CLAIM ASSISTANCE



Claim settlement is one of the most important services that an insurance company provides you. Insurance companies are bound to settle the claims promptly. Every product has a different claim process which you might go through. You must know the process of claim before initiating with it. Here, we attempt to help you provide the information on the claim process. This will tell you what information you need before you get in touch with your insurance company and what you can expect from the claim process.

Health Claim Process

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need arise?

 

Life Claim Process

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Tribulation is difficult to deal with. It is a distressing situation anyone could face. Here we help you with the details required to process your claims

 

Motor Claim Process

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Going through an accident would be a very traumatic experience. Just stay calm in such situation and follow these procedures to get your claim

 

Travel Claim Process

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Planning to visit abroad for a vacation? Worried about any mishap or illness? Not knowing what to do? We help you for your vacation tension free.

 

Home Claim Process

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Your home is an investment for lifetime. You buy home insurance to protect it. Find out what you need to do in case of any mishappening

 
  • Cashless Basis

  • Reimbursement Basis

On a Cashless basis:

Cashless hospitalization is a facility provided by the Insurance Company wherein the policy holder can get admitted and undergo 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.

Inform your Insurer

Hospitalization happen under two circumstances - planned and emergency

Planned:

Once your doctor has recommended for the hospitalization, contact your insurer immediately and inform about the hospitalization.

Emergency:

In case of emergency hospitalization, you must inform your insurer within 24 hours of hospitalization.

Admit in the hospital

Get admitted to the hospital by showing your health ID card or policy number for identification purpose.Hospital will check your identity and fills up the Pre-Authorization Form with all the relevant details and send to the insurer.

Ready documents to be sent with pre-authorization form

Ready with you the below documents to be sent along with the pre-authorization form:

  • Policy Copy/ Health Card
  • ID proof with address
  • Investigation Test reports from Pathologist
  • Medico Legal Certificate (MLO)- in accident cases

(Note: you may require to send additional documents depending on your insurer's requirement)

Confirmation of insurer to proceed with services

Hospital will submit the pre-authorization form to the insurer. Insurer will review the documents and provide confirmation to the hospital to proceed with the cashless services. Normally, TPA issues a letter of confirmation within 3-6 hours provided all relevant documents are submitted.

Hospital sends bill to insurer during discharge

Hospital sends the final bill to the insurer at the time of discharge.

Direct payment

Once the bill is confirmed, insurer makes payment directly to the hospital.

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  • FAQ's

Which are the necessary documents for the compensation of claim ?

List of necessary claim documents to be submitted for compensation are as following:

  • Claim form duly signed.

  • Hospital Discharge summary

  • Copy of photo ID of patient

  • Investigation reports

  • Hospital Main Bill

  • Investigation reports

  • Operation Theatre notes

  • Hospital Break up bill

  • Original investigation reports, X Ray, MRI, CT films, HPE, ECG

  • Doctors reference slip for investigation

  • Pharmacy Bills

Are there any investigations that happen once the receipt of claim done?

The Company may investigate claims at their own discretion to inspect validity of claim. Such inquiry shall be concluded within 15 days from the date of assigning the claim for investigation and not later than 6 months from the date of receipt of claim intimation. Verification carried out, if any, can be done by people or entities authorised .

Whom do i actually have to contact for claim intimation and settlement?

You must notify your insurer either at the call center or in writing, in the event of planned or emergency hospitalisation.

Here we help you to guide through the various claim process which you might go through with insurance companies. If in case you need further assistance, you may simply email us @ helpdesk@policyx.com