CLAIMS PROCEDURE FOR MEDICLAIM INSURANCE.
IMPORTANT: As per the rules the hospitalization has to be intimated to TPA office or at Toll Free No. or at Accimate office on 022-46046645 / 022-22011929 or email at claims@accimate.co.in within 24 hours of Hospitalization. Also the claim papers need to be submitted to the TPA or Accimate Insurance & Risk Management Service Pvt Ltd Mumbai office within 5 days of Discharge. Post Hospitalization claim has to be submitted separately within 5 days after completion of treatment. The above sets of rules have to be followed strictly as instructions from the Insurer. Failure to follow the same will automatically result in rejection of your valid claim due to Non Intimation or Late submission of documents.
The expenses can be claimed in two ways.
A) Cashless Procedure B) Reimbursement Procedure
FLOW CHART OF THE CASHLESS HOSPITALISATION PROCEDURE
Step 1 |
Hospitalization in Cashless Network Hospital by paying a nominal deposit Amount. |
Step 2 |
Pre Authorization form to be duly filled by the treating doctor in hospital & fax the same to the TPA & inform the same to Accimate office. |
Step 3 |
TPA will sanction the cashless facility according to the Policy Terms & Conditions. |
Step 4 |
Hospitalization – Examination by doctor – admission – Pathological tests – Surgical or medical treatment – discharge. |
Step 5 |
At the time of discharge fax the final bill to the TPA & the amount will be settled by the TPA to hospital as per the policy Terms & Conditions. |
Step 6 |
In case of any Pre or Post Hospitalization expenses incurred than it will be settled as per the Reimbursement claim Procedure. |
FLOW CHART OF THE REIMBURSEMENT HOSPITALISATION PROCEDURE.
Step 1 |
Hospitalization |
Step 2 |
Intimation by family to TPA and Accimate office simultaneously on Contact details mentioned above by Email or phone. ( WITHIN 24 HOURS OF HOSPITALIZATION ) |
Step 3 |
Accimate will contact proceed accordingly. |
Step 4 |
Hospitalization – Examination by doctor – admission – Pathological tests – Surgical or medical treatment – discharge. |
Step 5 |
Submission of claim form & all papers / reports / bills / Cash Memo to Accimate by courier on address stated below. ( WITHIN 5 DAYS OF DISCHARGE) |
Step 6 |
Accimate to review the case, & forward it to TPA for processing |
Step 7 |
Accimate to hand over the cheque. |
Documents required in case of Reimbursement Claims (In Originals)
- Hospital / Nursing Home Pre Printed Invoice along with Payment Receipt.
- The discharge card and any other expenses incurred during, pre and post hospitalization.
- All the bills of medicines along with the prescription.
- The pathological reports and their bills and prescriptions.
- The bills of the bed charges as well as surgery charges of the doctor.
For more details regarding the Benefits, Exclusions and other terms and conditions in details visit our website www.accimate.co.in or mail us at claims@accimate.co.in or call us at 022-46046645 / 022-22011929.
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