Claim settlement Procedure in Insurance Health Policy

If any claim arises in health insurance policy, the same can be settled in any of the
following ways:

1. Reimbursement of expenses: If a policyholder falls sicand hospitalized in non-empanelled hospital then hshould follow the following procedure:

• Intimation to the insurer/ Third Party Administrator

(TPA) along with the name of the person who hasfallen sick

• Policy number
• Name of the hospital
• Name of the doctor

The above information should be sent within 7 days of the hospitalization. Within 30 days final claim form should be furnished along with the following documents:

• Hospital receipts/ original bills.
• Cash memos.
• Various reports and tests.
• Hospital admission and discharge slip.
• Case history.
• Any other documents desired by TPA or hospital.

Note: Kindly ensure that insured person has been
admitted to a hospital/nursing home as defined in the
policy.

2. Cashless facility for planned hospitalization:

• The expected expenses to be incurred should be sent to TPA through the agreed list of network hospital
• Policy no. & card number should be shown to the hospital
• On confirmation from the TPA the treatment can be taken in that hospital.
• If expenses increase during the treatment then the hospital will sent revised estimate to the TPA for their approval.
• For any post hospitalization treatment the original bills/cash memos can be sent to the TPA after completing the treatment for the reimbursement.

3. Cashless facility for emergent hospitalization

• A card issued by the insurer should be shown to the hospital.
• The expected expenses may sent to the TPA for their approval.
• For any post hospitalization treatment the original bills/cash memo can be sent to the TPA after completing the treatment for the reimbursement.

Important: Kindly ensure that the Identity-Card is easily available with the policyholder.