Process Guidelines

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Process Guidelines:

Lifekaplan.com is a Closed User Group (CUG) Portal & access to the same is by invitation only. The intended users include TATA Group employees, Employees of Corporates serviced by TMIBASL & Affinity Groups.

  • User Management: For accessing LifeKaplan portal, User Needs to Register himself by entering Basic Details like Name, Email, Mobile no and City
  • Only whitelisted email domains will be allowed to Register into Portal
  • Authentication OTP will be triggered to User's Email ID and Mobile No. After entering both the OTPs correctly system will activate the User Account
  • User Login will be OTP based on his registered Mobile no which will be valid till Midnight 11:59 Hrs of same day on which OTP is Generated.

Once a user is logged in, there is a gamut of choices displayed to him including the various products under health insurance, super top- up health insurance & retail term life insurance.

Once a user decides to explore any of the listed product categories, subsequent to clicking on the relevant tab, a window asking for basic details relevant to that product category needs to be filled, in order to procure the quote for the chosen line of business.

Basis the input received from the user, multiple quotes from insurance companies are generated. The details usually required to generate a quote are as follows:

Mediclaim

  1. Policy for Individual/ Family
  2. Deductible
  3. Gender
  4. Age
  5. Pin code
  6. Family member count that need to be insured along with their age

Super top –up

  1. Policy for Individual/ Family
  2. Deductible
  3. Gender
  4. Age
  5. Pin code
  6. Family member count that need to be insured along with their age

Term life

  1. Date of Birth
  2. Gender
  3. Policy term
  4. Tobacco habit
  5. Pin code
  6. Sum Assured
  7. Annual Income
  8. Education
  9. Occupation

Quote Comparison: The quote comparative page will display all products and premium options available to the user basis the inputs provided previously. These will include:

  1. Choice of Insurance Companies who have quoted for the user input.
  2. Product details.
  3. The user has an option to know more about the insurer & the selected product including an option to download the product brochure & all other product related documents including the policy wordings and claim forms.
  4. The user also has an option to explore changing the sum assured and witness the corresponding change in premium via a slide scale mechanism.
  5. The screen also provides the user with an option to view and / or edit the previously filled basic information at his discretion.
  6. Additional filters related to product features are also available to allow the user to customise the quote as per his requirement. Example - Pre-existing diseases, co-pay, plan benefits, room rent limits etc.
  7. All product features and related explanations related are readily displayed at a click of a button or simply by hovering the mouse over that section.
  8. The user has an option to send the chosen quote to his email id. The user also have an option of sending this quote to an alternate email if he wants to.

Process flow for Health & Life Insurance

If the customer decides to proceed, then the customer chooses a particular insurer quote and proceeds to provide the following details –

  1. Selected Plan, Proposer’s Details
  2. Insured Details
  3. Other Details (Nominee, Room Category, Rider etc)
  4. Medical Details
  5. Lifestyle information (tobacco and alcohol consumption)

Customer is then allowed to “Edit Information’ or “Make Payment’. On acceptance of terms and conditions, the customer proceeds to make the payment. A proposal transaction number is generated. Finally, the policy is issued and sent to the customer via email.

Note 1: In case of a NSTP case the underwriting process moves offline at the insurer’s end, followed by a request for additional documents and/or additional tests. Once the additional requirements are fulfilled by the customer, the policy is issued.

Note 2: Business Operations will raise IC wise invoices on the basis of the data received from the insurer as a feed file or an excel sheet.

Process flow for Health Insurance

Process flow for Life Insurance

Service Request:
Option A – Customer can place the service request with TMIBASL
Step 1: Customer will have the option to inform TMIBASL via a toll free number or email
Step 2: Call centre executive (CCE) takes the mandatory information over the call. In case a service request is initiated by the customer via email, then the CCE will email and SMS the customer for missing details if any.
Step 3: CCE will email customer for relevant documents to process service request.
Step 4: Once the relevant documents are received, the CCE forwards the documents to the relevant IC, keeping customer in cc. simultaneously, the CCE will update the service request status via email and SMS.
Step 5: CCE will follow up with IC for Intimation (Service Request) No.
Step 6: CCE will email and SMS Intimation (Service Request) No. to customer. Simultaneously, the CCE will update the service request status via email and SMS.
Step 7: Based on agreed SLA, service request stage etc., CCE will share the status with customer through mail & SMS.

Option B – Customer can place the service request with the insurer
Step 1: Insurer to provide a service request dump on a daily basis.
Step 2: CCE to upload the data dump on LKP portal for user dashboard updation on a daily basis.
Step 3: MIS/Dashboard to be shared by CCE with the Business team on the pre-agreed frequency.
Step 4: CCE to match Intimation (Service Request) No. with the relevant customer ID, if applicable.
Step 5: Based on agreed SLA, service request stage etc., CCE will share the status with customer through mail & SMS.

Process flow for Health & Life Insurance

Note: The below screenshot will be replaced by the actual screenshot of LKP, when available

Claims Process (Health) – Reimbursement Claims:

Step 1: Customer intimates the claim to TMIBASL via Email or Toll free number.
Step 2: CCE takes request from customer with mandatory details.
Step 3: CCE emails customer for documents to be submitted to the TPA (along with TPA details).
Step 4: Customer submits the claim to the TPA.
Step 5: Scrutiny of the documents (submitted by the customer) is done by the in-house TPA team.
Step 6A: If documents are found to be incomplete, then the customer is informed by e-mail and SMS about the requirement by the CCE/TPA.
Step 6B: If the documents are found to be complete, then claim is taken for further processing.
Step 7: TPA assigns a claim intimation number and emails and SMSs it to the customer.
Step 8A: If a query is raised by the medical/underwriting team, then Query letter sent to the customer by e-mail (with a cc to TMIBASL) with SMS. CCE/TPA updates claim status via email and SMS with details about modes of document submission and designated locations,

  • Step a: Reminder 1 e-mail (with a cc to TMIBASL) sent to the customer with SMS. CCE/TPA updates claim status via email and SMS.
  • Step b: Reminder 2 e-mail (with a cc to TMIBASL) sent to the customer with SMS. CCE/TPA updates claim status via email and SMS.
  • Step c: Final reminder e-mail (with a cc to TMIBASL) sent to the customer.
  • Step di: *Member submits the required documents at the designated locations and the claim is taken for further processing
  • Step dii: If the customer is unable to submit the required documents then the case is closed.

Step 8B: If no query is raised by the medical/underwriting team (i.e. clear case), then a payment advise to Bank for NEFT. Payment advise to be intimated to TMIBASL via Email. CCE/ TPA shares payment advise with the customer via email and SMS. Payment credited to customers account and a automated mail is sent to member. CCE/ TPA updates payment status via email and SMS
Step 8C: If the claim is rejected, then a mail sent to the member with justification for denial. CCE/ TPA informs the customer about the rejection via email and SMS. Email/SMS will also let the customer know about a detailed email that would be sent with reasons for rejection

Claims Process (Health) – Cashless Claims:

Planned Hospitalisation
Step 1: Customer approaches the hospital with the printout of the E-card from TPA 2 days in advance & get the preauthorization form filled Hospital sends the same to TPA
Step 2: TPA receives the request, checks the eligibility, tariff & coverage.
Step 3: If the case is approved, then the approval letter sent to the hospital. CCE/ TPA can intimate the customer about the approval via Email and SMS.
Step 4: If the case is rejected, then a denial letter sent to the hospital, with the justification for denying the cashless request. CCE/ TPA can intimate the customer about the denial via Email and SMS.

Emergency Hospitalisation
Step 1: Customer approaches the hospital to inform that he is covered by TPA XYZ. Hospital starts the treatment. Customer or customer's relative fills the preauthorization form and sends it to the TPA within 24 hrs of hospitalization.
Step 2: TPA receives the request, checks the eligibility, tariff & coverage.
Step 3: If a query is raised, then a query letter is sent to the hospital. Customer or the customer's relative gets the requirement fulfilled from the treating doctor. CCE/ TPA to intimate the customer about the request via Email and SMS and communicate the timeframe within which the query needs to be resolved.
Step 4: After getting the query resolved, the hospital faxes the letter to the TPA.
Step 5: If the case is approved, then the approval letter sent to the hospital. CCE/ TPA can intimate the customer about the approval via Email and SMS.
Step 6: If the case is rejected, then a denial letter sent to the hospital, with the justification for denying the cashless request. CCE/ TPA can intimate the customer about the denial via Email and SMS.

Please click the link below for the Process Flow for Health – Reimbursement and Cashless Claims

Claims Process (Life):
Option A – Customer can place the service request with TMIBASL
Step 1: Customer will have the option to inform TMIBASL via a toll free number or email
Note: At the time of intimation only the following information needs to be provided:

  • Policy number
  • Name of the deceased Insured person
  • Insured person’s Date of Birth and
  • Place and cause of death

Step 2: Call centre executive (CCE) takes the mandatory information over the call. In case a service request is initiated by the customer via email, then the CCE will email and SMS the customer for missing details if any.
Step 3: CCE will email customer the Documents Checklist along with the Claims Form. The Document Checklist is as follows –

  • Original copy of Completed Claimant Statement by the policyholder and designated beneficiary, with Policyholder’s Company stamp and authorized signature.

(Signature of the beneficiary is also required on the claim form)

  • Attested NEFT form (attested by the respective Bank) along with a copy of the cancelled cheque (with the printed name of the policyholder/nominee)

OR a Bank passbook front page copy, to validate the account details & IFSC Code of the payee.

  • Original/attested true copy of death certificate by Municipal Authority.
  • Certification of date of birth of the insured member on a letterhead signed by authorised signatory / Email from the ID of the Authorised signatory.
  • Attested true copy of last two month’s salary slip /appointment letter /promotion letter /increment letter confirming grade/designation of the insured member. 
  • Member Enrolment Form with name of the beneficiary mentioned.
  • Attested true copy of relationship proof between designated beneficiary and insured member.
  • If death is natural in addition to above documents – original/attested true copy of Death Certificate by doctor, with cause of death shown.
  • If death is due to accident in addition to above documents
  • Original/attested true copy of Police Investigation Reports,
  • If post-mortem is conducted then original/attested true copy of Post Mortem report is required.

Any other additional document might arise post scrutiny of the claim and which might not be a part of the above checklist.
Step 4: Once the relevant documents and the claims form are received, the CCE will forward the documents to the relevant IC, keeping customer in cc. Simultaneously, the CCE will update the claims status via email and SMS.
Step 5: CCE will follow up with IC for Claim No.
Step 6: CCE will email and SMS for Claim No to customer. Simultaneously, the CCE will update the claims status via email and SMS.
Step 7: Based on agreed SLA, service request stage etc., CCE will share the status with customer through mail & SMS.

Option B – Customer can place the claim request with the insurer
Step 1: Insurer to provide a service request dump on a daily basis.
Step 2: CCE to upload the data dump on LKP portal for user dashboard updation on a daily basis.
Step 3: MIS/Dashboard to be shared by CCE with the Business team on the pre-agreed frequency.
Step 4: CCE to match Claim No. with the relevant customer ID, if applicable.

Step 5: Based on agreed SLA, claim stage etc., CCE will share the status with customer through mail & SMS.

Process flow for Life Insurance

Note: The below screenshot will be replaced by the actual screenshot of LKP, when available

Grievance Handling for Health and Life Insurance:
An email ID along with a toll free number will be displayed on the LKP portal for grievance registration. Once a grievance is received, the CCE will highlight the same to the Business Team including the Principal Officer whose contact details will also be provided.
Escalation Matrix will be put into use if the closure does not happen within agreed TAT.