Reimbursement Claims

Documents Required for Reimbursement of Health Insurance Claim

Below is the indicative list.
 

• Duly Filled and Signed Cashless Claim form

• Discharge Summary

• Medical Records (Optional Documents may be asked on need basis: Indoor case papers, OT notes etc.)

• Hospital Main Bill

• Hospital Main Bill with breakup

• Pharmacy Bills with Prescriptions (except hospital supply)

• Consultation & Investigation Papers

• Digital Images/CDs of the Investigation Procedures (if required)

• KYC (Photo ID Card) Bank Details with Cancelled Cheque

There are some more documents that will be needed only in specific cases, such as:
 

• In case of an accident or involvement of police- MLC/FIR Report

• In case of death or disability- Post Mortem Report, Death Certificate or Disability Certificate Invoice/Sticker (If applicable)

• Attending Physician Certificate (If applicable)
   

How to Avoid Health Insurance Claims Rejection?

These are some important tips through which you can avoid a health insurance claim rejection:
 

• If you are suffering from a pre-existing illness or condition, be sure to mention this to your insurance provider before purchasing the policy. That way, if you need to be hospitalised or treated due to your condition, the insurer can ensure you receive adequate coverage.

• Inform your TPA if you are being admitted to the hospital for a planned or emergency treatment. The Reimbursement claim procedure starts soon after your TPA has been informed, which helps them settle your claim as required without any hassles or delays.
  

• Your policy document has all the details of the health insurance claim and policy coverages, Waiting period, General Exclusions. As soon as you get this document and before you file a claim, read all the terms and conditions carefully to avoid rejection of claims.

• Ensure all documents are in place while filing the claim. Although TPA does not require extensive documentation for a Reimbursement claim, a list of essential and correct documents must be submitted so that your claim can be settled on time and without any issues.