HomeMediclaim Claim Procedure

Mediclaim Claim Procedure

CASHLESS HOSPITALISATION

To avail cashless hospitalization treatment at network hospitals –

  • Step 1: We will provide the list of network hospitals offering cashless facility for treatment.
  • Step 2: The claimant needs to produce the TPA Health card at the hospital.
  • Step 3: Hospital sends Pre-authorization Request with the treatment details; past history and clinical notes along with estimate of hospitalization expense to TTK local office.
  • Step 4: TPA issues a letter authorizing treatment to the Hospital the approved amount upto the Sum Insured limits.
  • Step 5: In case the treatment is taken at other non network centers, the Insured is reimbursed the cost of treatment, subject to the provisions of the Policy on the basis of Admit Card/Discharge Card, Diagnostic Reports and Bills/Prescriptions. (See Claims Process below)

CLAIM REIMBURSEMENT

  1. In case of a claim, please follow the following procedures:
    • Step 1: Please immediately intimate AIMS Insurance Broking about the claim. Claim intimation can be done by the following methods
    • Intimation to :-
    • Policy Number:
    • Name of the insured
    • Name of the Patient
    • ID Card Number
    • Date of Hospitalization¬† & Hospital Name
    • Ailment
    • Date of Admission
    • Approximate Date of Discharge

    However reasonable cause to be furnished in the event of the Insured person or his representative for not notifying the admission immediately. This Clarification for delay in notification shall in any case be submitted within 7 days from the date of admission

    • Step 2: Fill all columns of Claim Form & Medical Certificate. The Medical Certificate Form will be filled by the treating doctor.
    • Step 3: Send the filled and signed Claim and Medical Certificate Forms to Aims insurance Broking Private Ltd (documents mentioned in the Check-list) by courier / hand delivery, along with the following papers
    • Original Discharge Summary;
    • Original Discharge Bill
    • Advance payment receipt & other Payment reciepts
    • All the Original Bills with break up.
    • All Original Diagnostic Test Reports performed on patient during hospitalization;
    • Copy of ID card
    • All Medical Bills must accompany the prescription
    • Scan /X-ray sheets to be submitted along with claims documents.
    • ¬†Copy of Bank Account Details /Cancelled Cheque leaf
    • Copy of Adharcard
    • All the claim documents should be submitted to the insurance company within 14 days of discharge from the Hospital
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