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Health Insurance claims

What is a Health Card?

A health card is a card that comes along with the Health Policy. It is similar to an Identity card. This card would entitle you to avail cashless hospitalization facility at any of our network hospitals. A health card mentions the contact details and the contact numbers of the TPA. In case of a medical emergency, you can call on these numbers for queries, clarifications and for seeking any kind of assistance. Moreover, you need to display your health card at the time of admission into the hospital

hat do you mean by Cashless Hospitalization?

In the event of hospitalization, the patient or their family will have a bill to pay the hospital. Under Cashless Hospitalization the patient does not settle the hospitalization expenses at the time of discharge from hospital. The settlement is done directly by insurer

How does hospitalisation for Planned Hospitalisation work?

The request for Pre- Authorization form for planned treatment has to be signed by the customer and sent by Hospital.  This request must reach insurer at least 2 days before hospitalisation.

Any change in the date of hospitalisation, Hospital, nature of illness or surgeon who is going to perform the procedure will make the authorization invalid. A fresh authorization will have to be taken. 

The authorization is valid only for Network Hospitals. 

The authorization will be addressed and faxed to the hospital.

How does one get Reimbursement for pre and post hospitalisation expenses under this scheme?

If your policy allows reimbursement of medical expenses incurred towards the ailment/ disease for which hospitalisation was necessitated prior to hospitalisation and up to a certain number of days after discharge. 

This is subject to the limits as described in the policy. The medical expenses incurred prior to Hospitalisation are called pre- hospitalisation expenses and those incurred subsequent to discharge as post Hospitalisation expenses. 

To claim pre hospitalization expenses , Any expenses incurred on OP treatment which leads to IP hospitalization prior to 30 days prior to the date of hospitalization is settled as Pre hospitalization. All original bills have to be produced.

To claim post hospitalization expenses 7% of the Hospital bill (excluding Room rent) up to a maximum of Rs.5000/ is settled as post hospitalization. This is done based on the recommendation of the doctor and prescriptions along with discharge summary

In case of any non settlement, customer can contact customer service toll free number

How does one get Reimbursements in case of treatment in non- network hospitals?

Cashless Hospitalisation is available only in Network Hospitals. While it’s recommended that you choose a network hospital you are at liberty to choose a non-network hospital also. In case you avail of treatment in a Non Network hospital, insurer will reimburse you the amount of bills subject to the policy taken by the policyholder.

The Policy Holders attention is drawn to the definition of Hospital in the Mediclaim policy. Insurer should be contacted within 24 hours from the time of admission with details of insurer id card number, nature of illness, name & address of the Hospital/ Nursing Home/ Clinic, Room Number etc. The claim will be registered by Customer Care and a claim number will be provided to the Policy holder. Claim form will be sent to the Policy holder address. This claim form must be filled fully and sent to insurer office along with the following documents in original.

Main Hospital Bill with Receipt for payment along with the break up. 

Doctors prescription and medicine bills. 

Discharge summary sheet from the hospital. 

Investigation reports along with the X Ray film

Other relevant details and documents connected to hospitalisation.

Note: Only expenses relating to hospitalisation will be reimbursed as per the policy taken. All non-medical expenses will not be reimbursed.

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This entry was posted on April 4, 2019 by in Uncategorized.

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