How are claims processed with India Network Health Insurance?

Claims for the open-network Standard or Premier Plans with India Network Health Insurance follow one of  two processes.

Direct Claim with the Provider and Chartis Claims or Administrative Concepts, Inc. (policies enrolled through ACE American Insurance Group):  This is the typical scenario with a hospital. The visitor presents the India Network Health Insurance enrollment ID to the provider. The hospital follows administrative procedures by contacting India Network, the plan administrator. The visitor medical insurance and deductible amount is confirmed for the visitor.  The India Network Health Insurance ID satisfies the provider with documentation for insurance payments. The visitor is responsible for the deductible amount and the provider works directly with the claims processor for payments in excess of the deductible amount. The member sponsoring the visitor has no involvement for payment with the provider. Any amounts over the reimbursed levels will be the responsibility of the visitor in this scenario.

Claims made by Visitor or Member directly with Chartis Claims or Administrative Concepts, Inc. (policies enrolled through ACE American Insurance Group): This may occur with a doctor visit or multiple visits in excess of the deductible amount. For example, a visitor has a $150,000 Maximum Coverage Standard Plan with a $75 deductible.  The visitor has two doctor visits for the same incident. Each visit is $125. In this scenario, the visitor presents the India Network Health Insurance ID.  The administrative staff at the facility request full payment of $125 at the time of visit.  To expedite reimbursement, the visitor prints the India Network Health Insurance Claim Form from the website at http://www.kvrao.org and has the provider complete their required section. The patient section is completed by the visitor at which time the Claim Form can be sent to the claims process mailing address. In this example, the visitor will receive reimbursements of $50 for the first visit and $125 for the second visit. The claims must be requested within 90 days of the visit.

With the Traditional Plan, India Network Health Insurance recommends using providers in the MultiPlan network. Providers are available from a link on http://www.kvrao.org.  The visitor presents the India Network Health Insurance ID to the provider. The hospital follows administrative procedures by contacting the claims  office directly where the visitor medical insurance and deductible amount is confirmed for the visitor.  The India Network Health Insurance ID satisfies the provider with documentation for insurance payments. The visitor is responsible for the deductible amount and the provider works directly with claims processing for payments. Once the $250 deductible is met, services performed by MultiPlan providers are reimbursed at 80% for the first $5,000 and 100% up to $150,000 for ages 69 and under. If providers outside the MultiPlan network are used in the Network based (80/20) Comprehensive Plan, co-insurance is reduced to 60% reimbursement for the first $5,000.

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