Your reimbursement claim for Mediclaim is needlessly delayed if you miss out any of the necessary documents. It is important to check while submitting that all of them are in order.Here are five documents which are often missed
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Reason for delayed intimation
Most policies require you to intimate the Insurance Company or TPA about impending hospitalisation. The intimation needs to be sent usually within 48-72 hours ( check your policy for exact details).
In case you forget, all you have to do is to enclose a letter saying why the intimation was delayed. One may just add that the patient was so busy with preoperative preparation that intimation could not be done in time.
The exact reason is not important. Better to intimate in time because even a simple email to the TPA containing details of policy, details of hospitalisation and approximate cost and name of doctor is enough.
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Reason for delayed submission of claim form
All policies stipulate a time within which the claim form has to be filed. The usual time limit is 7 to 15 days from discharge from Hospital.
In case you are late, never mind, your claim will not be rejected. This has been clearly mentioned in IRDA Health Insurance Regulation 2016 clause.
However, you need to give an explanation. The reason is not important but if you do not give any accompanying letter explaining the cause of delay, your claim will be held up
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PAN and Aaadhar Card of Insured and the Owner of the Policy.
If the claim is for a wife and the policy is in the name of the husband and includes husband wife and son , then while filing claim you need to include the Aadhar and PAN card of boht the Insured ( wife) and the Husband ( ownber of the policy.
Why is this so ? Well there is something called “Prevention of Money Laundering Act PML)” which requires these to be filed for “ high value claims” but often the Insurance Company expects this for all claims.
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The correct Form and the Correct dates.
Please make sure that you have the correct form for reimbursement . Normally the standard IRDAI form should do but some companies insist on their own form which has aadhar card and PAN card fields.
Make sure that the post hospitalisation expense is not mixed up. That has to go in a separate form and has to be submitted after 30 – 60 days of discharge ( please check your policy for the exact details )
Here is an example of the standard IRDA claim form from the Insurance Company website
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Some policies require Doctors fees to be included with Hospital Bill
Some Hospital bills have Medicine whose details are not included. They will be disallowed unless you send in the details authorized by the Hospital.
Some policies require surgeons or doctors bills to be included with the Hospital bill. Make sure that is done so else it will be excluded.
Some policies state that payment to Doctors have to be by cheque for bills of more than Rs 10000 and numbered receipt have to be obtained.