with process

An ISO/IEC 27001:2013 and ISO 9001:2008 Certified TPA

Guide Book

Family Health Plan Insurance TPA Ltd (FHPL) welcomes you into the fold of health insurance policyholders. FHPL, as the preferred TPA of your insurance company, is glad to provide you with services in a hassle free manner within the terms and conditions of your health insurance policy. As a Third Party Administrator for your Insurance Company, FHPL will provide you the following services

  • ID Card.
  • “Cashless Service” at all our Network Providers for all eligible ailments/conditions.
  • Processing and settlement of claims under your health insurance policy.
  • 24 hours Call Centre Service.

As soon as you receive this booklet and card, please go through:
  • Your card for any discrepancies. If you find any discrepancies, please bring it to the notice of our office nearest to you or return the card for rectification. Please keep a xerox copy of the card before returning it to FHPL.
  • Please go through the guidebook in detail to familiarize yourself with the proper procedures to be followed while availing the various services offered by FHPL.
  • Please go through your health insurance policy, especially the clauses pertaining to the exclusions under the policy, in detail to be aware of, what are the ailments covered under the policy and what ailments/conditions are excluded.


For any clarifications / information, please contact our nearest office or call on our Toll free line at 1-800-425-4033. or log-on to our website http://www.fhpl.net

Please carry FHPL Card with you whenever you go to a hospital for admission.

Please quote your UHID number, policy number and the name of your insurance company in all your correspondence with FHPL.

Network Hospitals and “Cashless Service”: Network providers are Hospitals and Nursing Homes who have contracted with FHPL to provide cashless service for inpatient treatment, ailments, diseases and medical conditions which are covered under the health insurance policy. The provisional list of our Network Providers is attached to this guidebook. Please note that we are constantly adding / deleting the Network Providers list. Please contact our nearest office or call us on our Toll free Number or log on to our website http://www.fhpl.net for the current list.

Cashless Service is the service wherein you need not pay any amounts either as a deposit at the time of admission or for the hospital bills at the end of treatment / discharge. This facility is available only at our Network Providers. To avail the “Cashless Service” you need to get an authorization from FHPL. This authorization along with a copy of the FHPL ID Card has to be given to the Network Provider at the time of admission.

Note: FHPL will authorize “Cashless Service” at the Network Providers in all cases eligible under the insurance policy. “Cashless Service” may be denied in some of the situations as listed below.
  • In case of any doubt in the policy terms with respect to the present ailment.
  • The ailment/condition etc. not being covered under the policy.
  • The insured amount not being sufficient to cover the hospitalization expenses.
  • If the request for preauthorization is not received by FHPL in time.
  • If the information sent to FHPL is insufficient to confirm coverage.


Denial of “Cashless Service” is not denial of treatment. You can continue with the treatment, pay for the services to the hospital, and later send the claim to FHPL for processing and reimbursement.


AVAILING INPATIENT HOSPITALIZATION SERVICES

In case you need to avail inpatient hospitalization services, you can go to any hospital of your choice, either a hospital on our network or a hospital outside the network. If you are getting admitted in a hospital that is not in our network, verify that the hospital satisfies the conditions as defined in the policy .The difference between the two being that FHPL can authorize for “Cashless Service” in the hospital on its network, whereas you will have to settle all the bills in the hospital which is outside our network.

However you have to follow the procedures listed below to get the services in different situations.

A) Emergency hospitalization in Non - Network Hospitals
Step 1. Get admitted in the hospital.
Step 2. As soon as possible, inform FHPL about the hospitalization.
Step 3. At the time of discharge, settle the hospital bills in full and collect all the bills, documents and reports.
Step 4. Lodge your claim with FHPL for processing and reimbursement.

B) Planned hospitalization in Non - Network Hospitals
Step 1. Inform FHPL about the planned hospitalization.
Step 2. Get admitted in the hospital.
Step 3. At the time of discharge, settle the hospital bills in full and collect all the bills, documents and reports.
Step 4. Lodge your claim with FHPL for processing and reimbursement.

C) Emergency hospitalization in Network Hospitals
Step 1. Get admitted in the hospital.
Step 2. As soon as possible inform FHPL and coordinate with the hospital to have the details sent to FHPL for
authorization cashless service.

Step 3. A) In case of very short stay at the hospital or if the authorization for “Cashless Service” was not received from FHPL or if “Cashless Service” was denied by FHPL then
i) At the time of discharge settle the hospital bills in full and collect all the bills, documents and reports.
ii) Lodge your claim with FHPL for processing and reimbursement
OR
B) If authorization for “Cashless Service” from FHPL has been received
i) At the time of discharge
a) Pay for those items that are not reimbursable under the health insurance policy.
b) Verify the bills and sign on all the bills.
c) Leave the original discharge summary and other investigations reports with the hospital.
Retain a photocopy for your records.

D) Planned hospitalization in Network Hospitals
Step 1. Please co ordinate with your doctor and the hospital and send in all the details of your planned
hospitalization including the plan of treatment, cost estimates etc. to FHPL. Also indicate the address
or fax number to where the authorization has to be sent. This should be sent to FHPL at least
3 days prior to the admission.
Step 2. A) If authorization for “Cashless Service” from FHPL has been received
i)At the time of admission, hand over the authorization letter and a photocopy of your ID card to the
hospital.
ii) At the time of discharge
a) Pay for those items that are not reimbursable under the MEDICLAIM policy.
b) Verify the bills and sign on all the bills.
c) Leave the original discharge summary and other investigations reports with the hospital
. Retain a photocopy for your records.
OR
B) In case “Cashless Service” was denied by FHPL
i) At the time of discharge settle the hospital bills in full and collect all the bills documents and reports.
ii) Lodge your claim with FHPL for processing and reimbursement

How to lodge your claim with FHPL for processing and reimbursement.
Please lodge your claim with FHPL for processing, Within 7 days after discharge. When lodging your claim with FHPL, please make sure that all the documents listed below are sent.

1. Claim form duly signed by the insured.
2. Photocopy of your ID card.
3. Photocopy of your policy.
4. Hospital bills in original. For all consolidated amounts, the detailed breakup of the billed amount is
required from the hospital.
5.For medicines purchased outside, the bills should be accompanied by a prescription from the doctor.
6. Discharge summary / Discharge card in original.
7. All investigation reports in original.
8. In case of hospitalization due to accident, medico legal certificate (MLC) from hospital.

Note: As per "AML/CFT guidelines for General insurance companies" issued by IRDA, beneficiary need to submit KYC documents where the amount payable is equal to or above Rs.1 lakh. Hospitals will collect the required documents from insured at the time of cashless. KYC documents are listed below:

Proof Identity
1.  Passport
2.  PAN Card
3.  Voter’s Identity Card
4.  Driving License
5.  Letter from a recognized Public Authority (as defined under Section 2 (h) of the Right to Information Act,2005) or
Public Servant (as defined in Section 2(c) of the ‘The Prevention of Corruption Act, 1988’) verifying the identity
and residence of the customer.
6.  Personal identification and certification of the employees of the insurer for identity of the prospective policyholder.
7.  Letter issued by Unique Identification Authority of India containing details of name, address and Aadhaar number. 8. Job card issued by NREGA duly signed by an officer of the State Government.

Proof of Residence:
1.  Telephone bill pertaining to any kind of telephone connection like, mobile, landline, wireless, etc. provided
it is not older than six months from the date of insurance contract.
2.  Current Passbook with details of permanent/present residence address (updated up to the previous month).
3.  Current statement of bank account with details of permanent/present residence address (as downloaded).
4.  Letter from any recognized public authority.
5.  Electricity bill
6.  Ration card
7.  Valid lease agreement along with rent receipt, which is not more than three months old as a residence proof.
8.  Employer’s certificate as a proof of residence (Certificates of employers who have in place systematic
procedures for recruitment along with maintenance of mandatory records of its employees are generally
reliable).

Identity and Address Proof:
1.  Written confirmation from the banks where the prospect is a customer, regarding identification and proof
of residence..

There are certain charges by the hospital, which are not reimbursable and hence have to be paid by the member even after “Cashless Service” has been authorized for treatment in the network hospitals?

The list as per IRDA is enclosed
Click Here

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