Find top Outpatient Department plans at just ₹ 105/-month

General Claim Intimation Format

The first step is to intimate the insurers with the following information along with the claim intimation:

• Name of the Patient
• Patient’s Health ID Card Number
• Hospital Name
• Hospital address with contact number etc.
• Date of admission
• Illness / disease for which hospitalized and treatment details.

In case of an accident, below mentioned information needs to be provided:

• Date & time of accident / loss
• Brief description of accident along with place of accident
• Name and address of police station if FIR filed
• Name of person who took insured to hospital (if possible)

Immediate Action Client Should Take

For Cashless:

Health insurance card and one identity proof needs to be submitted at TPA Desk in the hospital by the patient. The hospital then gets the settlement done through TPA.

For Re-imbursement:

Immediate claim intimation is provided to the broker/Insurance company. Claim documents to be summited after treatment.

Indicative General Documents for Settlement of Claims

Planned Hospitalization

Only pre authorization to be submitted in advance rest of the document would remain same for cashless and reimbursement procedure.

Emergency Hospitalization

Same documents would be required for cashless and reimbursement claims.

Cashless Claims

These documents are need to be submitted at TPA Desk in hospital at initial stage

• TPA Health Card
• One ID Proof of the Patient
• Pre-Authorization Form
• Investigation Reports
• Doctors Note

These documents are need to be at the time of Discharge:

• Discharge Summary
• Final Bill with Breakup
• Payment Receipt
• All investigation Reports

Reimbursement Claims

• Claim form duly filled and signed with employee code of the claimant/employee on it
• TPA Health Card
• Prescription Details by treating doctor/ surgeon
• Discharge card and discharge summary
• All original bills and payment receipts
• Investigation Reports
• X-rays, ECG/Films if any
• Cancelled Cheque of Employee
• Pre-post hospitalization bills supported with prescription/advice of treating doctor