The following categories are eligible for availing the medical facilities:-
- Members of Alexarya
- Seafarers & their dependent
- Unemployed and/or unmarried daughters.
- Unemployed sons below 25 years
- Spouse of Seafarer
- Dependent married son/daughter is entitled to medical facilities.
- Medical reimbursement not admissible if the parents do not stay either with the members.
Expenditure incurred on services provided by an Empanelled Hospital will be paid directly to them as per the approved facilities.(as the case may be) the First Admission Report/ Pre-Authorization duly signed by the Competent Authority of the concerned empanelled hospital is acceptable subject to the fulfillment of the other terms and conditions.
- PROCEDURE OF AVAILING REIMBURSEMENT
- Authorization letter from Empanelled Medical Facilities for Reimbursement
- FAR (First Admission Report) submitted by the Empanelled Hospitals/ Dental or Diagnostic Centres for issuing of Authorization letter must contain.
- Particulars of the Patient.
- Alexarya Foundation card or Med Sea Card
- Treatment/Procedure/Investigation to be given.
- Date & Time of admission.
- Signature of the representative of the empanelled hospital at the place specified.
SUBMISSION OF BILLS: Members will submit bills with the following enclosures:-
- Original FAR (First Admission Report) form completed filled by the Hospital.
- Photocopy of Alexarya Foundation Card or Med Sea Card
- Summary of the case, including outcome of treatment.
- All the supporting documents such as investigation report, first admission report/pre authorization letter, copy of authorization letter, original cash memos and discharge summary report , it should be submitted within the stipulated period of time within 2 months from the date of completion of treatment and necessary bill will be authenticated by the patient /escort’s signature.
- OTHER TERMS AND CONDITIONS
- The Hospital/ Dental/ Diagnostic Centre shall provide the agreed upon services to cases referred on a Referral slip duly authenticated and stamped. The Hospital/ Dental or Diagnostic centre would not refuse admission/treatment or investigations to referred cases on flimsy grounds.
- The Hospital/ Dental or Diagnostic centre shall raise bills in the prescribed format to the members’ on completion of treatment/ discharge of the patient.
- PROCEDURE OF AVAILING OUTDOOR FACILITY:
- Medical reimbursement for OPD treatment is not admissible to those who are in receipt of Fixed Medical Allowance.
- Consultation / injection fee for the treatment taken at the OPD of Empanelled Hospital not admissible.
- In case of outdoor treatment an employee or dependent can go for outdoor treatment but for maximum 10 days to empanelled hospitals. After taking treatment he has to submit the completely filled medical claim form along with the Bills countersigned by the treating doctor or medical in charge of the hospital.
- Where ever an employee wants to claim reimbursement of medical charges for more than 10 days say for one month in that case the employee has to produce a Prolonged Treatment Certificate which is valid for one year. On that basis a Member can claim reimbursement for 30 days instead of 10 days at a time.
- In case of prolonged disease medicine reimbursement the Member has to enclose medical claim form, prescription indicating the name of medicine prescribed by the treating doctor for the disease and prolonged treatment certificate countersigned by the Empanelled.
- Cash memos for purchase of medicines must be countersigned by the doctor prescribing the medicines.
- Designation and degree of the doctor is to be indicated.
- Acceptance of money receipts in lieu of cash memo.
- Time limit for medical claims: Bills to be preferred within 2 months for reimbursement by the Members in respect of a particular spell of illness or from the date of completion of treatment. Reimbursement shall be made with in 60 days from the submission of bills.
For more details please contact firstname.lastname@example.org
ANNEXURE – I
The list of specified prolonged diseases for OPD treatment shall include 13 prolonged diseases is given as under:
- Heartailments and FUC Hypertension
- Diabetes mellitus
- Paralysis/ Cerebrovascular attack
- FUC Thyroid disorder
- Kidney disorders
- Bronchial Asthma
- Cancer/ Malignant Tumors
- Hemolytic Disorder
- Rheumatoid Arthritis & (OA) Osteo Arthritis
- Chronic Liver Disease