Health Insurance: Documents Required to File a Claim in a Non-Network Hospital

-Name withheld on request

(Atul Deshpande is Head – Claims, Digital & Projects, Answers at SBI General Insurance)

In case of planned hospitalization in a network hospital, you need to inform the insurance company in advance or within the suggested time in case of emergency hospitalization to avail the cashless facility. This makes for a hassle free experience for the insured.

However, if you plan for treatment or have undergone treatment at a non-network hospital, you need to keep the following documents handy for a hassle free claim process on reimbursement basis:

Claim form duly filled and signed by the insured. The form is usually available on the websites of insurance companies or with the TPA

Discharge summary (original, photocopy for pre/post hospitalization claim)

hospital bills (original)

For medicines purchased from outside, the original bill should be accompanied by a doctor’s prescription

All diagnostic reports in original. They may be asked to return to you on processing/payment of the claim

In case of hospitalization due to accident, a Medico Legal Certificate (MLC) from the hospital will be required

All previous treatment papers related to illness

Canceled cheque/copy of proposer’s passbook for electronic fund transfer or duly filled NEFT form containing branch MICR code, branch IFSC code, account type, complete account number, duly signed by the insured and bank authority and sealed by the bank (all fields) are mandatory to process the claim in the form)

Copy of claim notice, if any

In case the claim amount is above Rs. 1 lakh, CKYC number/form and KYC documents will be required (Proof of Identity, Proof of Address and PAN Card copy/Form 60)

Many insurers accept submission of documents electronically which helps in faster processing of claims. You are advised to check this with your insurers.

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