EMPLOYEE INSURANCE
BENEFITS GUIDE
2025- 2026
FUTURISK PLUS – CRM & MOBILE APP
• Note, The username & password will be shared on email by [email protected]
GROUP MEDICLAIM
INSURANCE
PROCEDURE – PLANNED HOSPITALISATION
Hospital intimates Medi Assist & sends
Start Employee Approaches Network Hospital
Pre-Authorization request with approximate cost
with E-card
of the treatment for approval
Medi Assist issues letter of credit (for cashless)
At the time of Discharge hospital sends the final
Yes with approval for partial / full amount as per
bill and the discharge summary to Medi Assist
eligibility and coverage to the hospital
for the final approval
Medi Assist sends the final approval to hospital
which allows the employee to get discharged by Yes Hospital sends complete set of claims
paying all non-medical/ non-payable expenses documents for processing to Medi Assist
No No
Follow reimbursement process Claims Processing by TPA & Insurer,
release of payments to the hospital
PROCEDURE – EMERGENCY HOSPITALISATION
Member get admitted in the hospital in case of Member / Hospital applies for Medi Assist verifies admissibility of the
Start emergency by showing his pre-authorization to Medi Assist within claim to be registered and issues pre-
E-Card. Treatment starts 24 hrs
authorization
Hospital sends complete set of claims Member gets treated and discharged after Yes
documents for processing to Medi Assist paying all non-medical / Pre-Authorization given
non-payable expenses by Medi Assist
No
Claims Processing by TPA & Insurer
Follow reimbursement process
Release of payments to the hospital
PROCEDURE – REIMBURSEMENT
Employee submits all the documents Medi Assist will check for the
to Medi Assist within 30 days from eligibility and admissibility of the
Start claim as per policy terms
discharge from the hospital.
Yes Yes
Yes Are Documents Yes Is Claim
Medi Assist will process the claim and settle
the reimbursement through NEFT, along Intact? Payable?
with the settlement letter
No
Yes No
Medi Assist will re-access the complete claim No
No On rejection of the claim, Mediassist
documents for admissibility as per policy terms
would provide the reason for
rejection
Employee submits the shortfall Medi Assist will ask for the additional / missing
Documents to MediAssist documents
TAT: 18 working days
GMC – CLAIM DOCUMENTS
Documents GMC Claim
Original Claim Form fully filled up and duly signed by you ✓
Original Main Hospital bill with Bill No. & break-up (with detailed break-up of various heads
✓
like Room Rent / OT Charges / Nursing Charges etc.)
Original Discharge Summary (Gives the summary of diagnosis and treatment in hospital) ✓
Original Death Summary (Only in case of death of patient during hospital stay) ✓
Original Hospital Payment Receipt with Receipt No. ✓
Hospital Registration No. (Registration No. & No. of beds on hospital letterhead with
✓
signature)
Doctor’s Registration No. (On Doctor’s letterhead with signature) ✓
Original Pharmacy & Investigation bills ✓
Original Prescriptions ✓
Investigation Reports in Original / Attested from hospital (reports for all tests done along with
✓
images)
Cancelled cheque with name printed of the employee ✓
POINTS TO REMEMBER
• Cashless for all network hospitals https://mediassist.in/network-hospital-search/
• Reimbursement Claims can be submitted within 30 days from the date of discharge.
• Mid-term inclusion of dependents for existing employees not allowed (Exception: Newly married spouse & newborn baby)
• Mid-term inclusion of dependents for existing employees not allowed (Exception: Newly married spouse & newborn baby)
• Any charges under, Admission charges, Registration Charges, Administrative Charges, Surcharge, Service Charge and all non-medical charges falling under the heading of Miscellaneous charges are
not payable
• Please retain a copy of all documents submitted to us for further reference
• Please retain POD copy of the courier for tracking your consignment in case of any delay etc.
• For implants used in Cataract, Heart Valve Surgeries, CABG, Abdominal Surgeries, Knee replacement surgeries. Please submit the bill (in case purchased outside) from the vendors for the prosthetic
devices used along with Sticker
• Reimbursement claim from Network hospital will be admissible as per the agreed package with Insurance company.
FAQ
• What is a Mediclaim policy?
A Mediclaim policy reimburses hospitalization expenses incurred as an inpatient for the treatment of sickness or accident occurring during
the period of insurance.
• What is the duration of the policy?
One year effective from the date of inception of policy.
• Is there a minimum time limit for stay within the hospital under Mediclaim?
Under Mediclaim, the minimum stay within the hospital must be for a minimum of 24 hours. However, for dialysis, chemotherapy, eye surgery, etc (as per the defined list) – the stay can
be for less than 24 hours.
• Who is a Third-Party Administrator (TPA)?
TPA is an agency appointed by the insurance company to take care of claim settlements in health insurance., Mediassist is the TPA for Resilinc
• Who is an Insurance Broker ?
An Insurance broker is appointed by the Infinite Computer Solution to assist you in all your Insurance related requirements. Futurisk is your Insurance Broker.
• What is the Role of Futurisk?
Futurisk is your SPOC for any & all insurance related matters.
• What is a floater policy?
A Floater policy is a single policy that takes care of the hospitalization expenses of your entire family who has been declared at the time of taking the policy. Any member of your family or all put
together can claim up to the maximum sum insured.
• What is Sum Insured?
Sum insured is the maximum amount that can be claimed under the policy. This is the limit for the policy period
LINKS
Medi Assist website : https://mediassist.in/
Claim form for reimbursement claim*
Reimbursement check list*
*Click on the PDF icon to access the document
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HELPDESK
ESCALATION MATRIX
Particulars SPOC 1 ESCALATION 1 ESCALATION 2
Name Mr Rahul Kumar Mr Deepak Manral Mr Sourabh Sehgal Mr Nishant Mehra
Mobile No. +91 9717-115-614 +91 9205-292-006 +91 9999-123-938 +91 8800-825-831
THANK YOU!
CHENNAI BANGALORE MUMBAI DELHI HYDERABAD KOCHI MYSORE
