Insurance and 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.

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