Health Claims Process
How do I file a claim?
Chola MS health policies cover medical expenses incurred towards the ailment provided that it is admissible under the policy. Following are the broad heads of expenses payable on a health policy.
- Hospital (Room & Boarding and Operation Theatre) charges
- Fees of Surgeon, Anesthetist, Nurse, Specialists
- Cost of diagnostic tests, medicines, blood, oxygen, internal appliances like pacemaker (if prescribed medically)
In the event that an insured is hospitalized in a network hospital / nursing home,
he / she need not pay the medical expenses (as per coverage) up to the sum insured specified under the policy. This is subject to claim intimation to Chola MS and approval of the request as per terms of the policy. Chola MS will co-ordinate with the hospital / nursing home directly and settle the bills after the insured patient is discharged.
The insured has to approach the TPA desk of the hospital along with the Chola MS Health Card, a Photo ID card and the investigation reports. The hospital will then send the request for authorization of treatment to Chola MS. In case we deny the request, the insured has to pay the bills and submit the claim documents for a reimbursement.
Network Hospitals can fax the form to 044-39910510. For more information, contact our 24-hour helpline: 1800-425-2200.
In the event that an insured is hospitalized in any hospital / nursing home (within India) as defined in the policy and pays the treatment expenses at the time of discharge, he / she needs to file a claim with Chola MS for the amount due under the policy. Chola MS will process the claim as per the terms of the policy and reimburse the medical expenses covered to the insured if the claim is admissible.
Documents required for processing of the claim in a Health Policy:
- Claim form duly filled and signed
- Prescription of doctor advising the admission
- Discharge card issued by the hospital
- Final hospital bill (in original) and payment receipt
- Medical investigation reports
- Medicine bills with the supporting prescriptions
- Invoice / sticker for implants if used in the surgery
- Other bills or documents related to the treatment
- Medico Legal Certificate (MLC) / FIR in case of road traffic accidents (RTA)
- Cancelled Cheque of insured bank account to make the claim payment through NEFT.
Documents required for processing of the claim in a Critical Care Policy:
- Claim form duly filled in and signed
- All supporting reports to prove diagnosis of the critical illness (pathological, imaging or any other reports)
- Detailed attending physician's report mentioning the past medical and surgical history of the patient with duration and confirming the diagnosis
- First Consultation paper