Critical Illness Health Insurance Claims - Reliance General Insurance

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1 Critical Illness Health Insurance Claims - Reliance General Insurance Critical Illness Health Insurance Claims To provide prompt claims servicing to you we have appointed Third party administrator duly licensed by IRDA. Our TPA will be happy to provide you with services in a hassle free manner within the terms and conditions of your Health policy. They will provide you the following claims services: "Cashless Service" at all our Network Providers for all eligible ailments/conditions. Processing and settlement of claims under the MEDICLAIM policy with a time bound approach. 24 hours Call Centre Service. As soon as a claim occurs, please intimate to the TPA Help line/toll free number as mentioned in your Health Card. Alternatively, please click at the following link to find your TPA and view the contact details Our Third Party Administrator Following information needs to be furnished by you while intimating a claim: Your Contact Numbers Policy Number and Membership ID number (as reflecting on the Health Card) Name of Insured person who is Sick or Injured, Nature of Sickness/Accident, Date & Time of Loss in case of accident, commencement date of symptom of disease in case of sickness, Location of Loss, Place & contact details of the Insured Person. Claim Procedure: Claims are broadly of two types: Reimbursement Claims Cashless Claims Claims under the above categories can be further of two types: Planned Hospitalization & Emergency hospitalization. Procedure for Reimbursement Claims Procedures for Cashless Claims Document Checklist and procedure to submit a Health Claim Frequently asked questions

2 Claim Reimbursement Reliance General Insurance Procedure for Reimbursement Claims To avail inpatient hospitalization services, you can go to any hospital of your choice, either a hospital on our network or a hospital outside the network. The difference between the two being that TPA can authorize for "Cashless Service" in the hospital on our network whereas you will have to settle all the bills in the hospital which is outside our network. However you have to follow the procedures listed below to get the services in different situations. A) Emergency hospitalization Step 1. Take admission into the hospital. Step 2. As soon as possible, inform TPA about the hospitalization. Step 3. At the time of discharge, settle the hospital bills in full and collect all the bills, documents and reports. Step 4. Lodge your claim with TPA for processing and reimbursement. B) Planned hospitalization Step 1. Inform TPA about the planned hospitalization. Step 2. Get admitted into the hospital. Step 3. At the time of discharge, settle the hospital bills in full and collect all the bills, documents and reports. Step 4. 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."

3 Know more about Cashless Claims Insurance Reliance General Insurance Page 1 of 2 HEALTH INSURANCE TRAVEL INSURANCE STUDENT TRAVEL You are at:- Critical Illness Policy Key Features Policy Coverage Policy Exclusions Claim Process Calculate Premium Cashless Hospitals View Brochure Policy Wordings FAQ 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

4 Know more about Cashless Claims Insurance Reliance General Insurance Page 2 of 2 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."

5 Know how to Lodge Insurance Claim Reliance General Insurance Critical Illness Policy Key Features Policy Coverage Policy Exclusions Claim Process Calculate Premium Cashless Hospitals View Brochure Policy Wordings FAQ How to submit your claim with TPA for processing and reimbursement. Step 1. Please collect all documents Step 2. Please fill up the claim form provided to you fully. Step 3. Within 7 days after discharge, please lodge your claim with TPA local branch for processing. Please note, when lodging your claim with TPA, please make sure that the documents are sent as per the check list mentioned below: Document Check list for Health & Critical illness: Hospitalization / Day Care Treatment First prescription of doctor with commencement date of the symptom of disease. Treatment papers along with doctors prescriptions Investigation reports (X-ray/Scan/ECG, Laboratory etc) Original medical bills and receipt of Hospital, doctors, medical shops, Diagnostic centre etc supported by Doctor's advice. Hospital discharge card. Copy of FIR (if any in case of accident). Critical Illness Claims Claim form duly completed. Original Specialist Doctor's certificate confirming the diagnosis and when the symptoms first occurred. Relevant Investigation reports (Radiology, Pathology etc) confirming the diagnosis. Hospital admission & discharge card / certificate Domiciliary Hospitalisation First prescription of doctor with commencement date of the symptom of disease. Treatment papers along with doctors prescriptions Investigation reports (X-ray/Scan/ECG, Laboratory etc) Original medical bills and receipt of doctors, medical shops, Diagnostic centre etc supported by Doctor's advice. Copy of FIR (if any in case of accident). Certificate from attending Doctor / Physician stating the condition of the patient is not permissible for him / her to be removed to Hospital/Nursing Home or documentary proof of lack of accommodation in hospital/nursing home ***Please note above list is only indicative. We may call for additional documents/information if required