CORIS International A Presentation for Star Health and Allied Insurance Company Limited

CORIS International

www.coris.fr

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.

•Heritage Health TPA Pvt.Ltd., established on 30th 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, 5th Floor, 2 Hare Street, Kolkata – 700 001.

Tel : +91 33 22486430; 22482784

Front Office : 1102, Raheja Chambers, 11th Floor, Free Press Journal Road,

Nariman Point , Mumbai – 400 021.

Tel : +91 22 66547960/ 61

Introduction to Heritage

Introduction to Coris

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. AndUnited India Co.Ltd.

and a few private players namely : 

Star Health & Allied Insurance Co.Ltd. Universal Sompo General Insurance Co.Ltd.

CORIS NetworkOwn & Tie-up Offices - Europe

Albania - TiranaAndorra – La VelleAustria - ViennaBelarus – MinskBelgium – Gent Bulgaria - SofiaCroatia – ZagrebCyprus - LimassolCzech Rep. – PragueDenmark - CopenhagenFinland - TuusulaFrance – Paris (2)Germany – Munich / Voerde Greece- AthensHungary - BudapestItaly – Milan

Latvia - RigaLithuania – VilniusMalta – VallettaNorway – Oslo Poland - WarsawPortugal - OeirasRomania - BucharestRussia - MoscowSerbia - BelgradeSlovakia - BratislavaSlovenia - LjubljanaSpain – Madrid (2)Sweden – Stockholm Switzerland (Tie-up Office also)TurkeyUkraine - KievUK – London / Farnham

Europe

CORIS NetworkOwn & Tie-up Offices – North & South America

Argentina - Buenos AiresBrazil - Sao PauloColombia - Bogotá

Ecuador - QuitoMexico - Mexico D.F.Uruguay - Montevideo

North and South America

USA - Miami

Africa and Middle East

CORIS NetworkOwn & Tie-up Offices – Africa & Middle East

Egypt – Cairo Israel – Tel AvivKenya – Nairobi Morocco – CasablancaSaudi Arabia – RiyadhSouth Africa – Edenvale Tunisia – Tunis

Asia Pacific

CORIS NetworkOwn & Tie-up Offices – Asia Pacific

AustraliaChinaIndiaMalaysiaSingaporeSri LankaThailand

•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 75011Paris,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 OFFICESCOORDINATING OFFICES

MumbaiMiami

Paris

North & South America

Europe , Africa &Middle East ( Incl. Pakistan)

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 & +1-800-3589105 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 MedicalService 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

- 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

Process-Flow of a Claim

• 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

First Call

• 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

ASSISTANCE - CORIS

Assistance

• 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

Evaluation of Medical Records

• 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

Determining the Admissibility of the Claim

• 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

Issuance of Cost Guarantee / Authorisation to the Provider

Services by Heritage

Services Provided by Heritage Health TPA Pvt.Ltd.1. High quality 24x7 service through Indian languages

speaking operators.

2. Strong web enabled client server based software.

3. Online with Coris Network worldwide.

4. Helping in reconciliation & management of funds between Coris and Star Health.

5. Maintaining confidentiality.

6. 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.

CORIS INTERNATIONAL   |  110 Avenue de la république 75011 Paris, FranceTél. 33(1) 41 61 23 07   |   Fax : 33 (1) 44 51 16 93   |   Email : ops@coris.fr

www.coris.fr

Thank you