There are two types of claims which are received as per the policy i.e. Cashless and Reimbursement. Procedures for intimation of claim are as follows:
Cashless
Inform the hospital of the claim before hospitalization. This helps in fast approval of the claim and pre-authorization.
Get admitted to the hospital.
Share the KYC docs such as TPA Card - Medical e-card (If recieved), Identity proof - Pancard/Driving License, Address Proof - Aadhar Card with the Insurer.
Authorization for cashless to be processed is received from Insurer & shared directly with the hospital.
Once discharged, inform the Insurer to process all the requirements. Insurer will then connect with the Hospital for summary.
Payment is then made by the Insurer directly to the Hospital.
Reimbursement
Inform the insurer of hospitalization well in advance. (Min. 24 hrs prior)
Get the treatment done from the hospital.
Mail all the claim documents as mentioned below on the given address:
1. PFA and Duly Filled & signed Claim Form of The Insurance Company Ltd.
2. Original Discharge Card / Summary,
3. Original Final Bill of the Hospital,
4. Original Bill Paid Receipt,
5. Original Investigation Reports,
6. All Imaging Films, ECG Strips, Doppler / Angiogram CD etc
7. Original Prescriptions and corresponding Medicine bills,
8. Hospital Registration Certificate (in case of unknown hospital)
9. Any other original documents related to the claim.
10. MLC/FIR in case of Accident cases.
11. Patient Age Proof
12. Cancelled cheque or front page of Bank passbook of the policy holder is MUST along with the submission of claim documents. (MANDATORY)
13. Indoor case paper.
Kindly send all the claim documents on below mentioned address.
Landmark Insurance Brokers Pvt Ltd.(Kurla Office)
Unit 3, 4th floor,
The Centrium, Phoenix Marketcity,
Kurla (West),
Mumbai - 400 070.
Note : Kindly photocopy all the documents for future reference.
Insurer will scrutinize the documents once mail is received and confirm back if additional documents(If any) are required.
Insurer approves the claim if all the received documents are valid as per the intimation given by the employee.
Payment is released with 5 -7 working days and is directly credited to the employees account as per the bank details provided.