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Health insurance: Documents required for filing claim at a non-network hospital

In case of a planned hospitalisation in a network hospital, you are required to intimate the insurance company in advance, or within the suggested time in case of an emergency hospitalisation, to avail cashless facility. (Photo: iStock)Premium
In case of a planned hospitalisation in a network hospital, you are required to intimate the insurance company in advance, or within the suggested time in case of an emergency hospitalisation, to avail cashless facility. (Photo: iStock)

  • Many insurers accept electronic submission of documents that help faster processing of claims. You are advised to check with your insurers on this

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I am currently undergoing medical treatment and may require hospitalisation. The doctor I am consulting has suggested a hospital where cashless facility is not available. What are the documents required for processing claims if I undergo treatment 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 planned hospitalisation in a network hospital, you are required to intimate the insurance company in advance, or within the suggested time in case of an emergency hospitalisation, to avail cashless facility. This makes for a hassle-free experience for the insured.

However, in case you plan a treatment or have undergone treatment at a non-network hospital, you need to keep the following documents handy for a hassle-free claims process on a reimbursement basis:

Claim Form duly filled and signed by the insured. Form is generally available on the websites of insurance companies or with TPAs

Discharge summary (original, photocopy for pre/post hospitalisation claim)

Hospital bills (original)

For medicines purchased from outside, original bills should be accompanied by a prescription from the doctor

All diagnostic reports in original. They can be asked to be returned to you upon processing/payment of claim

In case of hospitalisation due to an accident, a medico legal certificate (MLC) from the hospital would be required

All previous treatment papers related to the ailment

Cancelled cheque/copy of passbook of the proposer for electronic fund transfer or a duly filled NEFT form stating branch MICR Code, branch IFSC Code, account type, complete account number, duly signed by insured and Bank authority and sealed by the bank (all fields in the form are mandatory to process the claim)

Copy of claim intimation, if any

In case claim amount is above Rs. 1 Lakh, cKYC Number/Form and KYC documents will be required (proof of identity, proof of address & PAN card copy/ Form 60)

Many insurers accept electronic submission of documents that help faster processing of claims. You are advised to check with your insurers on this.

(Send queries and views at mintmoney@livemint.com)

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