TATA AIG Claim Process

TATA AIG Health Insurance Claim Process

Raising a claim can be a tedious task. To make the process effortless, insurance companies design user-friendly platforms such as websites and mobile applications. TATA AIG Health Insurance has crafted a hassle-free claim filing procedure. Let us discuss all TATA AIG health insurance claim procedures in this article.

Claim Filing Processes Offered by TATA AIG Health Insurance

The company's claims are classified into two categories based on the settlement and payment process. Let us examine each type:

Cashless Claims

This type of claim enables the policyholder to avail treatment without paying medical expenses upfront. The insurance company then settles the bill directly with the hospital.

Cashless claims can be divided into two categories based on the hospitalization situation:

Planned Hospitalization

• Inform the Company: The policyholder must inform the insurance company 5 days before hospitalization.
• Wait for Confirmation: The company will issue a confirmation letter, valid for 7 days from the date of issue.
• Admission Procedure: On the day of admission, the policyholder must submit the health card and confirmation letter to the hospital. Treatment will commence after submission.

Emergency Hospitalization

• Inform the Insurer: The policyholder must inform the company within 24 hours of hospitalization.
• Required Documents: Submit all necessary documents, such as the insurance card, policy copy, customer ID proof with photo, address proof, and a duly filled and signed CKYC form (if the amount is more than ₹1 Lakh).

Reimbursement Claims

Reimbursement claims allow the insured to receive medical care outside the insurance company's network hospitals. The policyholder pays the bill upfront and later requests reimbursement from the insurer. Reimbursement claims can be filed within 21 days after hospitalization, along with the submission of all necessary details.

TATA AIG Health Insurance: Cashless Claim Process Steps

If all paperwork is aligned, cashless claims are a straightforward and quick process. Let's look at the steps:

1. The hospital's Help Desk Staff or TPA fills out the cashless claim request and submits it to the insurance company. The TPA coordinates with the hospital to complete all paperwork and assists the policyholder in filling out the 'Pre-Authorization' form.
2. After reviewing all documents and pre-authorization forms, the company issues an 'Authorization Letter' to the hospital and completes the remaining steps for settling the claim.

TATA AIG Health Insurance: Reimbursement Claim Process Steps

Follow these steps for a smooth reimbursement claim filing process:

1. Verify Details: Before signing the final bill, ensure all details are accurate and complete. The policyholder should avoid any delays in the process.
2. Collect Documents: Collect all necessary documents before leaving the hospital.
3. Document Submission: Submit the documents to the Third Party Administrator (TPA), assigned by the company or the hospital authority. Your part of the work is finished here.

Later, the company will verify the documents and transfer the amount to your bank account.

Important Points for Reimbursement Claims

• Submit all documents to the TPA within 21 days of discharge.
• The company may assign its own TPA if the hospital's TPA is not authorized by the hospital administration or if there is no direct contact.
• In case of claim rejection, contact the TPA or the company's customer care for assistance.
• You can download the claim form from the company's official website.

Documents Required for Reimbursement Claims

The company may request additional documents for better claim verification. Here is a list of documents:

• Duly signed claim form
• Insurance Card or Policy Copy
• Medical certificates
• Pathology reports
• Hospital discharge summary/bill
• Original bills and receipts
• Original pharmacy bills
• Investigation reports
• FIR/MLC (First Information Report/Medico-Legal Case) if applicable
• NEFT or bank transaction details
• Duly filled and signed CKYC form (if the bill exceeds ₹1 Lakh)

Conclusion

Filing claims with TATA AIG is extremely easy. Policyholders can choose between cashless or reimbursement claims, depending on their convenience. Cashless claims are settled directly with the hospital, whereas reimbursement claims offer customers the flexibility to choose their preferred healthcare facility. The company's customer services are readily available to assist policyholders with any confusion. You can find customer care details on their official website.