INSURANCE & TPA

To ensure smooth facilitation of cashless policy and documentation, the  BMB has a dedicated third-party administrator (TPA)/insurance help desk. A list of empanelled TPA/insurance companies is listed for reference.

Guidelines for Seamless Qualification of Health Insurance Policies

Essential Documentation Required for Cashless Services

  • Cashless card from TPA
  • Photocopy of ID card
  • Photocopy of current insurance policy

To avail in-patient hospitalisation services, follow the procedure stated below:

For Planned Hospitalisation
  • Contact the insurance helpdesk with the mentioned documents, along with the doctor’s admission advice, at least 3 days prior to the admission for necessary formalities
  • Authorisation for cashless service from patient’s TPA
For Emergency Hospitalisation
  • Admit the patient
  • Contact the insurance helpdesk with the essential documents as early as possible for necessary formalities
  • If authorisation for ‘cashless service’ from TPA is received, one can avail cashless facility thereafter for treatment in the hospital, up to the amount sanctioned by the TPA
Declaration Form

Please fill the declaration form related to patients with mediclaim policies at the time of admission. Do try and ensure accuracy in information to help us serve you better.

Payment for Non-Authorised Items

If authorisation for cashless service from the TPA has been received at the time of discharge, the patient needs to pay for the following:

  • Items that are not reimbursable under the mediclaim policy
  • Hospitalisation expenses in excess of the insured amount
Denial of Cashless Service

In case of denial of cashless service by the TPA, the patient is requested to settle hospital bills themselves. BMB will then supply all bills and reports to enable the patient to lodge their claim for processing and reimbursement directly with the TPA.

Being a referral & model hospital for many organizations, the centre has agreements with many PSUs, state government and private companies. For guidance for admissions and other processes, please contact the corporate. Our team of executives stand ready to assist you.

 

S.No

Company Name

1

Airports Authority Of India

2

Balmer Lawrie & Co.Ltd

3

Bharat Coking Coal Limited

4

Bharat Petroleum Corpn Limited

5

Bharat Sanchar Nigam Limited – Itpc

6

Bharat Sanchar Nigam Limited – Telecom Factory, Alipore

7

Bharat Sanchar Nigam Limited – Telecom Stores

8

Birla Industrial And Technological Museum

9

Border Security Force

10

Bose Institute

11

British Deputy High Commission

12

Calcutta Telephones

13

Central Coalfields Limited

14

Central Hospital South Eastern Railways, Gardenreach

15

Central Mine, Planning & Design Institute Limited

16

Central Warehousing Corporation

17

Cesc Limited

18

Cisf

19

Clacutta High Court

20

Coal India Ltd

21

Crpf

22

Csir – Central Glass And Ceramic Research Institute

23

Csir – Central Institute Of Mining & Fuel Research

24

Csir-Indian Institute Of Chemical Biology

25

Damodar Valley Corporation

26

Dredging Corpn Of India Ltd.

27

Dredging Corporation Of India Limited

28

Eastern Coalfields Limited

29

Employees State Insurance Corporation Esi – Pgimsr & Esic Hospital & Odc(Ez)

30

Employees State Insurance Corporation, Ssmc

31

Employees State Insurance Corporation, West Bengal Region

32

Engineering Projects (India) Ltd.

33

Ferroscrap Nigam Limited

34

Food Corporation Of India

35

Garden Reach Shipbuilders & Engineers Limited

36

Hindalco Hospital-Renukoot

37

Hindalco Hospital-Renusagar

38

Hindalco Industries Limited – Belur Works

39

Hindustan Copper Limited

40

Hindustan Petroleum Corporation Limited

41

Housing & Urban Development Corporation Limited

42

Icar- National Institute Of Research On Jute And Allied Fibre Technology

43

Iiest

44

Iiser – Kolkata

45

India Government Mint

46

Indian Airlines(Nat.Aviation Co.Of India)

47

Indian Ass.For Cultivation Of Science

48

Indian Institute Of Management Calcutta

49

Indian Institute Of Technology – Kharagpur

50

Indian Institute Of Technology Hall Management Centre – Kharagpur

51

Indian Oil Corporation Limited – Marketing Division

52

Indian Oil Corporation Limited – Pipelines Devision

53

Indian Oil Corporation Limited – Refinery Division

54

Indian Science Congress Association

55

Insdag

56

Ircon International Limited

57

Irctc

58

Joint Plant Commitee

59

Kolkata Police

60

Kolkata Port Trust

61

Kolkata Port Trust – Haldia Dock Complex

62

Kolkata Port Trust-Haldia Dock Complex

63

Mahanadi Coalfields Limited

64

Mecon Limited

65

Mmtc Limited

66

National Bank For Agriculture And Rural Development (Nabard)

67

National Council Of Science Museums

68

National Hydro Electric Power Corporation Limited

69

National Institute For The Orthopaedically Handicapped

70

National Mineral Development Corporation Limited

71

Ndrf

72

Neepco

73

Nia Limited

74

North Eastern Coalfields Coal India Limited Margherita

75

Northern Coalfields Limited

76

Ntpc Limited

77

Ntpc-Sail Power Company Limited

78

Oil And Natural Gas Corporation Limited

79

Oil India Limited

80

Paradip Port Trust

81

Pec Limited

82

Posco

83

Power Grid Corporation Of India Limited

84

Punjab National Bank Sramik Union

85

Rastriya Ishpat Nigam Limited

86

Recl

87

Reserve Bank Of India

88

Saha Institute Of Nuclear Physics

89

Sail Alloy Ateel Plant

90

Sail Iisco Burnpur

91

Sail, Bhillai Steel Plant

92

Sail, Growth Division

93

Sashastra Seema Bal

94

Satyajit Ray Film And Television Institute Is A Film And Television Institute

95

Satyendra Nath Bose National Centre For Basic Sciences

96

Science City

97

South Eastern Coalfields Limited

98

South Eastern Railways Main Hospital, Kharagpur

99

State Bank Of India

100

State Trading Corpn.Of India Ltd

101

State Trading Corpn.Of India Ltd 

102

Steel Authority Of India (Raw Material Division)

103

Steel Authority Of India Ltd (Bokaro Steel Plant)

104

Steel Authority Of India Ltd (Central Marketing Organization)

105

Steel Authority Of India Ltd (Durgapur Steel Plant)

106

Steel Authority Of India Ltd (Rourkela Stell Plant)

107

Tata Communications Ltd.

108

Tata Motors Limited

109

The Shipping Corporation Of India Ltd.

110

The West Bengal Power Development Corporation Limited.

111

United Bank Of India

112

Uranium Corporation Of India Ltd.

113

Uti Asset Management Company Limited

114

Variable Energy Cyclotron Centre

115

Victoria Memorial Hall

116

Visva Bharati (Pn Memorial Hospital)

117

West Bengal Police

S.No

Company Name

1

National Insurance Company Limited

2

The New India Assurance Co. Ltd

3

The Oriental Insurance Company Ltd.

4

United India Insurance

S.No

Company Name

1

Atal Amrit Abhiyan Society Limited

2

Central Government Health Scheme

3

Govt Of Tripura

4

Govt. Of Meghalaya

5

Govt. Of Mizoram

6

Govt.Of Bihar

7

Govt.Of Jharkhand

8

Govt.Of Manipur

9

Regional Center Echs – Kolkata

10

Tripura State Illness Assistance Fund

11

Wbsh Family Welfare -Sishu Sathi

12

West Bengal Health Scheme

S.No

Company Name

1

Aditya Birla Health Insurance Corporation Limited

2

Apollo Munich Health Insurance Company Limited

3

Bajaj Allianz Insurance Corporation Limited

4

Chola Mandalam Ms General Insurance Co. Ltd

5

Ericson Insurance Tpa Private Limited

6

Future Generali Ins. Co. Ltd.

7

Hdfc Ergo General Insurance

8

Icici Lombard Genera Insurance Company Ltd.

9

Icici Prudential Life Insurance Company

10

Iffco Tokio General Insurance Co Ltd.

11

Max Bupa Health Insurance Co. Ltd.

12

Reliance General Insurance Company Limited

13

Religare Health Insurance Co. Ltd.

14

Rothshield Insurance Tpa Limited

15

Star Health & Allied General Insurance Co. Ltd.

16

Universal Sompo General Insurance Company Limited

S.No

Company Name

1

Ambuja Cements Limited

2

Dic Limited

3

Hindustan Unilever Limited

4

I.T.C Ltd.-Munger

5

Itc – Head Office

6

Itc – Khidirpore Factory

7

Mn Dastur And Company Limited

8

Tata Main Hospital

9

Tata Steel Limited

10

The Tinplate Company Of India Limited

11

Trf Limited

S.No

Company Name

1

Dedicated Healthcare Services(I) Private Ltd. (Dhs)

2

East West Assist Pvt

3

E-Meditek Solutions Ltd.

4

Family Health Plan Tpa Ltd

5

Genins India Tpa Ltd

6

Good Health Plan Ltd

7

Happy Insurance Tpa Services Pvt Ltd

8

Health India Tpa Services Pvt. Ltd.

9

Heritage Health Services Pvt Ltd.

10

Md India Health Care Services

11

Medi-Assist India Tpa Pvt Ltd.

12

Medicare Tpa Services (I) Pvt Ltd.

13

Medsave Healthcare Tpa Ltd.

14

Paramount Healthservices Pvt Ltd.

15

Raksha Tpa Pvt. Ltd.

16

Safeway Tpa Services(P) Ltd

17

Ttk Healthcare Tpa Pvt. Ltd.

18

United Healthcare India (Private) Limited

19

Vidal Health Insurance Tpa Pvt. Ltd.

20

Vipul Medcorp Tpa Pvt. Ltd.

21

Wbpdcl – Paramount

22

Wbsedcl – Fhpl

Given below are a few frequently used terms pertaining to medical insurance that you need to be familiar with.

Cashless Access

A special benefit extended by an insurer or by the assigned TPA for availing medical treatment as an inpatient without the necessity to pay the treatment costs up front to the hospital. Under this procedure, the payment due to the hospital will be met out either by the insurer or by the assigned TPA. After the discharge from the hospital the bills pertaining to medical expenses incurred at the hospital, are sent to the Insurer/TPA, (subject to insurance policy and conditions) for reimbursement by the hospital. The hospital can claim in accordance to the pre authorised limit and additional cost as envisaged by the enhancement. In any case the upper limit of this facility cannot exceed the sum insured under the contract of insurance.

Denial

Repudiation of a pre authorisation request /admission liability/cashless facility and or settlement of a claim under the insurance contract.

Discrepancies

Any difference between the amount claimed and admissible amount and also any violation of terms & conditions of the insurance policy or agreement.

Domiciliary Hospitalisation

Medical treatment for period exceeding 3 days for such illness/diseases/injury, which in the normal course would require care and treatment at a hospital but is actually taken whilst confined at home under certain circumstances (where the patient cannot be moved to the hospital or due to lack of accommodation – as per the definition of insurance policy).

Enhancement

A situation when insurer seeks to increase the limit of the authorized claim amount resulting from extension of hospitalisation.

Exclusions

The items that are specifically and expressly removed from the scope of the insurance contract and hence are not payable.

Hospitalisation

Medical treatment after getting admitted in a hospital.

Insured Amount

The maximum limit up to which the insured can seek medical treatment under that mediclaim policy.

Insured/Policy Holder

Individual, who by paying a premium, secures himself to receive medical treatment up to a fixed sum of money in the event of injury, loss or damage to his body.

Insurer

A corporate body licensed by IRDA for underwriting various insurable risks against any or all insurable perils with an assurance to make good the loss in an unforeseen eventuality.

IRDA

Insurance regulatory & development authority, a body constituted under the ministry of finance to deal with licensing, regulating and monitoring all activities relating to the insurers, brokers, agents, corporate agents and the TPA’s.

Limitations

Restrictions in the operative clause of the insurance contract to the limit of benefits, use etc.

Mediclaim Card

A card issued by your TPA with a primary purpose of identification. This contains the policy number, name and validity period. Many of the TPA’s prefer to place insured’s photograph & signature to improve its authenticity. Though it is being popularised as a cashless card, it serves only as a means to avail cashless benefit subject to the terms & conditions of the policy.

Mediclaim Policy

An insurance policy that covers hospitalisation expenses incurred during an inpatient hospitalisation. Please check terms and conditions of the policy to understand the nature and the scope of risk covered.

Medico Legal Case

A situation arising out of treatment at the hospital for any bodily injuries sustained in an accident or an attempt of suicide, which needs to be intimated to the police and other concerned authorities for any investigation and procedures. For example burns, suicide, road traffic accident, assault, etc.

Network Hospital

A hospital which has entered into an agreement/MOU with an insurer or a TPA to request pre authorisation, extend cashless facility and accept payment at a later date on submission of bill complying to the policy requirements. Those hospitals who do not have a prior agreement for cashless hospitalisation with your insurer/TPA are called non-network hospitals.

Planned Hospitalisation

Taking advantage of the medical condition where one does not require immediate hospitalisation (as it would not affect his quality of life in any way), the insured seeks pre authorisation sufficiently in advance of actual admission in the hospital for treatment on cashless basis.

Policy Terms & Conditions

Terms and conditions outlining the details and the limitations of the insurance contract indicating the requirements for fulfilling or adhering to the contract of the insurance.

Pre Authorisation

Authorisation issued by the insurer or by the assigned TPA for admission and treatment up to a value as deemed fit by the insurer, for treatment by the hospital. To receive pre authorisation one has to make a request providing the details contained in the pre authorisation Form.

Query

Clarification requested to dispel any doubt pertaining to the line of treatment and the contract of insurance.

Reimbursement

A facility under which the insured can claim the expenses borne by him during hospitalisation which is otherwise claimable under his insurance contract.

Toll Free Number

A telephone number (calls to which are not charged) provided by your insurer/TPA to get in touch with them for any clarification.

TPA

A corporate body licensed by IRDA for processing and setting on their behalf, claims arising under medical insurance policies and to coordinate with hospitals for all relevant and related processes.