A. Cashless

Cashless hospitalization is a facility provided by the Insurance Company where in the policy holder can get admitted and under go the required treatment without paying directly for the medical expenditure. The eligible medical expense, thus incurred, shall be settled by the Insurance Company directly with the hospital. The Cashless claim facility can be obtained only at the hospital listed in the network of the Insurance Company.

Cashless Hospitalization Procedure:

1. After your doctor has recommended admission, contact the admission counter and present your insurance card. They will advice you on how to proceed. The Insurance Card can only be used for inpatient admission which exceeds a minimum of 24 hours. It cannot be used for outpatient consultation / investigations. For some policies the card can also be used for day care procedures listed in the policy document modified.

2. The preauthorization form is filled by the Insurance coordinator at the hospital. You just need to provide the original Health insurance card issued to you by your TPA& ID Proofs of the patient being admitted.

3. Your form will be sent to the Claims Department of the concerned TPA by the hospital. The decision on the pre-authorization request will be sent to the hospital by the TPA within 4-6 hours. The case will be decided as per the policy terms and conditions.

4. In some instances, more information may be required to take a decision on the pre-authorization request and the same will be conveyed to the hospital. The hospital would need to revert to the claim department who would then give the final decision after evaluating the pre-authorization request.

B. Reimbursement Claim

In case of a reimbursement claim, the policy holder pays the expenses (which otherwise can be claimed under his / her Health policy) himself / herself with the hospital and then claims for a reimbursement of those expenses from the Insurance Company by providing necessary documentation.

Documentation required for a Reimbursement Claim:

In case of a Reimbursement Claims the below documents need to be submitted:

1. Duly filled and signed Claimant Settlement Form

2. Photocopy of Policy Certificate

3. Copy of Health Card (optional)

4. Attending Doctor’s Certificate

5. Discharge Card / Discharge Summary

6. Admission Notes / Indoor Case Papers

7. Hospital / Pharmacy / Doctor Bills

Health Insurance Companies
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