Health Claims Procedure
If you are suffering from an illness / disease or meet with an accident which requires hospitalisation, contact Third Party Administrator, a service provider appointed by us for servicing your health policy.
It is advisable to get hospitalised in a Network hospital and undergo Cashless access.
If you are not able to utilize the cashless access, pay the hospitalisation expenses and submit the bills to service provider for Reimbursement.
It is mandatory to intimate the hospitalisation to your service provider through Email/ Toll Free Line / Fax.
For more details visit the website of TPA
While intimating the hospitalisation, TPA may ask for certain information as mentioned:
- Policy No.
- TPA Health Identity Card No.
- Name of the Insured / Patient
- Group / company name & Employee No (for Group Mediclaim)
- Hospital Name & Location
- Date of admission
- Date of discharge (if known)
- Illness / disease for which hospitalised and treatment details.
In case of an accident, mentioned information would be asked while intimation of hospitalisation:
- Date & time of accident / loss
- Brief description of accident along with place of accident
- Name and address of police station if FIR filed
- Name of person who took insured to hospital
Note: Hospitalisation if not intimated to service provider is liable to get rejected.
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Cashless Claims Procedure
- To avail cashless benefit, intimate the hospitalisation through Preauthorization Request Form atleast 72 hrs prior to getting hospitalised. In case of an emergency hospitalisation, you need to intimate within 24 hrs of hospitalisation but before your discharge from the hospital.
- You can collect the preauthorization request form from the hospital (billing department or a TPA co-ordination department). If not available at the hospital, you can download from the TPA website or collect from the nearest TPA office.
- Hospital will check for TPA ID card and any photo identity card for the reason of identity proof.
- Get the preauthorization form filled and signed by the treating doctor, put your sign on the form and hand over to the hospital for the process.
- Hospital will stamp the form and fax it to TPA for authorization.
- TPA will process the preauthorization request and authorize the reasonable amount for hospitalization based on policy terms and conditions.
- Authorization letter will be faxed to the hospital from TPA office and simultaneously you will be kept informed on authorization.
Procedure to be followed at the time of discharge:
- Sign the final bill and check the bill for correctness.
- Ensure that all supporting documents are attached to the bill.
- You must pay all bills not associated with the condition for which hospitalization was authorized and the amounts towards non medical expenses.
- Retain a copy of the final bill and discharge summary.
- Sign a Future Generali claim form filled in all respects and give it to the hospital along with copy of all previous relevant consultation letters before discharge.
Hospital will submit the claim documents to TPA office for claim processing.
Reimbursement Claims
- Intimate the hospitalisation atleast 72 hrs prior to getting hospitalised. In case of an emergency hospitalisation, you need to intimate within 24 hrs of hospitalisation.
- Take the necessary treatment at the hospital and settle the hospitalisation bills.
- Before getting discharge collect all original hospital papers (including discharge summary) and hospital bills.
- Submit the hospitalisation documents (including hospital bills) to TPA office for claim processing within 7 days of discharge from the hospital.
- Claim settlement will take approximately 7 days from the date of submit of final document, provided all document are in order.
Pre-hospitalisation and Post-hospitalisation Claims
Submit the claim documents to TPA office for claim processing within 7 days of completion of treatment.
Claim settlement will take approximately 7 days from the date of submit of final document, provided all document are in order.
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