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.
Medical expenses incurred by the insured, towards the ailment provided is covered under Chola MS Health policies. THese are the broader head of expenses that the are payable under the policy:
- Hospital charges
- Fee of specialists, nurses, etc.
- Costs of various diagnostic tests, internal appliances, etc.
If the individual insured under the policy is admitted in a network hospital or facility, they will not have to pay upfront for their expenses of hospitalisation and treatments. Once the patient has been officially discharged, Chola MS will get in touch with the insured’ care providers and settle the necessary bills and expenses.
The insured must approach the TPA desk of the hospital with their Chola MS health card, photo ID card and concerned reports. Right after which the hospital will send an authorization request to Chola MS for the required treatment. In case it is denied, the patient must pay and file a claim with Chola MS with the necessary forms and documents.
If the insured is hospitalised with a hospital that requires them to settle the amount at the time of discharge, the insured must settle the expenses and then apply for a claim for the same with Chola MS. With the necessary documents in place, Chola S will process the claim as per the terms of the policy and reimburse the medical expenses as required, if admissible.
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: 1800-208-5544
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.
For notifying your claim and tracking your claims status, please use the below links:
Individual Customer - Click here
Corporate Customer - Click here
for more information, email to email@example.com
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