Cashless: It can be availed only at network hospitals of TPA’s/Insurance to the amount of pre-authorisation sanctioned.

Reimbursement: It is a claim where the member pays all the expenses related to the hospitalization and submits the claim to the TPA/Insurance for reimbursement of expenses.

The liability for paying the hospital will be on you. You would have to submit the claim documents to TPA’s/Insurance for reimbursement. The Insurance company will then reimburse the admissible amount to you.

• Select our Plan in "We Assist" portal. Click here to view Plans
• Based on the plan opted by you, our medical expert team guide you on how to submit the documents collection.

• 1) Claim Form duly filled and signed by the Customer
• 2) Original Main hospital Bill with the breakup
• 3) Original Hospital Payment Receipt with the Serial Number
• 4) Original Detailed Discharge summary of the hospital
• 5) Original Receipts with Serial Number
• 6) Original Investigation bills and Reports
• 7) Original pharmacy bills with Doctors prescriptions
• 8) Copy of ID card -Self attested
• 9) Original Death Summary in case of death Claims
• 10) Police FIR/ Medico Legal Certificate
• 11) Cancelled cheque of Primary Policy Holder
• 12) In case of Maternity-Letter from treating Doctor with the Gravida Detail

Expenses incurred at a hospital or a nursing home for diagnostic purposes such as X-rays, blood analysis, ECG, etc. will be reimbursed if they are related to the ailment for which the policy-holder has been hospitalized. In any other scenario, these expenses will not be reimburse.

The claim amount is paid to the registered nominee of the insured.

Co-pay is the percentage applied on payable amount which the policy-holder has to bear.

Yes, claims will be reimbursed even if insured is not treated in a network hospital. The hospital should fall under the definition of Policy wordings.

There is no restriction on the size of the individual claim in a year as long as the family does not exceed the Sum Insured.

If your cashless is rejected due to some reason, please make the payment and submit the bills for reimbursement, claim will be reviewed as per policy terms & conditions.

There is no limit on the number of claims in a years, claim amount will be limited to Sum Insured.

Deductions can pertain to non medical expenses, non submission of bills, co pay deductions etc.,

This is a very important document; it will mention the Date of Admission and Date of Discharge, Past History, details of treatment given, and requirement of medication post hospitalization, if any and doctor’s signature. This will be on the letter head of the hospital.

There is no limit on the number of times one can take treatment, however insurance company will reimburse claims up to the sum insured. And subject to policy terms.