Cashless Service at GKNM Hospital

G. Kuppuswamy Naidu Memorial Hospital provides cashless medical insurance (mediclaim) services for patients having a health insurance (mediclaim) policy from the following empanelled private insurance companies and third party administrators (TPAs) :-

1. Insurance Companies

2. Family Health Plan Insurance TPA Ltd

(Under FHPL cashless only for below mentioned Insurance Companies)

Aditya Birla Health Insurance Co.
Aditya Birla Sun Life Insurance Co. Ltd.
Bajaj Allianz General Insurance Co.
Care Health Insurance Ltd.
Future Generali India Insurance Co. Ltd.
Go Digit General Insurance Co. Ltd.
Iffco – Tokio General Insurance Co. Ltd.
Icci Lombard General Insurance Co. Ltd.
Kotak Mahindra General Insurance Co.
Liberty General Insurance Co. Ltd.
Magma HDI General Insurance Co. Ltd.
Royal Sundaram Alliance Insurance Co.
Sbi General Insurance Co.
Star Health & Allied Insurance
Universal Sampo General Insurance Co.
Zuno General Insurance Company Ltd

3. Vidal Health Insurance TPA Private Ltd.

(Under Vidal Health cashless is only for the below mentioned Corporate Companies)

Roots Group of Companies
Lakshmi Machine Works
The Hindu Group
Sree Saradhaambal Automobiles
Anamallais Eicher
Jagadamba Motors
Access Health Care
ABT Limited

4. Medi Assist TPA Private Ltd.

(Under Medi Assist cashless is only for the below mentioned Corporate Companies)

Tata Consultancy Service
Lakshmi Machine Works
TVS
CTS
INFOSYS
BOSCH

Government Scheme

1. Tamil Nadu Chief Minister's Comprehensive Health Insurance Scheme (CMCHIS - PMJAY)

Admission procedure under cashless scheme

(For Private Insurance / TPA card holders)

Planned Admission

When a routine hospitalization is required, the patient holding a mediclaim policy from any of the recognised companies is advised to contact the insurance cell.
A pre-authorisation form will be issued which is to be filled and signed by both the patient and the treating Consultant. The patient is to produce the insurance policy (current and renewed) and ID card to the staff in the insurance cell. These will be faxed to the insurance / TPA office for approval. After receiving the authorisation the patient have to contact the treating Consultant for a date for admission.

Emergency Admission

In the case of an emergency admission, the patient holding a mediclaim policy from any of the recognised companies can get admitted by producing the mediclaim ID card at the registration counter.
Following admission they are advised to contact the insurance cell as early as possible and furnish the particulars required for obtaining sanction for cashless treatment.
In cases where the patient requires an emergency procedure / investigation / treatment they are to deposit the required amount which will be later refunded once the sanction from the Insurance / TPA is received. The payment also can be made in the form of a guarantee cheque.

Hospitalisation

During the course of hospitalisation if the patient requires any additional treatment / procedure apart from the one planned originally for which sanction was obtained, this is to be brought to the notice of the insurance cell.
The Insurance / TPA will be informed and an application for an additional sanction will be made. In the event the additional sanction is not granted, the patient is to pay the amount out of pocket prior to discharge. If the recommended treatment is beyond the scope of GKNM Hospital, then the patient will be referred to a Centre where it is available and the bills will be included in the final bill.

Pre-Authorisation

Patients are expected to give correct information about their present and past illnesses and complaints to fill the pre-authorisation form to be sent to the insurance / TPA. Information once submitted, will not be changed or altered for any reason. The same details will be given in the discharge papers also. Health information should not be concealed or altered while informing the treating Consultant, as this will affect the plan of treatment and also result in non sanction of claim.

Discharge Process

On discharge the patient is to pay all the expenses listed as “Non medicals / Non payables / Dis allowable items” by the Insurance / TPA prior to settling the final bill. They are to collect a copy of the Discharge Summary and copies of all investigation reports from the Staff Nurse-Ward in charge before discharge.
The original hospital bill, pharmacy bills, prescriptions, investigation reports, discharge summary will be retained by the Insurance Cell and sent to the Insurance / TPA for reimbursing the expenses incurred by the hospital.
At the time of discharge the patient has to wait till the insurance cell gets the final sanction from the Insurance / TPA. In case of the re-sanction not materialising immediately, the patient has to stay back in the hospital till such time the additional claim is approved.
In case the approval is received after working hours the patient has to wait till the next working day for discharge. Patients are requested to cooperate with the insurance cell to get clearance from the insurance / TPA. The patient has to pay charges for diseases for which no cover is provided by insurance companies / TPAs.

Tamil Nadu Chief Minister's Comprehensive Health Insurance Scheme (CMCHIS - PMJAY)

GKNM Hospital is recognised under the Tamil Nadu Chief Minister's Comprehensive Health Insurance Scheme (CMCHIS - PMJAY) to provide treatment (outpatient and inpatient care) in the following specialties.

Cardiology
Oncology (Radiation therapy)
Cardiothoracic Surgery
Interventional Radiology

This scheme is applicable to the CMCHIS card holders. The following documents (originals) are to be produced by the individuals who wish to avail the scheme.

Smart Card (CM Scheme Card) issued by Tamil Nadu Govt.
Ration Card (Old and New)
Birth Certificate (for children whose name is yet to be added in the ration card)
Old Age Pensioner Card with VAO certificate
Uzhavar Pathukappu Card
Srilankan refugees’ card with VAO certificate

For further information regarding the CM scheme in GKNM Hospital, kindly contact the Liaison officer / staff in 'Tamil Nadu Chief Minister's Comprehensive Health Insurance Scheme (CMCHIS - PMJAY) cell located in 'D Block'

General Information

Patients can inform about their mediclaim policy while registering in the outpatient department itself. Brochures with full information about availing cashless insurance services are available in the insurance division.

Contact details to avail cashless facility

All activities regarding Cashless and Mediclaim services are co-ordinated by personnel of the insurance division at GKNM Hospital. The insurance division is located at ‘C’ Block room no. A – 023 and functions on all 7 days in a week except hospital holidays .

Contact Number

For Private Insurance / TPA

0422 - 4305676, 0422- 4305207
Mail ID : insurance@gknmh.org

(Mon – Sat)8.30 am - 10.00 pm

(Sun)9.00 am - 5.00 pm

For CMCHIS

Contact Number: 0422- 4305700

Timing8.30 am - 6.00 pm

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