Family Floater Claims Settlement

ICICI Lombard Health Care

Cashless Claims Overview

		Get admitted in any one of our networked hospitals Click here for empanelled list of Cashless Hospitals
		Fax the pre-authorisation form along with relevant documents (Investigation reports, Previous consultation papers if any, Cashless ID, Photo ID) Click here to download pre-authorisation form Click here to view list of required documents
		ICICI Lombard Health Care reviews your claim request and accordingly will approve, query or reject the same (as per policy terms & conditions) Click here to view status descriptions Click here for important do's and don'ts Click here to check your claim status
		ICICI Lombard Health Care settles the claim (as per policy terms & conditions) with the hospital after completion of all formalities. Click here to view standard payments and exclusions Click here for detailed claim process

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Claims Do's & Don'ts

Make sure to fill up the mobile number in pre-authorisation form
Non-payable items have to be borne by the Insured
In case of cashless denial, the Insured has to pay the hospitalisation expenses
In case of planned surgery, send the pre-authorisation form in advance ( but not
before 15 days from the admission date)
All claims to be submitted within 21 days from the Date of Discharge (DOD)
Post hospitalisation claims may be submitted within 81 (60 + 21) days from Date Of
Discharge
Use the website to access the claims tracker, network hospital list, e-card and
various other information and services
Do not refer network list of any other service provider
Do not submit the claim documents at any local ICICI Lombard GIC Ltd office
Always keep a photocopy of the claim documents submitted to ICICI Lombard GIC Ltd
All claim forms should be duly and completely filled

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Required Documents

Duly filled Claim form (signed by the Insured and the treating doctor)
Discharge summary (with details of complaints & the treatment availed
Final Hospital Bill (detail breakup) along with interim bills
Payment Receipts
Doctor’s consultation papers
All investigation reports (e.g. Blood report, X-ray, Sonography, MRI, etc.)
All pharmacy bills supporting with doctor prescriptions
Implant sticker / invoice, if used (e.g. lens details in cataract case, stent details in
angioplasty)
Medico Legal Certificate (MLC) and / or FIR for all accident cases
For miscellaneous charges - detail bills with supporting prescription of the Treating
doctor
Copy of Health card
Any other related documents

Note: All documents should be Original

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Standard Payments & Exclusions

Payments include:

Accommodation Charges - Room Rent (as per eligibility)
ICU Charges (wherever applicable)
Treating Doctor fees (e.g. - Surgeon charges, Visit fees, Consultation fees, etc.)
Nursing Charges
Anesthesia & Anesthetist charges
Operation Theatre charges (wherever applicable)
Investigation charges
Pharmacy bills
Consumables
Implant(s) charges (wherever applicable) – e.g. Stents, Lens, etc.

Exclusions include:

Ambulance charges (unless specified in policy)
Administration charges
Admission / Registration fees, File / Records Management charges
Service / Surcharges
Bed booking / Reserving charges
Food & Beverages
Soaps , Toiletries & Laundry
Patients’ Attendant charges
Special Nurse / Attendant charges
Telephone / Photocopy / Courier / Insurance Processing Fees, etc
FIR / MLC charges
Others (non-insurance, items not related to treatment)
All Items mentioned as exclusions in the policy

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Status Descriptions

Claims may be Approved or Rejected or Queried:

Approved Cases - Settlement letter and the cheque in favour of the proposer is sent at the mailing address mentioning approved and disallowed amount and reasons.

Queried Cases - Query letter is sent to the insured requesting submission of additional documents/information. Two query reminders are also sent within a span of 15 days each, failure to revert within 45 days of initial query leads to closure of the claim. Closure of a claim is not equivalent to rejection. Closed cases may be reopened if adequate documents are provided.

Rejected Cases - Rejection letter is sent to the insured mentioning sufficient grounds as per the terms and conditions of the policy.

Note:

Cashless Facility is only available at hospitals in our cashless network.
In case of Planned Hospitalisation contact your service provider two days prior to
admission.
In case of Emergency Hospitalisation contact your service provider within 24 hours
of hospitalisation.
ICICI Lombard Health Care is an in-house health claim processing and wellness
centre of ICICI Lombard.