Common use of Cashless Access of Services Clause in Contracts

Cashless Access of Services. a. The AB-PMJAY beneficiaries shall be provided treatment free of cost for all such ailments covered under the Scheme within the limits/ sub-limits and sum insured, i.e., not specifically excluded under the Scheme. b. The insurer shall reimburse EHCP as per the package cost specified in this Document agreed for specified packages or as pre-authorised amount in case of unspecified packages. c. The Insurer shall ensure that each EHCP shall at a minimum possess the Hospital IT Infrastructure required to access the AB-PMJAY Beneficiary Database and undertake verification based on the Beneficiary Identification process laid out, using unique AB- PMJAY Family ID on the AB-PMJAY Card and also ascertain the balance available under the AB-PMJAY Cover provided by the Insurer. d. The Insurer shall provide each EHCP with an operating manual describing in detail the verification, pre-authorisation and claims procedures within 7 days of signing of agreement. e. The Insurer shall train Xxxxxxxx Xxxxxx that are deputed in each EHCP who responsible for the administration of the AB-PMJAY on the use of the Hospital IT infrastructure for making Claims electronically and providing Cashless Access Services. f. The EHCP shall establish the identity of the member of a AB-PMJAY Beneficiary Family Unit by Aadhaar Based Identification System (No person shall be denied the benefit in the absence of Aadhaar Card through use of alternate Government ID) and ensure: (i) That the patient is admitted for a covered procedure and package for such an intervention is available. (ii) AB-PMJAY Beneficiary has balance in her/ his AB-PMJAY Cover amount. (iii)Provisional entry shall be made on the system using the AB-PMJAY ID of the patient. It has to be ensured that no procedure is carried out unless provisional entry is completed through blocking of procedure.

Cashless Access of Services. a. The AB-PMJAY XXXX XXXXXXXX UTTARAKHAND beneficiaries shall be provided treatment free of cost for all such ailments covered under the Scheme within the limits/ sub-limits and sum insuredbenefit limit, i.e., not specifically excluded under the Scheme. b. The insurer EHCP shall reimburse EHCP be reimbursed as per the package cost specified in this the Tender Document agreed for specified packages or as pre-authorised amount in case of unspecified packages. c. The Insurer SHA / ISA shall ensure that each EHCP shall at a minimum possess the Hospital IT Infrastructure required to access the AB-PMJAY XXXX AYUSHMAN UTTARAKHAND Beneficiary Database and undertake verification based on the Beneficiary Identification process laid out, using unique AB- PMJAY XXXX XXXXXXXX UTTARAKHAND/AB-NHPM Family ID on the XXXX AYUSHMAN UTTARAKHAND/AB-PMJAY NHPM Card and also ascertain the balance available under the AB-PMJAY XXXX XXXXXXXX UTTARAKHAND Cover provided by the InsurerSHA. d. The Insurer SHA/ ISA shall provide each EHCP with an operating transaction manual describing in detail the verification, pre-authorisation and claims procedures within 7 days of signing of agreementprocedures. e. The Insurer SHA / ISA shall train Xxxxxxxx Xxxxxx Arogya Mitras that are will be deputed in each EHCP who that will be responsible for the administration of the AB-PMJAY XXXX AYUSHMAN UTTARAKHAND on the use of the Hospital IT infrastructure for making Claims electronically and providing Cashless Access Services. f. The EHCP shall establish the identity of the member of a AB-PMJAY XXXX XXXXXXXX UTTARAKHAND Beneficiary Family Unit by Aadhaar Based Identification System (No person shall be denied the benefit in the absence of Aadhaar Card through use of alternate Government IDCard) and ensure: (i) That the patient is admitted for a covered procedure and package for such an intervention is available. (ii) AB-PMJAY XXXX AYUSHMAN UTTARAKHAND Beneficiary has balance in her/ his AB-PMJAY XXXX XXXXXXXX UTTARAKHAND Cover amount. . (iii)Provisional iii) Provisional entry shall be made on the system server using the XXXX AYUSHMAN UTTARAKHAND / AB-PMJAY NHPM ID of the patient. It has to be ensured that no procedure is carried out unless provisional entry is completed through blocking of procedureclaim amount. (iv) At the time of discharge, the final entry shall be made on the patient account after completion of Aadhaar Card Identification Systems verification or any other recognised system of identification adopted by the SHA of XXXX XXXXXXXX UTTARAKHAND Beneficairy Family Unit to complete the transaction.

Cashless Access of Services. a. The AB-PMJAY NHPM beneficiaries shall be provided treatment free of cost for all such ailments covered under the Scheme within the limits/ sub-limits and sum insured, i.e., not specifically excluded under the Scheme. b. The insurer EHCP shall reimburse EHCP be reimbursed as per the package cost specified in this the Tender Document agreed for specified packages or as pre-authorised amount in case of unspecified packages. c. The Insurer SHA/ Insurer/ ISA shall ensure that each EHCP shall at a minimum possess the Hospital IT Infrastructure required to access the AB-PMJAY NHPM Beneficiary Database and undertake verification based on the Beneficiary Identification process laid out, using unique AB- PMJAY AB-NHPM Family ID on the AB-PMJAY AB- NHPM Card and also ascertain the balance available under the AB-PMJAY NHPM Cover provided by the Insurer. d. The Insurer SHA/ Insurer/ ISA shall provide each EHCP with an operating transaction manual describing in detail the verification, pre-authorisation and claims procedures within 7 days of signing of agreementprocedures. e. The Insurer SHA / Insurer/ ISA shall train Xxxxxxxx Xxxxxx that are will be deputed in each EHCP who that will be responsible for the administration of the AB-PMJAY NHPM on the use of the Hospital IT infrastructure for making Claims electronically and providing Cashless Access Services. f. The EHCP shall establish the identity of the member of a AB-PMJAY NHPM Beneficiary Family Unit by Aadhaar Based Identification System (No person shall be denied the benefit in the absence of Aadhaar Card through use of alternate Government IDCard) and ensure: (i) That the patient is admitted for a covered procedure and package for such an intervention is available. (ii) AB-PMJAY NHPM Beneficiary has balance in her/ his AB-PMJAY NHPM Cover amount. . (iii)Provisional iii) Provisional entry shall be made on the system server using the AB-PMJAY NHPM ID of the patient. It has to be ensured that no procedure is carried out unless provisional entry is completed through blocking of procedureclaim amount. (iv) At the time of discharge, the final entry shall be made on the patient account after completion of Aadhaar Card Identification Systems verification or any other recognised system of identification adopted by the SHA of AB-NHPM Beneficairy Family Unit to complete the transaction.

Cashless Access of Services. a. The AB-PMJAY PMJAY, MA and MAV beneficiaries shall be provided treatment free of cost for all such ailments covered under the Scheme within the limits/ sub-limits and sum insured, i.e., not specifically excluded under the Scheme. b. The insurer shall reimburse EHCP as per the package cost specified in this Document agreed for specified packages or as pre-authorised amount in case of unspecified packages. c. The Insurer shall ensure that each EHCP shall at a minimum possess the Hospital IT Infrastructure required to access the AB-PMJAY PMJAY, MA and MAV Beneficiary Database and undertake verification based on the Beneficiary Identification process laid out, using unique AB- PMJAY AB-PMJAY, MA and MAV Family ID on the AB-PMJAY PMJAY, MA and MAV Card and also ascertain the balance available under the AB-PMJAY PMJAY, MA and MAV Cover provided by the Insurer. d. The Insurer shall provide each EHCP with an operating manual describing in detail the verification, pre-authorisation and claims procedures within 7 days of signing of agreement. e. The Insurer shall train Xxxxxxxx Xxxxxx that are deputed in each EHCP who responsible for the administration of the AB-PMJAY PMJAY, MA and MAV on the use of the Hospital IT infrastructure for making Claims electronically and providing Cashless Access Services. f. The EHCP shall establish the identity of the member of a AB-PMJAY PMJAY, MA and MAV Beneficiary Family Unit by Aadhaar Based Identification System (No person shall be denied the benefit in the absence of Aadhaar Card through use of alternate Government ID) and ensure: (i) That the patient is admitted for a covered procedure and package for such an intervention is available. (ii) AB-PMJAY PMJAY, MA and MAV Beneficiary has balance in her/ his AB-PMJAY PMJAY, MA and MAV Cover amount. . (iii)Provisional iii) Provisional entry shall be made on the system using the AB-PMJAY ID of the patient. It has to be ensured that no procedure is carried out unless provisional entry is completed through blocking of procedure. (iv) At the time of discharge, the final entry shall be made on the patient account after completion of Aadhaar Card Identification Systems verification or any other recognised system of identification adopted by the SHA of AB-PMJAY, MA and MAV Beneficiary Family Unit to complete the transaction.

Cashless Access of Services. a. a) The AB-PMJAY beneficiaries shall be provided treatment free of cost for all such ailments covered under the Scheme within the limits/ sub-limits and sum insured, i.e., not specifically excluded under the Scheme. b. b) The insurer ISA shall reimburse EHCP as per the package cost specified in this Document agreed for specified packages or as pre-authorised amount in case of unspecified packages. c. c) The Insurer ISA shall ensure that each EHCP shall at a minimum possess the Hospital IT Infrastructure required to access the AB-PMJAY Beneficiary Database and undertake verification based on the Beneficiary Identification process laid out, using unique AB- PMJAY Family ID on the AB-PMJAY Card and also ascertain the balance available under the AB-PMJAY Cover provided by the InsurerISA. d. d) The Insurer ISA shall provide each EHCP with an operating manual describing in detail the verification, pre-authorisation and claims procedures within 7 days of signing of agreement. e. e) The Insurer ISA shall train Xxxxxxxx Xxxxxx that are will be deputed in each EHCP who that will be responsible for the administration of the AB-PMJAY on the use of the Hospital IT infrastructure for making Claims electronically and providing Cashless Access Services. f. f) The EHCP shall establish the identity of the member themember of a AB-PMJAY Beneficiary Family Unit by Aadhaar Based Identification System (No person shall be denied the benefit in the absence theabsence of Aadhaar Card through use of alternate Government ID) and ensure: (i) That the patient is admitted for a covered procedure and package for such an intervention is available. (ii) AB-PMJAY Beneficiary has balance in her/ his AB-PMJAY Cover amount. . (iii)Provisional iii) Provisional entry shall be made on the system server using the AB-PMJAY ID of the patientthepatient. It has to be ensured that no procedure is carried out unless provisional entry is completed through blocking of procedureclaim amount. (iv) At the time of discharge, the final entry shall be made on the patient account after completion of Aadhaar Card Identification Systems verification or any other recognised system of identification adopted by the SHA of AB-PMJAY Beneficairy Family Unit to complete the transaction. g) Provided the SHA has entrusted the responsibility of beneficiary verification to the ISA, the ISA shall ensure due diligence and rigorous review at the time of giving approvals of beneficiary identity at the time of registration in an EHCP as per beneficiary identification guidelines under AB-PMJAY issued by the SHA from time to time. Any violation of the beneficiary identification guidelines at the time of issuing verification and either ineligible person being approved as a beneficiary or an eligible beneficiary being denied timely verification shall be deemed as a material breach of this Contract and a possible episode of fraud; and be liable for further investigations as per the Anti- Fraud Guidelines of the SHA and as per the provisions of the Contract

Cashless Access of Services. a. The AB-PMJAY Ayushman Uttarakhand beneficiaries shall be provided treatment free of cost for all such ailments covered under the Scheme within the limits/ sub-limits and sum insured, i.e., not specifically excluded under the Scheme. b. The insurer EHCP shall be reimburse EHCP as per the package cost specified in this the Tender Document agreed for specified packages or as pre-authorised amount in case of unspecified packages. c. The Insurer ISA shall ensure (Verify IT Infrastructure, oversee its performance and provide training) that each EHCP shall at a minimum possess the Hospital IT Infrastructure required to access the AB-PMJAY Ayushman Uttarakhand Beneficiary Database and undertake verification based on the Beneficiary Identification process laid out, using unique AB- PMJAY Ayushman Uttarakhand Family ID on the AB-PMJAY Card and also ascertain the balance available under the AB-PMJAY Cover provided by the InsurerAyushman Uttarakhand Cover. d. The Insurer ISA shall provide each EHCP with an operating manual describing in detail the verification, pre-authorisation and claims procedures within 7 days of signing of agreementprocedures. e. The Insurer ISA shall train Xxxxxxxx Xxxxxx that are who will be deputed in each EHCP who and they will be responsible for the administration of the AB-PMJAY Ayushman Uttarakhand on the use of the Hospital IT infrastructure for making Claims electronically and providing Cashless Access ServicesServices to the Ayushman Uttarakhand beneficiaries. f. The EHCP shall establish the identity of the member of a AB-PMJAY Ayushman Uttarakhand Beneficiary Family Unit by Aadhaar Based Identification System (No person shall be denied the benefit in the absence of Aadhaar Card through use of alternate Government IDCard) and ensure: (i) That the patient is admitted for a covered procedure and package for such an intervention is available. (ii) AB-PMJAY Ayushman Uttarakhand Beneficiary has balance in her/ his AB-PMJAY Ayushman Uttarakhand Cover amount. . (iii)Provisional iii) Provisional entry shall be made on the system server using the AB-PMJAY Ayushman Uttarakhand ID of the patient. It has to be ensured that no procedure is carried out unless provisional entry is completed through blocking of procedureclaim amount. (iv) At the time of discharge, the final entry shall be made on the patient account after completion of Aadhaar Card Identification Systems verification or any other recognised system of identification adopted by the SHA of Ayushman Uttarakhand Beneficiary Family Unit to complete the transaction.