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Posted by Royal Sundaram on 16 Jan 2018
A claim rejection may not be a pleasant feeling, especially at a time when there is a medical issue. To ensure it doesn’t happen, you need to fill the claim form with all the correct details. Here is how you do it.
For a simple understanding, we divide the claim form into various sections.
Section A: This section requires you to fill in details about the policyholder.
- Ø Policy number
- Ø Third Party Administrator (TPA) ID.
- Ø Your name, address, phone number
- Ø Email Id and an alternate Email Id
Section B: This section requires you to provide details about your health insurance history.
- Ø Do you own any other mediclaim or health insurance?
- Ø Company name and policy number
- Ø Sum insured under that policy
- Ø Date of commencement of first insurance
Section C: This section requires you to provide details of the hospitalized individual
- Ø Name, age, D.O.B., gender
- Ø Relationship to the policyholder
- Ø Complete communication address
- Ø Occupation and employer details
Section D: This section requires you to provide details about the hospitalization details
- Ø Name and complete address of hospital where admitted
- Ø Reason for Hospitalization and details on room category
- Ø Admission and discharge date
- Ø System of medicine administered
Section E: This section requires you to provide claim/claims information details
- Ø Total hospitalization charges
- Ø Pre and post hospitalization charges
- Ø Ambulance charges
- Ø Health check-up costs
Section F: This section requires you to provide details on the cash/benefits
- Ø Hospital daily cash
- Ø Any critical illness benefit
- Ø Cash for surgery
- Ø Benefits for pre/post hospitalization.
Section G: This section requires you to tick the documents you submit.
- Ø Hospital bill. (main bill, break-up), other medical reports.
- Ø Pharmacy bill and medical prescriptions
- Ø FIR/MLC in case of accident injury.
- Ø KYC documents with cancelled cheque of bank where policyholder owns an account.
Section H: This section requires you to provide details on the bills you need to enclose
- Ø Main hospitalization bill
- Ø Pre-hospitalization bills
- Ø Post-hospitalization bills
- Ø Pharmacy bills
Section I: This section requires you to provide the bank details as mentioned.
- Ø Your PAN details
- Ø Your account number.
- Ø The bank branch and account number
- Ø The IFSC code
Section J: This section requires you to provide declaration
- Ø It means that you confirm that all the documents and data you’ve provided is genuine
- Ø Write the day’s date
- Ø The place (your city)
- Ø Policyholder’s signature
Bear in mind, the insurer will verify all details before approving any claims. Therefore, you must provide genuine details.
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