Ramesh has a health insurance policy for the last 2 years. When his wife admitted to hospital, he was sure that he will get the full amount from health insurance policy. He was not provided the cashless claim by the TPA because the hospital was not on the panal. He has the option to reimburse the claim. He had submitted all the claim documents on 8th day after first intimation. To his surprise his claim was rejected due late submission of claim documents after discharge.
What is the Time Limit for Filing A Claim?
The time limit for intimation and submission of documents varies companies to company –
|Insurer||Time limit for intimation to TPA||Time Limit for Submission of documents after discharge|
|Apollo Munich||7 days||7 days|
|Bajaj Allianz||7 days||15 days|
|Bharti Axa||1 day||As early as possible|
|Cholamandalam||2 days||30 days|
|Future Generali||24 hours||7 days|
|HDFC Ergo||15 days||30 days|
|ICICI Lombard||24 hours||20 days|
|IFFCO TOKIO||No time limit||30 days|
|Max Bupa||48 hours||30 days|
|New India Assurance||7 days||30 days|
|National Insurance||24 hours||25 days|
|Oriental Insurance||48 hours||7 days|
|Reliance||7 hours||30 days|
|Royal Sundaram||No time limit||30 days|
|Star Health||24 hours||15 days|
|United India||24 hours||15 days|
What info/documents required for preliminary intimantion to TPA/Insurer?
Preliminary intimation of claim carries information relating to policy number, name of insured person in respect of whom claim is made, nature of illness/injury and name and address of attending medical practitioner/hospital/nursing home.
What documents required for final claim submission to TPA/Insurer?
Completed Final claim form with originals of all receipts, bills and cash memos, and other documents (as listed in the claim form) such as Admission-cum-Discharge Summary from the Hospital, Attending Doctor’s Certificate (in the prescribed format), copies of diagnostic test reports, prescriptions for medicines purchased, police report/FIR (only in case of accidents) wherever applicable, etc., and policy copy.
Hospital/Diagnostic center bills should be supported by proper printed and revenue-stamped receipts and the receipts for Doctor’s fees should have the name, address and registration number of the Doctor printed therein.