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CHECK LIST OF ENCLOSURES FOR SUBMISSION OF CLAIMS |
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[Please tick (ü) the appropriate box] |
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| Duly filled in Claim Form | Orginal
invoice for Implants (vis Stent/PHS mesh/IOL etc) |
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| Photocopy
of ID card |
First consulation letter
for the presenting complaints |
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| For Individual:- | Orginal copies of doctors
consultation prescription /notes |
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| Copy of current year policy | Treating Doctors
certificate regarding presenting complaints its etiology past history of
presenting complaints along with duration |
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Previous policy copies (2-3 years) in continuation |
Pre-hospitalization
prescriptions |
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| For
Corporates:- |
Original
prescription/doctor notes of previous treatment for the presenting
complaint |
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| Endorsement
letter from the Manager-HR regarding date of joining of the policy |
Details of previous claims
for the same complaints with current status |
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| For
PP Claims: |
Date of previous operation (if any) along with copy of discharge summary and details of previous hospitalization | ||
| Copy of admission Request note | For
Death Cases: |
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| Copy of approval letter | Attested copy of death
summary in pre-printed stationery of hospital signed by the consultant
with hospital stamp and registration number of the hospital. |
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| Letter from hospital regarding utilization / non | Attested copy death
certificate from competent authority |
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| Utilization
of preauthorization |
Legar heir certificate (in
case of death of the main member) |
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| General |
For Maternity Cases | ||
| Orginal
copy of consolidated bill of pre-prented stationery with serial number
and IP number of hospital, with breakup as below |
Original
copy of treating doctor certificate regarding obstetric history (Gravida,
Para, Living children, Abortions, Death) |
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| Professional
charges |
Original
letter from treating doctor stating marital status and number of living
children |
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| Nursing charges | For
RTA |
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| Surgeons
assistants anesthetists fees (either individual receipts and in case of
shared to be authenticated with signatures of persons accepting the
amount) |
Attested
copy of MLC report |
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| Details of OT charges | Attested
copy of Fir |
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| Details
of Medical care (if any) |
Original copy of treating doctors certificate with circumstances and injuries sustained due to RTA | ||
| Details
for equipment charges (if any) |
Original
copy of treating doctors certificate for any evidence of influence of
alcohol/other narcotics substance during the accident |
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| Room
rent – breakup with number of days |
Attested
copy of post mortem report (in case of death) |
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| Orginal
medicine and pharmacy bills |
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| Break
up of Pharmacy and OT Consumables |
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| Break
up of medicines used in OT/ward |
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| Break
up of laboratory charges |
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| Dialysis
chart with the corresponding dates stamped and authenticated by the
hospital |
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| Orginal copy of the receipt of payment | |||
| All
orginal prescriptions for the bills attached |
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| All
the Orginal Investigation Reports |
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| Original
discharge summary in Pre-printed stationery of hospital
stamp and registration number of the hospital |
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Important :All enclosures should be arranged in the above order |
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