Lifeline Health Plan Claim Procedure | Medical Insurance Claim Procedure
Lifeline - Claims Procedure
Please review your Lifeline policy and familiarize yourself with policy benefits, terms and conditions and exclusions which will help you during claims.
All claims for all regular benefits other than a few exceptions will be settled through Medi Assist Insurance TPA Private Limited
Claims for the below mentioned 4 benefits will be serviced through our service provider "Europ Assistance India Pvt. Ltd".
- Second Opinion for 11 Critical Illness
- Emergency Domestic Evacuation
- Worldwide Emergency Hospitalization
- International Treatment for 11 specified Critical Illness
1. You should intimate Royal Sundaram atleast 48 hours prior to hospitalization in case of planned hospitalization or within 24 hours in case of any emergency hospitalization.
2. You can contact us through:
- 24 x 7 Toll Free: 1860-258-0000, 1860-425-0000
- Email: firstname.lastname@example.org
3. You are required to provide the following details during intimation:
- Name of the patient (insured person)
- Hospital Details - Name, Address, Contact No
- Treating Doctor Details - Name & Contact No
- Date of Hospitalization
- Expected Discharge
Procedure to avail Pre-Authorization for Cashless facility (for domestic claims);
- For any planned hospitalization, kindly intimate to TPA and seek cashless authorization at least 72 hours prior to the start of the hospitalization.
- For any emergency hospitalization, inform TPA within 24 hours of the hospitalization.
- TPA will check your coverage as per the eligibility and send a cashless authorization letter to the hospital within 3 hours post receipt of complete documents. In case there is any deficiency in the documents sent, the same will be communicated to the hospital within 4 hours of receipt of documents.
- Please pay the non medical charges and expenses which are not covered to the hospital prior to the discharge.
- In case the ailment/treatment is not covered under the policy, a rejection letter would be sent to the hospital within 2 hours.
- You are entitled for cashless facility only in our Network Hospitals. Please click here to view the list of cashless hospitals.
- Rejection of cashless facility is not a rejection of the claim.
Procedure for Reimbursement Claims
- Please send the duly filled and signed claim form and all the information/documents mentioned* therein to Royal Sundaram within 30 days from the date of discharge. * Please refer to claim form for complete documentation.
- If there is any discrepancy in the documents/information submitted by you, Royal Sundaram will send the deficiency letter within 7 days of receipt of claim documents.
- On receipt of the complete set of claim documents, Royal Sundaram will make the payment for the admissible amount (as per Policy Terms & Conditions), along with a settlement letter within 30 days.
- The payment will be made in the name of the proposer.
- Claim documents can be sent on:
Health Claims Department
Royal Sundaram General Insurance Co Ltd
Vishranthi Melaram Towers,
No.2/319, Rajiv Gandhi Salai (OMR)
Karapakkam, Chennai – 600097
Procedure to avail Pre-Authorization for Cashless facility (for Worldwide Emergency Hospitalization)
- You need to notify the Service Provider within 24 hours of hospitalization.
- Our Service Provider will evaluate the request and the eligibility of the Insured Person under the Policy and call for more information or details, if required.
- Our Service Provider will communicate directly to the Hospital whether the request for pre-authorization has been approved or denied.
- If the pre-authorization request is approved, Our Service Provider will directly settle the claim with the Hospital. Any additional costs or expenses incurred by or on behalf of the Insured Person beyond the limits pre-authorized by the Service Provider shall be borne by the Insured Person.
Procedure for International Treatment for 11 specified Critical Illness
- In the event of the diagnosis of a Specified Critical Illness, the Insured Person should call Our Service Provider immediately and in any event before the commencement of the travel for treatment overseas, on the helpline number specified in the Schedule of Insurance Certificate requesting for a pre-authorization for the treatment.
- Our Service Provider will evaluate the request and the eligibility of the Insured Person the Policy and call for more information or details, if required.
- Our Service Provider will communicate directly to the Hospital and the Insured Person whether the request for pre-authorization has been approved or denied.
- If the pre-authorization request is approved, Our Service Provider will directly settle the claim with the Hospital. Any additional costs or expenses incurred by or on behalf of the Insured Person beyond the limits pre-authorized by the Service Provider or at any Non-Network Hospital shall be borne by the Insured Person.
Contact Details of Service Provider:
Europ Assistance India Pvt Ltd
301, C Wing, Business Square,
Andheri Kurla Road, Chakala,
Mumbai – 400093
Contact No: +91-22-67872035
|Procedure||Notify Claims||Download Claim Forms|
|Cashless Hospital List||Access TPA||Excluded Hospital list|
“Please note that accepting claim intimation does not indicates claim admissibility. Claim will be processed as per policy terms and conditions. Also please note that claims arising out of “Excluded hospital” will not be approved, as per policy terms and conditions. Please refer our websitewww.Royalsundaram.in for list of excluded hospitals.”