✅ Cashless Authorization letter is issued on the basis of information provided in Pre- Authorization form. In case misrepresentation/concealment of the facts or any material difference/ deviation/ discrepancy in information is observed in discharge summary/ IPD records, then cashless authorization shall stand null & void. At any point of claim processing, Insurer or TPA reserves the right to raise queries for any other document to ascertain admissibility of claim.
✅ KYC (Know your customer) details of proposer/employee/beneficiary are mandatory for claim payout above Rs 1 lakh.
✅ Network providers shall not collect any additional amount from the individual in excess of Agreed Package Rates except costs towards non-admissible amounts (including additional charges due to opting higher room rent than eligibility/choosing separate line of treatment which is not envisaged/considered in package).
✅ Network providers shall not make any recovery from the deposit amount collected from the Insured except for costs towards non-admissible amounts (including additional charges due to opting higher room rent than eligibility/ choosing separate line of treatment which is not envisaged/considered in package).
✅ In the event of unauthorized recovery of any additional amount from the Insured in excess of Agreed Package Rates, the authorized TPA / Insurance Company reserves the right to recover the same or get the same refunded to the policy holder from the Network Provider and/or take necessary action as provided under the MOU.
✅ Where a treatment/procedure is to be carried out by a doctor/surgeon of insured's choice (not empanelled with the hospital),Network Provider may give treatment after obtaining specific consent of policy holder.
✅ Differential Costs borne by policy holder may be reimbursed by insurer subject to the terms and conditions of the policy.
✅ Detailed Discharge Summary and all Bills from the hospital
✅ Cash Memos from the Hospitals / Chemists supported by proper prescription.
✅ Diagnostic Test Reports and Receipts supported by note from the attending Medical Practitioner / Surgeon recommending such diagnostic tests.
✅ Surgeon's Certificate stating nature of operation performed and Surgeon's Bill and Receipt
✅ Certificates from attending Medical Practitioner / Surgeon giving patient's condition and advice on discharge.