1Is the Insurance Card a Credit Card?
Please, note that the Insurance / TPA Card are only for the purpose of Identification of the Insured at the Network Hospital while availing Cash Less facility. It shall not be misunderstood with as a Credit Card. Cash Less facility is approved after due verification of Policy papers & Medical documents and is granted only when Authorization letter is issued to the Hospital. Mere acceptance of the Card at the Hospital does not entitle an Insured of an automatic Cash Less Access.
2When can a request for Cash less are rejected?
Cashless may be denied if found non-payable as per the Policy Terms, conditions & exclusions. Further, it is worth noting that Cashless facility is extended either, before or during the course of treatment. Decisions for claim payment are made on the basis of only few available documents. Given the nature of a particular case, the Cashless may also be rejected in the absence of relevant information required for arriving at clear decision. Also, the cashless request may be rejected in doubtful cases. Please, note that the denial of cashless access does not mean denial of treatment and does not in any way prevent the patient from seeking necessary medical attention or hospitalization. It also does not prevent the patient to submit his claim for Reimbursement.
3What is a Reimbursement Claim?
Reimbursement of Claim takes place when, after incurring the treatment expenditure from his pocket, the Insured claims payment under the Policy.
4What is the procedure for applying for Reimbursement Claim?
Intimation to regarding hospitalization is required to be made.
Subsequently, the policyholder has to submit the relevant treatment papers & bills as prescribed by insurance company to claim the treatment expenses incurred, within 7 days from discharge from the Hospital.
5What are the Documents to be submitted under the Reimbursement Claim?
In support of the claim, please, enclose the following original documents (check with insurance company)
Filled in Claim Form.
certificate/card from the Hospital.
Memos from the Hospitals (s) / Chemists (s), supported by proper prescriptions.
and Pathological test reports supported by the note from the attending Medical
Practitioner/ Surgeon recommending such Pathological tests.
Chest X-ray, Sonography, Echo Cardiography, CT-Scan, MRI – all originals with
receipt and reference letter.
from treating Doctor regarding nature of disease.
of insurance card
of the Policy Schedule
– If any
All Original Papers Related To Hospitalization And Xerox Copy Of Indoor Papers