- Количество слайдов: 22
www. coris. fr CORIS International A Presentation for Star Health and Allied Insurance Company Limited
Introduction to Coris • Coris International is an International Assistance Company established in 1987. • CORIS International quickly developed its network worldwide, handling international claims and assistance on behalf of insurance companies and automobile clubs to the highest professional standards • Coris International owns 50 offices worldwide in 47 Countries around the world. • Coris International has 34 tie up offices in 30 countries around the world.
Introduction to Heritage • Heritage Health TPA Pvt. Ltd. , established on 30 th December, 1998, is the Indian Co-ordinator of CORIS International since July 2002 and having its offices as under : Registered : Mcleod House, 3 Netaji Subhas Road, Kolkata – 700 001. Tel : +91 33 22484648 Corporate : Nicco House, 5 th Floor, 2 Hare Street, Kolkata – 700 001. Tel : +91 33 22486430; 22482784 Front Office : 1102, Raheja Chambers, 11 th Floor, Free Press Journal Road, Nariman Point , Mumbai – 400 021. Tel : +91 22 66547960/ 61
Introduction to Coris International and Heritge Health are the overseas medical service provider (OSP) for the GIPSA (Public Sector) Companies namely : National Insurance Co. Ltd. New India Assurance Co. Ltd. Oriental Insurance Co. Ltd. And United India Co. Ltd. and a few private players namely : Star Health & Allied Insurance Co. Ltd. Universal Sompo General Insurance Co. Ltd.
CORIS Network Own & Tie-up Offices - Europe Albania - Tirana Andorra – La Velle Austria - Vienna Belarus – Minsk Belgium – Gent Bulgaria - Sofia Croatia – Zagreb Cyprus - Limassol Czech Rep. – Prague Denmark - Copenhagen Finland - Tuusula France – Paris (2) Germany – Munich / Voerde Greece- Athens Hungary - Budapest Italy – Milan Latvia - Riga Lithuania – Vilnius Malta – Valletta Norway – Oslo Poland - Warsaw Portugal - Oeiras Romania - Bucharest Russia - Moscow Serbia - Belgrade Slovakia - Bratislava Slovenia - Ljubljana Spain – Madrid (2) Sweden – Stockholm Switzerland (Tie-up Office also) Turkey Ukraine - Kiev UK – London / Farnham
CORIS Network Own & Tie-up Offices – North & South America North and South America USA - Miami Argentina - Buenos Aires Brazil - Sao Paulo Colombia - Bogotá Ecuador - Quito Mexico - Mexico D. F. Uruguay - Montevideo
CORIS Network Own & Tie-up Offices – Africa & Middle East Africa and Middle East Egypt – Cairo Israel – Tel Aviv Kenya – Nairobi Morocco – Casablanca Saudi Arabia – Riyadh South Africa – Edenvale Tunisia – Tunis
CORIS Network Own & Tie-up Offices – Asia Pacific Australia China India Malaysia Singapore Sri Lanka Thailand • The Haj Experience
Introduction to Coris • Coris has allocated 3 centres to cater to the policy holders of Travel policies as under : • • Coris USA Inc: 11900 Biscayne Blvd # 803, Miami, Florida 33181, USA Jurisdiction : North, Central & South America • • • Coris International & Coris Assistance : 110 Avenue de la république 75011 Paris, France Jurisdiction : Continental Europe, UK & Ireland, Africa, Pakistan • Heritage Health TPA Pvt. Ltd. : 1102, Raheja Chambers, Free Press Journal Road, Nariman Point, Mumbai- 400 021, India. Jurisdiction : South & South East Asia, Middle East, Australia & New Zealand •
COORDINATING OFFICES Paris Miami North & South America Europe , Africa &Middle East ( Incl. Pakistan) Mumbai Asia Pacific Region (Excl. Pakistan)
Details of Toll Free Numbers (America, Europe, & India) Europe - Toll Free Numbers - No. (800) - 4141 4444 is operative and can simultaneously handle 25 incoming calls at a time. Toll-Free lines are manned by employees fluent in English. North America - Toll Free Numbers - +1 -877 -5367264 & +1 -8003589105 can handle several incoming calls simultaneously and is operative all over North America including Canada. Toll-Free lines are manned by employees fluent in English. India - Phone no. 1800 224004 (Toll Free) is operative in India. Toll. Free lines are manned by employees fluent in Hindi & English.
CORIS Employees dealing with Health Insurance Claims CORIS worldwide employs more than 900 persons in their own offices dealing with Travel Health Insurance Claims, for Example: • France – 57 employees • USA – 50 employees • India – 20 employees CORIS Management in most countries have over 25 years of Experience in the business • 95% of the staff that are recruited are multi-lingual and are fluent in more than one language
Coris’s Tie-up with Hospitals in US/ Canada and Other countries CORIS Group has Twelve Thousand Five Hundred plus tie ups with Medical Service Providers (Hospitals) all over the world out of which in USA alone, CORIS has over : · 6, 200 tie ups with Hospitals In addition to above CORIS has also tied up with : · 400, 000 with Physicians in USA · 40, 000 with Dental Physicians in USA · 80, 000 with Medical Centers in USA The list of hospitals in USA/ Canada and other countries can be viewed on the website www. coris-heritage. com
Process-Flow of a Claim - First Call - Assistance - Evaluation of Medical Records - Determining of Admissibility of the Claim - Issuance of Cost Guarantee to the Provider - Processing - Billing - Payment - To Insured / To Provider
First Call • • • Calls received at the Toll-Free numbers at Coris Operator at Coris answers the call and verifies the information For GIPSA Cos and Star Health the policy is faxed to the number shown in the Policy For a valid policy the Claim Dossier is created for the Insured in the Software which Includes: – Type of Loss – Type of Assistance Required Software will generate a Reference No. which will be given to the Insured for tracking the claim status online and for quoting the same in all future correspondences Even if the Call requires no Assistance, all the data of the call is recorded on the system. The Call Centre at Coris will have all the information required to handle the situation and will guide the Insured on: – The claims process – The deductible and SI – The documentation – The exclusions
Assistance ASSISTANCE - CORIS • If Assistance is required, then Coris will arrange for the Assistance which would be Arranging the following: – Ambulance – Doctor’s Visit / Appointment – Referral to Nearest Hospital – Legal Assistance – Any other type of assistance required
Evaluation of Medical Records • The different types of Medical Claims will be taken care of by the following services as under: – OPD – Hospitalisation / ER (Emergency Room) • For OPD Treatment, the following documents will be sent to Coris: – Doctor’s Diagnosis – Reports • For Hospitalisation / ER, the following documents will be sent to Coris: – Admission Diagnosis – Reports and Discharge Summary • Coris’ Medical Department will Evaluate the Medical Records
Determining the Admissibility of the Claim • After Evaluation of the Medical Records by Coris’ Medical Panel, the admissibility of the claims will be determined based on the following criteria: – – The Claim is not ELECTIVE, but a NECESSITY Not due to a pre-existing disease Not the sole reason for the trip The customer should not have availed of treatment if not needed
Issuance of Cost Guarantee / Authorisation to the Provider • Coris will provide the cost guarantee / authorisation for the procedure to the provider • If the claim is not admissible, then Coris will inform the patient and the provider accordingly • All Medical Reports / Discharge Summary received by Coris will be scanned for completing the documentation required for claims processing
Services by Heritage Services Provided by Heritage Health TPA Pvt. Ltd. 1. 2. 3. 4. 5. 6. High quality 24 x 7 service through Indian languages speaking operators. Strong web enabled client server based software. Online with Coris Network worldwide. Helping in reconciliation & management of funds between Coris and Star Health. Maintaining confidentiality. Respond to any queries raised by the Star Health.
Services by Heritage 8. Guide clients in completing claim documentation 9. Process and sanction claims upto US $ 3000 10. Maintain complete liaison between Coris and Star Health 11. Investigate in India, if needed, any doubtful and specific claim. 12. Provide information on claims every month to Star Health. 13. Follow up with Coris on specific enquiries for claims. 14. Consolidate premium data received from Star Health to Coris.
www. coris. fr Thank you CORIS INTERNATIONAL | 110 Avenue de la république 75011 Paris, France Tél. 33(1) 41 61 23 07 | Fax : 33 (1) 44 51 16 93 | Email : [email protected] fr