Procedures for Cashless Claims:

Cashless Service is the service wherein you need not pay any amounts either as a deposit at the time of admission or for the hospital bills at the time of discharge. This facility is available only at our Network Hospitals. To avail the "Cashless Service" you need to fill "Cashless request form" available in the network hospital get an authorization from TPA. This authorization along with a copy of the card issued by TPA has to be given to the Network Provider at the time of admission. Please Note: TPA will authorize "Cashless Service" at the Network Providers in all cases eligible under the insurance policy.

"Cashless Service" may be denied in some of the situations as listed below.

• In case of any doubt in the policy terms with respect to the present ailment.
• If the information sent to TPA is insufficient to confirm coverage.
• The ailment/condition etc. not being covered under the policy.
• If the request for preauthorization is not received by TPA in time.

Denial of "Cashless Service" is not denial of treatment. You can continue with the treatment, pay for the services to the hospital, and later send the claim to TPA for processing and reimbursement.

A) Emergency hospitalization

Step 1. Take admission into the hospital.

Step 2. As soon as possible, please obtain the pre-authorization form from hospital and get the same filled in and signed by the attending doctor.

Step 3. Fax the pre-authorization form by you/hospital along with necessary medical details like investigation report etc to TPA at the number mentioned in your health card.

Step 4.
A) If authorization for "Cashless Service" from TPA has been received by hospital

• At the time of discharge settle the hospital bills in full and collect all the bills documents and reports
• Pay for those items that are not reimbursable under the MEDICLAIM policy.
• Verify the bills and sign on all the bills.
• Leave the original discharge summary and other investigations reports with the hospital. Retain a Xerox copy for your records.

OR

B) In case "Cashless Service" was denied by TPA

• At the time of discharge
• Lodge your claim with TPA for processing and reimbursement

B) Planned hospitalization

Step 1. Please co ordinate with your doctor and the hospital and send in all the details of your planned hospitalization including the plan of treatment, cost estimates etc. to TPA. This should be sent to TPA at least 2 days prior to the admission.

Step 2. A) If authorization for "Cashless Service" from TPA has been received

• At the time of admission, hand in the authorization letter and a photocopy of your ID card to the hospital.
  • Pay for those items that are not reimbursable under the MEDICLAIM policy.
  • Verify the bills and sign on all the bills.
  • Leave the original discharge summary and other investigations reports with the hospital. Retain a Xerox copy for your records.

OR

B) In case "Cashless Service" was denied by TPA

• At the time of discharge settle the hospital bills in full and collect all the bills documents and reports.
• Lodge your claim with TPA for processing and reimbursement

"Please note: failure to intimate TPA as soon as the claims occur may invalidate your claim."