Claims can be settled in 2 ways, either at a cashless facility at a network hospital or as reimbursement of claim.
Cashless treatment at a network hospitalisation is subject to pre-authorization by the TPA. Call TPA for claim intimation and provide your health card ID number. On admission, produce your health ID card to get a cashless request form. Fill out the form and sent it to the TPA. TPA then verifies your request and sends the pre-authorization letter to the hospital. A the time of discharge, the insured verifies and signs the discharge papers and the bill is settled directly with the hospital by the company.
Reimbursement of claims is done when treatment is taken in a non-network hospital provided all the necessary documents are submitted to the TPA within the prescribed time limit. The claim needs to be supported with certain documents like a completed claim form, doctor’s certificate and prescription regarding diagnosis, medical history of the insured, bills and payment receipts, discharge summary, payment bills from the doctors, surgeons, diagnostic centre and chemist.
Notice of Claim
In case an event gives rise to a claim under the policy, a notice with full details should be sent to the TPA immediately. In case of emergency hospitalisation, notice should be sent within 24 hours of hospitalisation and for planned hospitalisation notice should be sent 48 hrs prior to the hospitalisation. All supporting documents relating to the claim should be submitted to the TPA within 15 days from the date of discharge. For post-hospitalisation, documents should be provided within 7 days after completion of the treatment.
