REIMBURSEMENT PROCEDURE

1. NOTICE OF CLAIM: Immediate WRITTEN (Email/Fax) notice of claim with particulars relating to Policy Number, ID Card No., Name of insured person in respect of who claim is made, Nature of disease / illness/ injury, Name and Address of the attending medical practitioner / Hospital/Nursing Home etc. Such notice should be given to the TPA within 24 hours of admission from Hospital / Nursing Home, whichever is earlier. 2. CLAIM DOCUMENTS SUBMISSION: Final claim along with hospital receipted original Bills/Cash memos/reports, claim form and list of documents as listed below. a. Duly Signed & Filled Claim Form. b. Original Indoor case papers and vital charting.[ Daily Nursing Chart Require] c. Original bills, receipts and discharge certificate / card from the hospital. d. Medical history of the patient recorded by the Hospital. e. Original Cash-memo from the hospital (s) / chemist (s) supported by proper prescription. f. Original receipt, pathological and other test reports from a pathologist / radiologist including film etc supported by the note from attending medical practitioner / surgeon demanding such tests. g. Attending consultants / Anesthetists / Specialist certificates regarding diagnosis and bill / receipts etc. in Original h. Surgeons original certificate stating diagnosis and nature of operation performed along with bills / receipts etc. i. Any other information required by TPA / Insurance Company. j. Hospital registration certificate/ inpatient facility certificate. [Form C from the Hospital Authority in order to registration of Hospital with local authority] k. Prescriptions and investigation reports supporting treatment taken, for present ailment, prior to admission, if any. l. Original Bar Code with respect to all external equipments such as contact lenses, cochlear implants etc. m. Last 4 years policies copies of Present or Previous Insurance companies [ Continuity benefits for the waiting period ailments ] All documents must be duly attested (signed) by the Insured person. In case of post hospitalization treatment all supporting claim papers / documents as listed above should also be submitted within 7 days after

completion of such treatment to the Company / T.P.A. In addition insured should also provide the Company / TPA such additional information and assistance as the Company / TPA may require in dealing with the claim. The above should be submitted to the Company / TPA within 7 days of discharge from the Hospital / Nursing Home.

Note: Claims are being denied by TPA/Insurance Companies due to noncompliance.

Medimanage Assistance Medimanage assistance would be available for the first 5 days from Discharge. After which, the customer would have to coordinate with the TPA directly. For any assistance on the above procedures, please call as soon as you are aware of the hospitalization. You can submit the Original Claim documents to Medimanage [ At least 4 days after Discharge] at below said address. Address :Medimanage Insurance Broking Pvt. Ltd 101, Shiv Krupa, Kirol Village, Kirol Road, Vidyavihar (West), Mumbai- 400086 Contact Number :- 91 22 67282973/9820246961