TCS Health Insurance Hospitalisation Claim Reimbursement Guidelines

Hospitalisation Claim Guidelines Importantt guidelines Importan guid elines for processing processing of HIS Claims Claims 

Raise separate Claim requests f or each illness. il lness.

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Staple the Clai m Form along with supporting documents ( in case of multiple claims, staple them separately). separately).

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Write your empl oyee ID and and Domicili ary Claim on the envelope.

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Retain the scanned/photo copies copi es of all the documents to produce whene ver requested. requested.

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Original documents along with the duly dul y filled Claim Form needs to be submi tted through internal/externa internal/externall courier courier Or handover to the TPA helpde sk team.

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Submit the Claim Cl aim documents within 24 hours from f rom the date you sel ected to submit the documents on your claim form; else the request wil l be rejected. rejected.

Hospitalisation Hospitalis ation Claim Hospitalisation benefits are applicable only if the insured person is admitted to a hospital with an Active Line of Treatment continuously  continuously for f or a minimum of 24 hours hours (wi th exception to Day Care Procedures Procedures mentioned in the pol icy). All Hospitalisation Hospitali sation claims claims should be raised wi thin 90 90 days days from the Date of Discharge includi ng Pre & Post Hospitali Hospitali sation sation claims. 90 days’ ti meli ne is not applicable for the expenses expe nses incurred incurred during the last quarter of the financial year  and should be regi stered as per the communication communication post on Ulti Ultimatix matix .

Following are the mandatory documents for processing the Hospitalisation Claims:   

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Duly fill fi lled ed and signed Claim Form as generated through the portal. Original and detailed detaile d admission admission or discharge summary/card issued by the hospital hospital.. Original hospital hos pital bill bi ll along with break-up bill of all hospi talisation talisation expenses expenses – This will hel p us understand the breakup of all hospitali zation charges. ormation and Original cash paid receipt/cash receipt /cash memo issued by the hospital . – With Pre- printed doctor’s inf ormation receipt number. Blank document with the doctor’s signature and stamp wil l not be considered. Original investigati inve stigations/ ons/ lab/ test reports (wherever applicable) from hospitals or from any other l ab or diagnostic diagnostic centres during and before or after the hospi talisa tali sation. tion. Original medical bi lls or receipts with prescriptions for the medicines purchased from the pharmacy store. Original /attested /attested Settlement letter from the other/onsite insurer in case the actual actual claim is settled settle d by other insurer (l etter supported with the photo copies of Hospital Bill , Discharge Discharge summary & Investi gation reports, reports, etc.) Copy of Hospitalisation Hospitali sation Indoor case paper (wherever applicable) applicable) may be requested . In case of accidents or road traffi traffi c accident accident cases, submit the complete comple te details of the accident along with the copy of First Fi rst Information Report (FIR) or Medico Legal Legal Case (MLC) (MLC) f rom the police poli ce station or hospital. In case of Cataract Cataract claims, Intraocular Lens (IOL) sticker is mandatory.

Overseas Expenses: In case ncurred outside India and the local insurer’s i nsurer’s settlem settle ment is still pending, case of expenses i ncurred employees employ ees should raise the claim for up to Rs 95,000/95,000/- (For General grades) and Rs. 2, 39,000 39,000 (For SP grades) wi thin 90 days from the date of discharge and in the same Fi nancial Year, thereafter submit the documents documents once they have the bills bil ls to support the same same or when the settl ement is completed, relaxation of 60 60 days will be b e give n only for document submission. submissi on. Please note the claim amount should be in equi valent valent to Indian Rupees only. Kindly ensure to send the claim form & support supporting ing documents documents only at the address mentioned by you in the claim form, for more details refe r the the Contact Contact Matr Matrix ix ava available ilable on the port portal al - Home page. There are are certa certain in exclusions in HIS where NO benefi benefits ts are are payable. payable. The list li st of o f exclusions e xclusions enumerated enumerated in the policy document docum ent is only indicative and not exhaustive. These Guidelines Guide lines should be read in conjunction with the policy document and and for more details on the poli cy; you you may refer the policy document document and FAQs on Health Insurance Insurance Scheme, available at: Ultim at atix ix -> Global HR -> M y HR on KNOWM A X -> Indi Indi a > Hea Health lth Safe Safety ty & Well nes ness s > Health Health & Insurance