In-Patient & Day-Care benefits Hospital Accommodation, Accidents and Emergencies, Intensive Care & Operation Theatre Costs, Surgical Operations & procedures, Surgeons, Anaesthetists & Physicians fees, Prescribed Medicine & drugs, Prostheses and Surgical Appliances, (Artificial body parts surgically implanted to form parts of an insured’s body), Diagnostic tests, Oncology Treatment, Radiotherapy & Chemotherapy, Ophthalmology, Acute (reversible) kidney failure, Physiotherapy.
Out-Patient Benefits Diagnostic tests, Specialists, Consultants, General Medical Practitioner and Family Physician fees, Out-Patient home visits for emergency conditions, Oncology, Prescribed Medicines & Dressings, Emergency Ambulance (to and/or from point of treatment), Outpatient Surgical Procedures, Physiotherapy
Other benefits: Chronic & Pre-existing conditions, Emergency local ambulance, Organ transplant, Nursing at home, Compassionate emergency home visit, Hospital cash benefits, Repatriation, burial or cremation of mortal remains, Emergency medical evacuation.
Optional benefits:
- Routine dental care benefits
- Maternity care benefits
- Optical benefits
Pre-Authorisations
Prior approval may be necessary for certain services/treatments for which your Provider shall contact OQIC either in writing or over the phone.
With this, your Provider as well you may be assured of:
- The eligibility of the stated service under your Policy/Plan.
- The extent/limit of cover of the specific service as per the limits specified in your policy.
Out-Patient Services
Services/treatments rendered by the Medical Practitioner in the Out-Patient clinic or that which do not require a stay in the hospital is termed as Out-Patient Service.
You should note that some non–urgent services require pre-authorization, here are a few examples:
- MRI, CT, PET Scans
- Endoscopic procedures
- Physiotherapy
- Complimentary therapies such as Chiropractic, Acupuncture, Osteopathy
- Dental services
- Maternity related investigations or Out-patient procedures
- Optical related services
In-Patient /Daycare Services
- Services /treatments rendered by the Medical Practitioner that requires a stay at the hospital for one or more night is termed as In–Patient Service.
- Services /treatments rendered by the Medical Practitioner that are eligible under the Policy benefits wherein an admission is necessary but does not require an overnight stay in the hospital is termed Daycare Service.
- Prior to availing any non – urgent or planned in–patient treatments and / or day care treatments the insured should inform the TPA (by email) with a medical report from the attending Medical Practitioner outlining the diagnosis, plan of management and estimated expense and obtain written pre-authorization for your proposed In-patient / Daycare admission or procedure a minimum of 48 hours prior to the planned admission.
- We shall validate, in writing to you, with a specified Pre-approval Code, the extent of the respective procedure’s coverage and further requirements, if any, subject to your policy terms, conditions and exclusions.
- Verbal confirmation does not constitute pre-authorization. If in doubt, please contact the medical helpline, as shown on your membership card.
- Planned Treatment under taken without pre-authorization from OQIC may not be eligible for a full refund in accordance with the policy terms and conditions, unless our Help Line response is delayed beyond a reasonable time. Furthermore, any expenses not related to the treatment shall be borne by the Insured.
The following Elective / Planned services such as but not limited to require pre-authorization:
- All In-Patient treatments specified or limited to under the Policy
- All Daycare admissions
Emergency Services
In the event of Emergency treatment pre-approval is not required but it is the liability of the Network Provider to inform OQIC of the case within 24 hours of admission to the hospital.
