How to claim?
Procedure for Cashless Claims
Cashless claims facility is available only with our network hospitals. The list of network hospitals is also available in the policy kit. Also available under the link “cashless hospitals” in claims section of the website.
- In case of emergency hospitalisation, on admission, Intimate Third party administrator (TPA) through Toll free number within 24 hours. In case of planned admission, please inform the TPA 3 days in advance. (Please remember to quote your health card Membership number).
- Fill in the cashless request form which is available with the Hospital Insurance Help Desk and get it certified by your treating doctor.
- This form, with supporting medical records shall be faxed by the hospital to the TPA's fax number.
- TPA scrutinizes the documents, conveys the decision to the hospital -sanction of cashless request or calls for additional documents, if required.
- On approval of cashless facility by TPA, the hospital bills will be settled directly (subject to policy limits). Inadmissible amounts like telephone charges, food, attendant charges etc would have to be settled by you.
- The turnaround time for the TPA for approving the cashless request shall be 4 hours after receipt of all documents.
Please note that if cashless is not approved by TPA, you will have to pay for the bills at the time of discharge. If you have reasons to believe that the claim is payable under the policy, you may file a claim for reimbursement. The claim will be processed as per policy terms and conditions.
Procedure for Reimbursement of Claim
Reimbursement facility is available at network hospitals as well as non-network hospitals.
- You have to avail treatment and settle all the bills with the hospital and file a claim for reimbursement.
- Intimate us immediately on admission not later than 7 days from the date of discharge. Please quote your Policy Certificate number. Claim may also be intimated online through our website.
- Submit the following Claim Documents to us within 30 days from the date of discharge.
Document checklist (Documents to be submitted in Original)
- Duly filled claim form along with Doctor's certificate (forming part of claim form)
- Discharge summary
- Bills and Receipts (Including advance & final receipts)
- Prescriptions for medicines and Doctor’s advice for lab tests
- Diagnostic Test Reports, X Ray, Scan and ECG and other films
- Claims would be processed on receipt of all required documents and additional documents/information if any required will be called for after scrutiny of the claim.
- NEFT claim settlement shall done if the claim is admissible. If not, a repudiation letter explaining the reasons for denial, would be sent to you.
- The turnaround time for Reimbursement claims is 15 working days from the date of receipt of all requisite documents.
- Some claims at random may be chosen for verification by our external agencies. The Turn Around Time for settlement for such claims shall be 35 working days from the date of receipt of all requisite documents.