In case of any event leading to a claim under the policy, please call the Toll Free number of our TPA, FHPL on 1800-425-4075, the Claims service personnel will guide you on the claim procedures and documents required.
A) Hospitalisation in Network Hospitals
For Availing the Cashless facility, FHPL will authorize “Cashless Service” at the empanelled hospitals in all cases eligible under the insurance policy.
As soon as possible inform FHPL and coordinate with the hospital to have the details sent to FHPL for authorization of cashless service.
On discharge, verify and sign the bills and pay for the items that are not payable under the health policy.
The original discharge summary and other investigation reports should be handed over to the hospital. Please retain a photocopy for your records.
Incase of a planned hospitalisation, kindly coordinate with the hospital and send in all the details of your hospitalisation at least 3 days prior to the admission, including the plan of treatment, cost estimates etc. to FHPL. Also indicate the contact details of the hospital to send the authorization.
B) Hospitalisation in Non - Network Hospitals
As soon as possible, inform FHPL about the hospitalisation. At the time of discharge, settle the hospital bills in full and collect all the bills, documents and reports. Register your claim with FHPL for processing and reimbursement.
How to lodge your claim with FHPL for processing and reimbursement?
Please register your claim with FHPL within 7 days of discharge. Kindly send the documents listed below for processing your claim:
- Duly signed claim form.
- Identity proof
- Copy of Policy Document.
- All hospital bills in original with detailed breakup for consolidated amounts.
- Bills for medicines purchased from outside, should be accompanied with a doctor’s prescription.
- Discharge summary / Discharge card in original.
- All investigation reports in original.
Documents in addition to those mentioned above may be called for depending on the nature of claim lodged. Please retain a copy of the documents sent for your records.
Kindly be informed that delay in intimation of claim may lead to rejection of claim.
Issuance of claim form should not be taken as admission of liability under the policy on the part of the insurer.
Notification of Claim:
- If any treatment for which a claim may be made is to be taken and that treatment requires hospitalization TPA must be informed immediately and in any event at least 7 days prior to the Insured Person’s admission.
- If any treatment for which a claim may be made is to be taken and that treatment requires hospitalization in an emergency, the TPA must be informed no later than the time of the Insured Person’s admission to Hospital.
- For all benefits which are contingent on the company’s prior acceptance of a claim under Section 1a (pls refer policy wording), the TPA must be informed within 7 days of the Insured Person’s discharge post hospitalization.
- If any treatment, consultation or procedure for which a claim may be made is required in an emergency, the TPA must be informed within 7 days of completion of such treatment, consultation or procedure.
- In all other cases the TPA or company 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 and the company or TPA must preauthorize such treatment, consultation or procedure.
(Please note that emergency means a sudden, urgent, unexpected occurrence or event, bodily alteration or occasion requiring immediate medical attention.)
Cashless Service:
- If any planned treatment, consultation or procedure for which a claim may be made is taken in a Network Hospital, cashless service will be provided by making payment to the extent of the company’s liability directly to the Network Hospital. Notice must be given that the Insured Person wishes to take advantage of the cashless service accompanied by full particulars at least 48 hours before the planned treatment or Hospitalization.
- If any treatment, consultation or procedure for which a claim may be made in an emergency, is taken in a Network Hospital, cashless service will be provided by making payment to the extent of the company’s liability directly to the Network Hospital. Notice must be given that the Insured Person wishes to take advantage of the cashless service accompanied by full particulars within 24 hours after the treatment or hospitalization.
Supporting Documentation & Examination
The Insured Person shall provide the company with any documentation and information that may be requested to establish the circumstances of the claim, its quantum or company’s liability for the claim within 15 days of the earlier of such request or the Insured Person’s discharge from Hospitalization or completion of treatment. Such documentation will include but is not limited to the following in English/Hindi
- 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, and diagnostic bill) and any attachments thereto like receipts or prescriptions in support of any amount claimed which will then become the company’s 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 doctor’s invoice where the doctor has been paid a fee and such a fee is being claimed for in this policy.
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 authorized by the company for this purpose when and so often as the company may reasonably require.
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