|If any treatment for which a claim may be made is to be taken then:
For all benefits, contingent on the companyís prior acceptance of a claim under Benefit 1a) (pls refer policy wording), the company or the TPA must be informed within 7 days of an Insured Personís discharge post Hospitalization.
- If the treatment requires Hospitalization, the company or the TPA must be informed immediately and in any event at least 7 days prior to the Insured Personís admission.
- If Hospitalization is required in an emergency, then the company or the TPA must be informed no later than the time of the Insured Personís admission to Hospital.
If any treatment, consultation or procedure for which a claim may be made is required in an emergency, then the company or the TPA must be informed within 7 days of the completion of such treatment, consultation or procedure.
In all other cases, the company or the TPA must be informed of any event or occurrence that may give rise to a claim under this Policy at least 7 days prior to any consequent treatment, consultation or procedure being taken and the company or the TPA must preauthorize such treatment, consultation or procedure.
Supporting Documentation & Examination
The Insured Person shall provide the company with any documentation and information the company or the TPA may request to establish the circumstances of the claim, its quantum or liability for the claim within 10 days of the earlier of the companyís request or the Insured Personís discharge from Hospitalization or completion of treatment. Such documentation will include but is not limited to the following in English:
Claim form, duly completed and signed for on behalf of the Insured Person.
- Original Bills (including but not limited to pharmacy purchase bill, consultation bill, diagnostic bill) and any attachments thereto like receipts or prescriptions in support of any amount claimed which will then become the companyís property.
- All reports, including but not limited to all medical reports, case histories, investigation reports, treatment papers, discharge summaries.
- A precise diagnosis of the treatment for which a claim is made.
- A detailed list of the individual medical services and treatments provided and a unit price for each.
- Prescriptions that name the Insured Person and in the case of drugs: the drugs prescribed, their price and a receipt for payment. Prescriptions must be submitted with the corresponding Doctorís invoice.
The Insured Person additionally hereby consents to:
- The disclosure to the company of documentation and information that may be held by medical professionals and other insurers.
- Being examined by any Medical Practitioner the company authorizes for this purpose when and as often as the company may reasonably require.