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

Where Base Policy Exists

Only re-imbursement can be applied. Immediate claim intimation is provided to the broker/Insurance company. Claim documents to be summited after treatment.

Where Base Policy Does Not Exists

For Cashless:

Health insurance policy details and claim form to be submitted in the hospital by the patient. The hospital then gets the settlement done through insurance company.

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 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

Same as health policy, the hospital will send the claim documents along with invoice and discharge summary to the insurer, which will pay the claim amount directly to the hospital.

Re-Imbursement Claims

• Claim form duly signed
• Copy of photo ID of insured
• Hospital discharge summary
• Operation theatre notes
• Hospital main bill
• Hospital break up bill
• Investigation reports
• Original investigation reports, X Ray, MRI, CT films, HPE, ECG
• Medicine bills
• MLC/ FIR report, Post Mortem Report if applicable and conducted
• Cancelled cheque for NEFT payment
• Payment receipt