Health Insurance

Below are some of the key documents that will be needed. Please refer to the policy terms and conditions for the complete list.

• Test reports and prescriptions relating to First / Previous consultations for the same or related illness.
• Case history / Admission-discharge summary describing the nature of the complaints and its duration, treatment given, advice on discharge etc issued by the Hospital.
• Death summary in case of death of the insured person at the hospital.
• Hospital Receipts / bills / cash memos in Original (including advance and final hospital settlement receipts).
• All test reports for X-rays, ECG, Scan, MRI, Pathology etc., including doctor’s prescription advising such tests/ investigations (CDs of angiogram, surgery etc need not be sent unless specifically sought).

• For admission in Network Hospital (Cashless Claims) Insured Person shall call the TPA helpline and furnish Membership Number, Policy Number and the Name of the Patient within 72 hours before admission to hospital for planned hospitalization and not later than 48 hours of admission in case of emergency hospitalization. The insured shall also provide to the TPA by fax or e-mail, the details of hospitalization like diagnosis, name of hospital, duration of stay in hospital, estimated expenses of hospitalization etc. in the prescribed form available with the Insurance help desk at the Hospital. The Insured shall also provide any additional information or medical record as may be required by the medical panel of the TPA. After establishing the admissibility of the claim under the policy, the TPA shall provide a pre-authorisation to the hospital guaranteeing payment of the hospitalization expenses subject to the sum insured, terms conditions and limitations of the policy.
• For admission in Non-Network Hospital or into Network Hospital if cashless facility is not availed (Re-imbursement Claims)
  • Notice of claim: Preliminary notice of claim with particulars relating to Policy number, Name of the Insured Person in respect of whom claim is made, nature of illness/injury and name and address of the attending hospital, should be given to the Insurer within 72 hours before admission in case of planned hospitalization, and not later than 48 hours or before discharge, in case of emergency hospitalization.
  • Submission of claim: The insured shall submit the claim form along with attending physician’s certificate duly filled and signed in all respects with all the necessary claim documents not later than 30 days from the date of discharge.

We will cover all of the below.

• Medical Practitioners’ fees;
• Room Rent, boarding expenses;
• Intensive Care Unit charges;
• Diagnostics Procedures charges;
• Medicines, drugs and consumables;
• Nursing Charges;
• Intravenous fluids, blood transfusion, injection administration charges;
• Anesthesia, Blood, Oxygen, Operation theatre charges, surgical appliances;
• The cost of prosthetics and other devices or equipment if implanted internally during a Surgical Procedure.