Effective April 2008, we have offered one more
innovation to our valued customers. Chola MS
HELP will offer quality service on health claims
whenever and wherever you need it. Some of the
services extended by Chola MS HELP are here
under.
Cashless access to our Network Hospitals
Reimbursement of Hospitalisation claims
Clarification on Policy Coverage, Claim
related
queries and Network Hospitals.
Planned Admission in Network
Hospitals - The member
has to obtain Pre-authorisation from
Chola MS HELP
atleast 72 HOURS PRIOR TO ADMISSION.
Chola MS HELP shall receive a
request for hospitalisation from the
Insured Person (OR Insured Person's
representative when he / she is
unable to personally communicate due
to medical condition) as per the
Form - 1 specimen which is provided
in this Book.
On receipt of such request and
after due scrutiny, Chola MS HELP
will issue a Pre-Authorisation
Letter (PAL) specifying his / her
entitlement of benefits under the
Policy.
The PAL will be dispatched to
the hospital through Email / Fax/
Post, for being produced to the
Provider at the time of admission.
The Provider will not extend
CASHLESS facility for planned
hospitalisation to any Insured
Person without PAL issued by Chola
MS HELP
Can a request for
Authorisation for cashless
hospitalisation be declined?
Yes, a request for authorisation
for cashless access may be declined
if,
- Inadequate information is provided
This only means that cashless access
is declined, and is no way to be
construed as denial of treatment.
The denial of pre-authorisation
request shall not be construed, to
mean that the policy holder cannot
claim under the terms and conditions
of the policy from Chola MS HELP. In
such cases insured is advised to
claim for reimbursement and Chola MS
HELP will process the claim as per
the policy terms and conditions.
Emergency Admission
When the Insured person requires
emergency admission in view of
accidental injuries or genuine
medical emergency, the Provider
shall admit on the basis of
identity and eligibility established
through Membership Card.
However it is the responsibility
of the Insured Person (or Insured
Person's representative when he /
she is unable to personally
communicate due to medical
condition) to intimate Chola MS HELP
details of the medical case along
with relevant documents WITHIN 24
hours of admission, for obtaining
Pre Authorisation Letter from Chola
MS HELP and submitting same to the
Provider.
Emergency admissions on
Membership Card shall be strictly
restricted only to accidental
injuries or genuine medical
emergency substantiated by proper
medical
examination / medical report /
diagnostic reports.
Billing and
discharge:
Insured will sign the final bill
and check the bill for correctness.
Chola MS HELP reserves its right for
recovery of any amount from the
insured person for billed services
which are not covered by the policy.
Ensure that all supporting
documents are attached to the bill.
You must pay all bills not
associated with the condition for
which hospitalisation was authorized
and the amounts in excess of the
approved limit.
Retain a copy of the final bill
and discharge summary.
Sign a claim form filled in all
respects and give it to the hospital
along with authorization letter
given by Chola MS HELP before
discharge.
Reimbursement for
pre and post hospitalisation expenses
As per terms & conditions of the
policy.
Reimbursement in
case of treatment in non-network
hospitals
Cashless
Hospitalisation is available only in
Network Hospitals. While it is
recommended that you choose a network
hospital, you have the liberty to choose
a non network hospital. In case you
avail of treatment in non Network
hospital, Chola MS HELP will reimburse
you the
amount of bills subject to the policy
terms and conditions. . Intimate Chola
MS HELP within 7 days from the date of
discharge. The following documents along
with the duly filled Claim form has to
be submitted to Chola MS HELP as per
terms & conditions.
Hospital bill with receipt for
payment along with the break up
signed by the member
In case of surgeons /
consultants bills, kindly insist on
a stamped, preferably numbered
receipt.
Doctors prescription and
medicine bills.
Discharge summary sheet from the
hospital
Pathological reports and other
investigation reports along with the
doctor's prescription.
Other relevant details and
documents related to hospitalisation.
Check the Health Card details like name,
age, etc.
Plan your hospitalisation for a smooth
and hassle free cashless approval
In case of Emergency admission in
network Hospitals, immediately intimate the
Corporate/ Insurance Desk of the Hospital
Inform Chola MS Help within 24 hours of
emergency hospitalisation • Verify the Final
Hospital Bill at the time of discharge
Please collect a duplicate copy of the
treatment papers from the hospital at the
time of
discharge
Intimate Chola MS Help within 7 days
from the date of discharge in reimbursement
claims and obtain a claim form
All original claim papers to be
submitted within the stipulated time as
stated in the Policy to Chola MS Help from
the date of discharge on reimbursement
claims
