If any claim arises in health insurance policy, the same can be settled in any of the
following ways:
1. Reimbursement of expenses: If a policyholder falls sicand hospitalized in non-empanelled hospital then hshould follow the following procedure:
- Intimation to the insurer/ Third Party Administrator
- Policy number
- Name of the hospital
- Name of the doctor
- Hospital receipts/ original bills.
- Cash memos.
- Various reports and tests.
- Hospital admission and discharge slip.
- Case history.
- Any other documents desired by TPA or hospital.
admitted to a hospital/nursing home as defined in the
policy.
2. Cashless facility for planned hospitalization:
- The expected expenses to be incurred should be sent to TPA through the agreed list of network hospital
- Policy no. & card number should be shown to the hospital
- On confirmation from the TPA the treatment can be taken in that hospital.
- If expenses increase during the treatment then the hospital will sent revised estimate to the TPA for their approval.
- For any post hospitalization treatment the original bills/cash memos can be sent to the TPA after completing the treatment for the reimbursement.
3. Cashless facility for emergent hospitalization
- A card issued by the insurer should be shown to the hospital.
- The expected expenses may sent to the TPA for their approval.
- For any post hospitalization treatment the original bills/cash memo can be sent to the TPA after completing the treatment for the reimbursement.
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