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 No 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 Claims

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 Claims

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

Indicative General Documents for Settlement of Claim

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
• Prescription of doctor advising the admission
• Discharge report issued by the hospital
• Final hospital bill (in original) and payment receipt
• Investigation Reports
• X-rays, ECG/Films if any
• Medicine bills
• Other bills or documents related to the treatment
• Medico Legal Certificate (MLC) / FIR in case of road traffic accidents (RTA)
• Cancelled Cheque of insured bank account to make the claim payment through NEFT