Health insurance coverage: Documents required for submitting declare at a non-network hospital

I’m at present present process medical remedy and should require hospitalisation. The physician I’m consulting has steered a hospital the place cashless facility shouldn’t be accessible. What are the paperwork required for processing claims if I bear remedy at a non-network hospital?

-Name withheld on request

(Answer by Atul Deshpande is Head – Claims, Digital & Projects at SBI General Insurance)

In case of a deliberate hospitalisation in a community hospital, you might be required to intimate the insurance coverage firm upfront, or throughout the steered time in case of an emergency hospitalisation, to avail cashless facility. This makes for a hassle-free expertise for the insured.

However, in case you propose a remedy or have undergone remedy at a non-network hospital, it is advisable to hold the next paperwork helpful for a hassle-free claims course of on a reimbursement foundation:

Claim Form duly crammed and signed by the insured. Form is mostly accessible on the web sites of insurance coverage corporations or with TPAs

Discharge abstract (authentic, photocopy for pre/publish hospitalisation declare)

Hospital payments (authentic)

For medicines bought from exterior, authentic payments ought to be accompanied by a prescription from the physician

All diagnostic reviews in authentic. They may be requested to be returned to you upon processing/cost of declare

In case of hospitalisation attributable to an accident, a medico authorized certificates (MLC) from the hospital can be required

All earlier remedy papers associated to the ailment

Cancelled cheque/copy of passbook of the proposer for digital fund switch or a duly crammed NEFT kind stating department MICR Code, department IFSC Code, account sort, full account quantity, duly signed by insured and Bank authority and sealed by the financial institution (all fields within the kind are necessary to course of the declare)

Copy of declare intimation, if any

In case declare quantity is above Rs. 1 Lakh, cKYC Number/Form and KYC paperwork might be required (proof of id, proof of deal with & PAN card copy/ Form 60)

Many insurers settle for digital submission of paperwork that assist sooner processing of claims. You are suggested to test together with your insurers on this.

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