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What is meant by cashless hospitalization?

Cashless Hospitalisation facility is available only at Network Hospitals. Cashless hospitalisation Facility enables the insured to obtain admission at designated hospitals subject to obtaining an Authority Letter from Medi Assist. In such cases, Medi Assist settles the hospital bills directly on your behalf.

What is the procedure for planned hospitalization (cashless)?

In the case of a planned admission, you would have first consulted a doctor who in turn would have advised you on the probable date of hospitalization. In such a case, you must apply for an approval of the estimated hospital expenses directly with Medi Assist India at least 72 hrs prior to the date of hospitalization. TPA desk or Hospital executive may assist you in filling up the form and the same shall be sent to Medi Assist.

Your claim would be assessed in the light of the policy issued to you by your insurance company and a letter of authorization will be issued to the hospital authorizing the patient's treatment. Once the Authority letter is sent to the hospital from Medi Assist, you need not pay to the hospital. Medi Assist will pay your hospital bills up to the amount authorized in the Authority letter.

What is an emergency hospitalization (cashless)?

Emergency hospitalization is a hospitalization which requires immediate admission to the hospital when an insured or covered family member meets with a sudden accident or suffers from a bout of illness

What is the procedure for emergency hospitalization?

Step 1 Approach the nearest Network hospital.

Step 2 Go to the TPA desk and fill in the Pre-auth form & submit. Hospital would send the filled in pre authorization request form to Medi Assist. Medi Assist will check the liability and send authorization letter (in case if the hospitalization is warranted and admissible under policy terms) or denial letter.

Step 3

  1. If authorization for cashless transaction from Medi Assist India has been received
    • At the time of discharge pay for those items that are not payable under the Health Insurance policy/excess/co-payments/deductibles
    • Verify the bills and sign on all the bills.
    • Leave the original discharge summary and other investigations reports with the network provider. - - Retain a Xerox copy for your record
  2. In case of non-receipt of authorization from Medi Assist or if Authorization is denied by Medi Assist
    • At the time of discharge/leaving the network provider premises, please settle the bills in full and collect all the bills documents and reports.
    • Lodge your claim with Medi Assist India for processing and reimbursement

Is there any time limit to submit the Pre-authorization request?

In case of emergency or unplanned admission, the hospital must send the pre-authorization request to Medi Assist within 24 hours from the time of admission .In case of planned hospitalization it is prudent to send the preauthorization request to Medi Assist at least 72 hours prior the admission date. This will ensure a hassle-free admission procedure for you at the hospital.

Do my medical expenses incurred before and after hospitalization covered?

Yes, Mediclaim policy allows reimbursement of relevant medical expenses incurred during pre & post hospitalization towards the ailment / disease for which hospitalisation was necessitated. This is subjected to the limits prescribed in the policy.

What is reimbursement claim (non-cashless) and its procedure?

If cashless facility is not availed, pre-authorisation is denied or treatment is availed at a non-network hospital, the insured will have to settle the bills directly with the hospital & subsequently claim reimbursement from Medi Assist by submitting the following documents in original to the nearest office of Medi Assist:

  • Claim form duly filled & signed
  • Original detailed Discharge Summary from the hospital
  • All original doctors prescriptions for medicines purchased
  • All original test reports
  • All original cash memos & bills for medicines
  • Your telephone numbers & e-mail ID
  • A cancelled bank cheque
  • Detailed medical history of the patient from the treating Doctor (optional)

Hospital / Nursing home should have a minimum of 15/10 in-patient beds depending on the class of town. Please refer your policy prospectus for a complete definition. Please ensure that the hospital / nursing home where you are contemplating treatment fulfils these criteria.

What is the deadline to submit reimbursement claim?

  • Claim intimation (with particulars relating to Policy Number, Name of the insured Person in respect of whom claim is made, Nature of illness / injury & Name & Address of the attending Medical Practitioner / Hospital / Nursing home) should be submitted within 7 (seven) days from the date of Hospitalisation/Injury.
  • Final Claim Form along with hospital receipt, bill / cash memos, the list of documents as listed in the Claim Form, should be submitted to Medi Assist within 30 (thirty) days from the date of discharge from the hospital.

Where can I submit the claim intimation?

You can submit the claim intimation at www.mediassistindia.com (Registration >> Claim intimation) or you can write to callcentre@mediassistindia.com with all the above particulars.

Do my medical expenses incurred before and after hospitalization covered?

Yes, Mediclaim policy allows reimbursement of relevant medical expenses incurred during pre & post hospitalization towards the ailment / disease for which hospitalisation was necessitated. This is subjected to the limits prescribed in the policy.

What is the TAT to process the reimbursement (Claim)?

15 working days after receiving all the required documents.

How does it take to receive the payment after the approval of the claim?

7 working days

What is a shortfall /information required (IR)?

In case of insufficient documents for the further validation of the existing claim, shortfall documents are raised.

Where and how can I send the Shortfall Documents?

In case of individual policy holders he can submit it to the nearest Medi-Assist branch. Corporate employees can hand it over to respective helpdesk person

What is the TAT for submitting the Shortfall documents?

10 working days

I have sent the claim documents but I cannot see my claim status

In case of Pre-Authorization request submitted through a network hospital, Please wait for up to 3 hrs to know the claim status. And in case of reimbursement claim, please check the claim status after 3 working days from the date of submission at Medi Assist office or from the date of correspondence through courier.

What happens to my Sum Insured after a claim is filed?

Sum Insured is reduced by the amount of claim paid for the rest of policy year.

What is the maximum number of claims allowed during the policy period?

There is no upper limit on the number of claims during the policy period. However, the total cumulative claim amount cannot exceed the Policy Sum Insured.

What is copay?

Copay is a percentage of amount which the policy holder has to bear at the time of discharge. It is applied on payable amount & the rest of the amount would be paid by the insurance company.

What if the cost exceeds the level of hospitalization insurance cover?

If the Sum insured exhausted, then the claimant has to pay the balance amount.

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