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Health Insurance for Individuals and Family protects your family and yourself with our Health Insurance Plans and gives you protection during sudden illness, surgeries, accidents and against acts of terrorism. Also get tax benefits under section 80D. |
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Family Health Insurance protects you your family's health and it is indeed the perfect answer for the entire family. It covers your whole family under a single premium with a common Sum Insured. No need to worry when the emergency strikes this is like a shield to protect you from the financial worry at the time of any crisis. |
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Secure your family now with the benefits of the insurance like never before. |
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No medical check up to the age of 55. |
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Also covers hospitalization activities arising out of |
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terrorist activities, Accident, |
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This policy also covers you for hospitalization for any ailments including cases of Swine Flu / H1N1 influenza. |
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Protects your Family in case of hospitalization for any ailments including cases of Swine Flu. |
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BANKSHARE™ GOLDEN HEALTH PALN Individual and Family Plans Health Maintenance Organizations (HMO) and Network |
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Our HMO and Network plans give you access to quality care with our excellent network of participating physicians. In addition, we offer HMO Open Access and Network Open Access plans, which allow you to visit in-network specialists without a referral from your BANKSHARE™ Plans & Services — HMO and Network |
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Features & Benefits |
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The Right Care at the Right Price |
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BANKSHARE™ GOLDEN HEALTH PLAN Health Maintenance Organization (GHPHMO) and Network plans offers access to quality health care from a broad network of participating physicians. During enrollment, members may choose a Primary Care Physician (PCP) who may provide routine care, coordinate care and provide referrals to in-network specialists and facilities.
During an emergency or urgent care situation, members may receive approval to use out-of-network services in a GHPHMO/Network plan. |
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Here is a summary of your plan's services and how to arrange for care. |
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Routine Medical Care comprises of physical examination for mild fever and pains, chronic pain and headaches, colds and flu.
Call your Primary Care Physician's (PCP) office during ofifce hours and he or she will provide you with medical advice and/or schedule an office visit for you. |
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Specialty Care (such as orthopedic or heart disease)
Make an appointment with your PCP for an initial assessment, and he or she will refer you to a participating specialist if needed. |
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Hospital Care (such as inpatient care and surgery, or outpatient surgery)
For non-emergency care, call your PCP and he or she will coordinate all your hospital care. |
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Urgent Medical Care (such as fever, sprains or strains, eye or ear infections, or severe sore throat)
Call your PCP. He or she will assess your situation and if necessary, give you advice on where to seek immediate care. |
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Emergency Care (such as poisoning, chest pains, broken bones, uncontrolled bleeding, loss of consciousness or sudden paralysis)
Go to the nearest emergency facility or call ___. Call your PCP as soon as reasonably possible and he or she will coordinate all follow-up care. |
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If you have a question about your health, call your BANKSHARE™ PCP. And for questions about your health plan or coverage, call the toll-free number on your BANKSHARE™ HealthCare ID card. |
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How does the GHPHMO/Network Plan work for you? |
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You selected a BANKSHARE™ HealthCare PCP to be your overall care coordinator, and make an appointment regarding the pain in your lower legs. Then your PCP refers you to a lab and X-ray facilities for additional tests before referring you to an orthopedic specialist. |
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Cost Example |
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Your initial Fund balance contributed by your employer and you
Your coverage for you and your family is |
Rs 17,000.00
Rs 10,00,000.00 |
| You see your doctor for your physical in a year |
Rs 10,000.00 |
| A minor accident sends you to the emergency room. |
1,00,000.00 |
| You fill your regular medicines . |
50,000.00 |
| Pharmacy Cost ( Subject to approval if applied for additional Pharmacy Coverage. |
Nil |
Lab fee
(No cost to you, No deductible applies)
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Nil |
X-rays
(No cost to you, No deductible applies) |
Nil |
You will be able to claim till Rs 10,00,000.00 each calendar year for you and your family.
Your balance claim will not be available to roll over to the next year. |
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These scenarios are for example only and may not reflect your actual experience. ( There can be no legal binding in the illustration above ) |
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Employer Advantages |
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Benefits |
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Flexible HMO/Network plan designs include benefits for employees and employers alike: |
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No referrals required for OB/GYN care or maternity care |
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Lower co-payments or out-of-pocket costs for urgent care |
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Pharmacy and behavioral-care benefits.(Subject to approval and type of plans) |
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Consolidated billing, accounting, reporting and banking |
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Standard health and wellness features, with optional features available at an additional cost. |
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Special Support Network |
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We've designed a flexible communication program to help your employees understand their plan and make better health care purchase decisions. |
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Your implementation manager will help you every step of the way with communication strategies and materials that best suit you and your employees. |
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Funding Options |
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Choose from multiple funding options: |
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Fully Insured |
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Full premium paid monthly/ yearly |
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Predetermined and guaranteed rates |
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Predictable, easy-to-budget expenses |
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Protection from high claim costs |
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Fully Insured - Participating |
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Full premium paid monthly / yearly |
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Predetermined and guaranteed rates |
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Predictable, easy-to-budget expenses |
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Protection from high claim costs |
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Year-end settlement |
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Minimum Premium |
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Lower premium paid monthly |
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Claims funded through your bank account with a monthly claim cap |
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Protection from high claim costs |
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Year-end settlement |
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Improved cash flow |
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Lower expenses and premium taxes |
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Administrative Services Only |
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No monthly premium or premium taxes paid, just an administrative fee |
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Exempt from most state regulations and mandates on coverage levels |
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Stop Loss coverage available |
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Maximizes cash flow |
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Freedom to design your health benefits |
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Financial protection against unanticipated, catastrophic claims |
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Do I have to choose a PCP? |
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You are required to choose a Primary Care Physician PCP), unless you are enrolled in a HMO Open Access or Network Open Access plan. |
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What if my doctor isn't on your list? |
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That means your doctor does not participate in the network. To receive coverage for healthcare benefits, you should select a doctor from the list of participating HMO or Network providers. Participating providers must meet standards to become a part of the network. |
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Do I need a referral to see a specialist? |
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Yes, unless you are enrolled in a HMO Open Access or Network Open Access plan. If you choose to see an out-of-network specialist, the health care services you receive will not be covered. |
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What is the difference between in-network coverage and out-of-network coverage? |
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HMO and Network products are lock in products. This means that a member will only be reimbursed for care covered through a BANKSHARE™ network provider. |
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How do I find participating doctors? |
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Search for participating HMO/Network Provider in the Provider Directory or visit the online directory at www.BANKSHARE™mic.com and select HMO/Network plans. |
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What is utilization review? |
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Utilization review is a process that helps determine if the services you receive are a covered benefit. BANKSHARE™ HealthCare performs utilization review, including hospital pre-admission certification, continued stay review and case management. Requests for non-emergency hospital stays other than maternity stays must be approved in advance. |
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Pre-certification is not required for a maternity stay of 48 hours for normal deliveries, or 96 hours for caesarean sections. Depending on your benefits plan, you may be eligible for additional benefits. Any maternity hospital stay beyond the initial 48 or 96 hours must be approved. Please call the toll-free number on your BANKSHARE™ HealthCare ID card for details. |
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Who is responsible for obtaining pre-certification? |
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Your doctor will help you decide which procedures require hospital care and which can be handled on an outpatient basis. If your doctor participates in the network, he or she will arrange for pre-certification. |
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What if my doctor keeps me in the hospital longer than my pre-certification allows? |
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BANKSHARE™ GOLDEN HEALTH PLAN HealthCare will contact your hospital the day before you are scheduled to be discharged. If your physician has extended your stay, then the additional days will be reviewed for coverage. BANKSHARE™ GOLDEN HEALTH PLAN HealthCare will continue to review your hospital stay for coverage until you are discharged. |
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If you remain in the hospital for services that are not covered, your out-of-pocket costs may be higher. |
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Can my current doctor be added to your network? |
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If your current doctor meets our credentialing standards and is interested in becoming a participating provider, he or she can call our Provider Relations Department to get more information on joining the Network. |
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What if my doctor is on the list, but his/her office is shown as "accepting current patients only"? Can I still choose my doctor? |
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If you are an existing patient of a participating doctor, you may select him or her to provide your care. |
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Am I covered for emergency care? |
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Whenever there is an emergency, seek medical help immediately. An emergency is an accident or sudden illness that a person with average knowledge of medical science believes needs to be treated right away or it could result in serious medical complications or permanent disability. |
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Our GHPHMO and Network Point of Service (NPOS) plans let you decide where to get care. You may use out-of-network providers, but your costs are lower and level of coverage higher when you use GOLDEN HEALTH PLAN HealthCare participating providers. |
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