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Securenow Docs Checklist

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61 views2 pages

Securenow Docs Checklist

Uploaded by

ankit rawat
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Health Insurance Claim Documents Checklist

Hospitalization Claim
Reimbursement claim must be intimated within 24 hours of admission and claim documents must be
submitted within 7 days from the date of discharge from hospital.

1. Claim form duly ( Part A and Part B) signed by the claimant.


2. Prescription details by treating doctor/surgeon.

3. Original hospital discharge card/summary mentioning the date of admission, date of discharge,
diagnosis, presenting complaints, past history, clinical findings, course in the hospital, treatment given
during the period of hospitalization and advise at discharge.
4. Original pre-numbered hospital bill with hospital seal and signature indicating complete details
of break-up and hospitalization period.
5. Original pre-numbered paid receipt with hospital seal and signature towards the final hospital bill.
6. Original of all laboratory & diagnostic test reports. E.g. X-Ray, E.C.G, Ultrasound, MRI Scan,
Haemogram etc.
7. If you have purchased medicines which have not been reflected in the hospital bill, please enclose
a prescription from the doctor and the supporting stamped medicine bill/receipt from the chemist.
8. If you have paid for Diagnostic or Radiology tests and it has not been reflected in the Hospital bill,
please enclose a prescription from the doctor advising the tests, the actual test reports and the stamped
bill/receipt from the diagnostic centre for the tests.
9. Photo copy of valid ID proof of patient and employee.

10. Cancelled Cheque of Employee with pre printed name on it. Complete NEFT details need to be
filled in claim form/EFT form as applicable.
11. Please enclose the IOL sticker in case of Cataract operation if covered in the policy.
12. Original implant sticker/invoice.
13. Indoor Case Papers ( ICP) in few cases post review of Initial documents.

Note – Above document checklist is standard checklist for health insurance claim. On case to case basis,
insurer/TPA may ask for any additional documents based on the requirement.
Pre/Post Hospitalization Claim
1. You are entitled to claim for relevant Pre & Post hospitalization expenses if the same is included
in your policy.
2. Pre & post hospitalization expenses are payable only if the main hospitalization claim is payable
under the policy and must be related to the ailment for which hospitalization was taken.

For Pre & Post Hospitalization expenses, please provide the following documents:

1. Claim form duly signed by the claimant.


2. Medicines: Please provide the doctor’s prescription advising medicines and the relevant chemist bill.
3. Doctor’s Consultation Charges/Fee: Please provide the doctor’s prescription and the doctor’s
bill/receipt.
4. Diagnostic Tests: Please provide the doctor’s prescription advising tests, the original test
reports and the bill & receipt from the diagnostic centre.
5. All original Prescriptions in support of medicine bills.

Important Points

1. ONLY ORIGINAL DOCUMENTS SHOULD BE ENCLOSED, DUPLICATES OR

PHOTOCOPIES WILL NOT BE ENTERTAINED BY INSURER/TPA.


2. CLAIM DOCUMENTS MUST BE PUT IN AN ENVELOPE AND DISPATCHED TO BELOW ADDRESS:

CLAIMS TEAM,

SECURENOW INSURANCE BROKER PVT LTD.

GROUND FLOOR, PLOT NO 68, SECTOR 18, GURGAON- 122001

CONATCT NO - 9696683999

CLAIM INTIMATION CAN BE GIVEN AT BELOW MENTIONED NUMBER OR E MAIL ID.

Email ID – [email protected]

Contact number – 96966-83999

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