Claim Documents Checklist for Group Insurance Policies

Documentation plays a very important role when it comes claims. If we submit the correct documents on time, claims get settled without any hassle.

For cashless facility, health insurance card and one identity proof needs to be submitted at TPA Desk in the hospital by patient.

Then, Hospital needs to submit following documents to the Insurer/TPA at the initial stage:

  1. Pre- Authorization form
  2. Investigation reports
  3. ID Proof of the patient
  4. Health card of the patient
  5. Doctor’s note

At the discharge time, following documents should be submitted by hospital:

  1. Discharge summary
  2. Final bill with breakup
  3. All investigation reports

 

Health insurance claim process

For Reimbursement, these are the documents which are required to be submitted for reimbursement in Group Mediclaim Claims:-

 Claim Acknowledgement Number (At the time of Intimation)
 Claim form duly filled and signed with employee code of the claimant / employee on it.
 Prescription Details by treating doctor/surgeon
 Discharge Card & Discharge summary in original
 All original bills & receipts
 Investigation Reports
 X-ray, ECG/Films if any.
 Cancelled Cheque of Employee alongwith filled ECS Form.
 Pre & post hospitalization bills supported with prescription /advice of treating doctor

For Group Personal Accident Claims, following documents are required:
1) Duly filled and signed Claim Form – attached
2) Initial Prescription of doctor recommending for bed rest.
3) Police Report, If any.
4) MLC Report
5) Copy of driving license
6) IPD records & Discharge summary in case of hospitalization.
7) OPD record along with Prescriptions etc.
8) Report of attending doctor as regards to cause of accident and nature of injury.
9) X-rays/ other Medical reports
10) Medical Bills corresponding to doctor’s prescription.
11) Leave Certificate from employer also mentioning date of joining, band and employee code.
12) Salary Slips for the last two months.
13) Medical Fitness certificate from attending doctor containing following information:
a) Name of the injured person
b) Date and the cause of the accident
c) Nature and extent of injuries in details
d) Disablement for work, whether:
i) Total or partial; and
ii) If worker has suffered Permanent Partial Disability, the percentage of loss of earning capacity.
e) Date on which worker/employee fit to resume duties.

Health insurance claim proccess

For any assistance, call us on +91 9910913339

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