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Claim Procedure for ICICI Lombard General Insurance Company Ltd.

 

Procedure for Cashless treatment

Given below is a basic and indicative Cashless Claim Procedure. To know about specific service providersí/ TPA's claim process please refer there website:

-Select a hospital from your service provider's network hospital tie-ups. Check the Network Hospitals booklet mailed to you or visit your service provider's website. However, do note that the hospital booklet might not be updated. Your provider may include or exclude hospitals without giving prior information. It is advisable to check the updated list from the website or contact them directly for information.

-The claims for Comprehensive Health Insurance are serviced by ICICI Lombard Health Care, ICICI Lombardís very own claims processing portal.

-In case of emergency or planned hospitalization, just use your health ID card at ICICI Lombard Health Care network hospitals and avail of cashless service. Call 24-hours-toll-free number 1800-209-8888 for the complete assistance. For treatment in non-cashless hospitals, the claim form should be filled fully after discharge from hospital and sent to ICICI Lombard Health Care office along with following documents in original.

Standard list of documents required:
  1. Claim form duly filled & signed by the insured & doctor.
  2. Original discharge card/ summary & final bill.
  3. All investigation reports in originals.
  4. All medicines /lab/ hospital bill in original.
  5. All payments receipts in original and should be stamped.
  6. Any other required documents depending upon the case.
Reimbursement Claim Procedure:
Given below is a basic and indicative Reimbursement Claim Procedure. To know about specific service providersí/ TPA's claim process please refer there website:

- In Reimbursement Claim, you can undertake treatment in any hospital, irrespective of whether it is in the cashless hospital network or not.

-Once discharged after treatment, fill in the Claim Form, which can be downloaded from the service provider's website . Certain fields need to be filled in by the treating doctor. Ensure the form is properly filled in by you and the doctor.

-Courier the filled and stamped Claim Form to the service provider's office, along with the following documents:
  1. Original detailed discharge summary
  2. All Payment receipt(s) in original
  3. Copy of Health card and supporting Photo ID (wherever applicable)
  4. . Original hospital bill(s) with break upóInterim bills and Final Bill
  5. Package break-up (if applicable)
  6. Original investigation reports and Bills
  7. Pharmacy bills with supporting prescription from the treating doctor
  8. Consultation Papers with Treatment details
  9. Indoor Case Sheet (wherever applicable)
-Your service provider shall then approve or reject the claim based on the insurance coverage and the documentation.

-On approval, the claim amount as approved by the service provider's doctors shall be reimbursed by cheque. If the documentation is incomplete, you would be intimated and the process shall continue. However, it is important that the said documents are sent within the prescribed Claim Intimation Period. In case the said ailment is not covered under the Memberís Policy Terms and Conditions, the claim request shall be rejected.
 
Download Claim Form Download OPD Form Download Pre-Authorization Form Hospital Network