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Claims Process: Cashless Claims - Steps involved

   
Approach the Service desk of Hospital   Show the ID card for identification purpose   Network Hospital would verify your identity and submit pre authorization form to insurer.
 
   
Company Doctors review and accordingly will approve, query or reject the claims as per terms and conditions of the policy   Company will also assign a Field doctor to make the hospitalization simple for you   Insurer settle the claim as per policy terms & conditions with the hospital after completion of all formalities

Reimbursement claim process - step involved
 
   
Company will assign a Field doctor to make the hospitalization simple for you   Upon discharge, pay all hospital bills and collect all original documents of treatments and expenses undergone.   Claim form has to be filled in and along with, all the relevant original documents have to be submitted at the Nearest branch office.
 
       
Insurer settle the claim in subject to policy terms & conditions.        

How to make a cashless claim?
Search tool is provided to help you find the Network Hospital nearest to you. Provide your Insurance Company Health ID Card at the Hospital reception. From the Hospital, insurance company will receive a request for authorization of the treatment and expenses thereof which will be accepted as per terms and conditions of the policy. Cashless Claim can be made at any of empaneled Network Hospitals across the country.
Documents for Claim Submission:
Health card
Duly filled Claim form
Doctor's consultation papers
Investigation reports (e.g. X-Ray, Scans, Blood report etc.)
Pharmacy invoices supported by respective prescriptions
In cases of accidents, Medico Legal Certificate (MLC) and / or FIR
Discharge summary
Other Relevant Documents
Documents other than the Health Card should be submitted in Original.
The Authorisation Process
Upon receiving an intimation from the Insured/Insured's Attender, and being contacted by the Network Hospital, insurer verifies the validity and coverage of the Policy. Field Visit Doctor is deputed who facilitates the pre authorization document request and confirms the warranting treatment given. Accordingly our Medical team approves cashless for the insured person subject to policy terms and conditions based on pre authorization request.
Getting a faster approval:
Look up the network list of your insurance company and locate a hospital, do not refer to another insurance Co.'s hospital list
If a surgery is being planned, send the pre-authorisation form to company 7 to10 days ahead of the date of operation
Claim forms should be filled in completely. Please mention your cellphone number in the pre-authorisation form
Retain a photocopy of the claim documents you submit
Important conditions:
Authorization request may be turned down when details are not completely provided then the member can come for reimbursement.
Non-payable items would be at the Insured's own cost
All claims to be submitted within 30 days from the date of discharge
Post hospitalisation claims may be submitted within 30 days from date of discharge
How to make intimation in case of an admission?
In case of an emergency admission, your company has to be intimated within 24 hours of the accident / illness / hospitalization. Intimation can be given either through contacting company at claim registration numbers / nearest office of insurer. Please mention the Health ID number/Policy number for easy reference.
Procedure for Reimbursement of Claim:
All claims will need to be intimated within 24 hrs of hospitalization. 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
Submit the Claim Documents to the Company within 30 days from the date of discharge
Cite your Policy number and intimate Health immediately about hospitalization to send you the Claim form
How to make a claim under overseas travel policy?
Inform our claims assistance company to register a claim.
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