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Q. What documents are required for processing your claims on reimbursement basis ?
Ans. Following documents are required for processing your claims on reimbursement basis:
  a. Claim Form properly filled and signed by the claimant
  b. Discharge Certificate from the hospital
  c. All documents pertaining to the illness starting from the date it was first detected i.e. Doctor's consultation reports/history
    i. Bills, Receipts
    ii. Cash Memos from hospital supported by proper prescription

Receipt and diagnostic test report supported by a note from the attending medical practitioner/surgeon justifying such diagnostics. Surgeon's certificate stating the nature of the operation performed and surgeon's bill and receipt

    iv Attending doctor's / consultant's / specialist's / anesthetist's bill and receipt, and certificate regarding diagnosis
    v Certificate from the attending medical practitioner / surgeon that the patient is fully cured
    vi Details of previous policies : if the details are not already with us except in the case of accidents
Q. What documents should we obtain before discharge from the hospital in case of cash less facility availed ?
Ans. All bills in original and a discharge certificate are to be left with the hospital providing cashless treatment. The patient has to countersign all bills and fill the claim form and also leave the same with the hospital at the time of discharge.
A copy of the bills & Discharge Summary can be carried by the patient for his records and for submission along with Pre & Post Hospitalization bills.
Q. Is there any exclusion in the first year ?
Ans. Yes. mediclaim policy does not cover a few disease which have occurred within one year of policy commencement.
Diseases which are not payable during the first year of the operation of insurance cover are :
  • Cataract Benign Prosthetic Hypertrophy
  • Hysterectomy for Menorhegia or Fibromioma
  • Hernia, Hydrocele
  • Congenital, Internal Diseases
  • Fistula in anus, Piles, Sinusitis .
Q. I want to increase my Sum Insured and also add another family member to the policy. Please Advice.
Ans. You will need to contact your Insurance Company for any addition / deletion of the above type. Once we get a notification from them, we will update our records similarly
Q. Can I lodge more than one claim for the same disease ?.
Ans. Yes. Your mediclaim policy covers 30 days Pre-hospitalization expense reimbursement and 60 days Post-hospitalization expenses. You may lodge your Pre-hospitalization claim along with hospitalization claim.The Post-hospitalization claim may be lodged after 60 days of the hospitalization. However, please quote your Claim Number for easy referral and sorting
Q. During the course of my treatment, can I change the hospitals ?
Ans. Yes it is possible to shift to another hospital for reasons of requirement of better medical procedure. However, this will be evaluated on the merits of the case and as per policy terms and conditions.
Q. Can I get outpatient treatment using my TPA Card ?
Ans. No. The TPA Card is issued to you against your mediclaim policy which only covers hospitalization expenses. The outpatient / domiciliary expenses pertaining to the treatment of disease which is the cause of hospitalization is however covered (Please see Pre & Post Hospitalization benefits)
Q. I have received my policy, however, I have not yet received my ID Card. Please advice.
Ans. There could be a chance that the Insurance Company has still not forwarded your details to us. Also there is a possibility that your card has been dispatched and you have not received the same.
You can call our call center and they will guide you suitably. Alternatively, you can enter the policy number at our website ( ) and you can get your card status.
Q. I went to one of your network hospitals and they did not entertain me. How should I proceed ?
Ans. You may immediately call our call center, giving details of such hospitals/medical providers. Our network department will immediately contact the concerned medical provider and sort out the matter
Q. I am not keen to avail of Cash Less facility. Can I go in for reimbursement ?
Ans. Yes. Under the Mediclaim Policy, you can opt for Cash Less as well as Reimbursement. We would advise that in case you are taking treatment from a network hospital, then you should avail of the Cash Less facility. This will give you the financial advantage of not paying for your hospital treatment and also gives you more cushion to meet your post-hospitalization expenses.
Q. I have taken Mediclaim from Insurance at Delhi and I have been posted to Mumbai. can I still avail of Medsave 's service ?
Ans. Yes. The TPA service is of All-India nature. You can access any of our offices and in the event of a hospitalization, use the services of any network hospital spread across the country.

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