Health Insurance Claim process

Step 1. Hospitalization

Who Will Do it : Policy Holder

What Should be done? click Here  to locate nearest network hospital

Step 2. Avail Cashless Hospitalization & Submission of Documents

Who Will Do it : Policy Holder

What Should be done? Avail cashless at the network hospital by showing your health card and valid photo ID

Step 3. Preauthorization

Who Will Do it : Network Hospital

What Should be done? Hospital will send the cashless request to HDFC ERGO / STAR / ICICI / CARE and coordinate with us for the  Pre-authorization form .

We request you to kindly submit the below mentioned mandatory documents as applicable for efficient and faster claim processing:

1. Duly filled Pre-authorization form.

2. Doctor's prescription with diagnosis, etiology, and recommended line of treatment mentioning hospitalization.

3. Investigation reports supporting the patient's diagnosis.

4. A detailed cost estimate of expected hospitalization expenses.

5. In case of Dengue / Thrombocytopenia, platelet count reports & vital signs related documentation.

6. Past medical history.

7. In case of accidental claim:

   1. Detailed narration of the incident, including date & time

   2. Medico-Legal Certificate (MLC) copy / causality records from the hospital

   3. First consultation papers issued immediately after the incident

   4. All relevant investigation reports
      
      
      

Step 4. At the time of Discharge & Settlement of claim

Who Will Do it : HDFC ERGO / STAR / ICICI / CARE

What Should be done? HDFC ERGO / STAR / ICICI / CARE TPA will scrutinize all the received documents and convey the final stand on the claim.

Step 5. Status Update

Who Will Do it : HDFC ERGO / STAR / ICICI / CARE

What Should be done? You will receive an update through SMS/Emails at every stage of the claim on your registered mobile number or email id.

Step 6.Cashless authorization & Approval of Claim

Who will do it: HDFC ERGO / STAR / ICICI / CARE & Network Hospital

What should be done? Hospital shall send the final bill to HDFC ERGO / STAR / ICICI / CARE for authorization and HDFC ERGO / STAR / ICICI / CARE shall scrutinize the same and give final authorization in case of approved transactions to the hospital. Any inadmissible expenses, copayments, deductions will have to be paid by you.

Document Check List
On receipt of complete documents, the claim would be processed in 1 hour from the time the last document is received.
( Please note In case of internal verification the final stand will be confirmed within 48 hours from the time the last document is received by HDFC ERGO / STAR / ICICI / CARE TPA )

• Step 1. Claim Registration
  
  

• To register the reimbursement or supplementary claim and to upload the documents instantly click here (file size to be 10MB each documents). To Download the KYC /NEFT & Digital claim form links are mentioned here for your further reference. Click here KYC,  NEFT, Digital Claim form. If your claim is already registered kindly click here to upload your documents instantly.
  
  

• Step 2. Processing of Claim

• Once you have shared the documents, HDFC ERGO / STAR / ICICI / CARE doctors team will review all the documents. Post satisfactory receipt of all necessary documents the claim will be processed in 15 days from the time of last document is received as per Terms & Conditions by HDFC ERGO / STAR / ICICI / CARE. You would also receive update with claim status through SMS / Emails at every stage of the claim. You can also track your claim status instantly here click here

• Step 3. Process for uploading Additional/Pending documents

• In case of any additional information or documents are required, HDFC ERGO / STAR / ICICI / CARE will sent an intimation through SMS & Email for the same.

• Post satisfactory receipt of all necessary documents the claim will be processed in 15 days from the time of last document is received as per Terms & Conditions by HDFC ERGO / STAR / ICICI / CARE

• Step 4. Settlement of claim

• Upon satisfactory receipt of all necessary documents the claim will be settled by HDFC ERGO / STAR / ICICI / CARE within 15 days from the time of last document is received and approved claim payment would be processed. The payment will be made to your bank account through NEFT.

• (Please note in case of any internal verification the final stand will be confirmed within 30 days from the time of last document is received by HDFC ERGO/ TPA)

List of documents required for claim registration:

• Duly filled and signed claim form with HDFC ERGO / STAR / ICICI / CARE policy number. 

• Original discharge summary

• Original final bill with detailed breakup, payment receipt and original pharmacy invoices supported by prescriptions

• Original investigation reports (e.g. blood reports, X-Ray, etc.)

• Implant sticker/invoice, if used (e.g. stent in angioplasty, lens for cataract, etc.)

• Past treatment documents, if any

• In case of accident, Medico Legal Certificate(MLC) or FIR

• In case of Proposer's death, nominee details to be provided. Legal heir certificate is required if nominee is minor

• NEFT details for payment - Copy of cancelled cheque with proposer's name printed on it or passbook copy attested by bank. Also, ensure KYC ID of the proposer is linked to the policy.

• Other relevant documents, if any