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Request Claim Assistance
Please select an insurer to get the contact details
ICICI Pru iProtect Smart helpline details:
1860 266 7766
claimsupport@iciciprulife.com
HDFC Life helpline details:
1860 267 9999
service@hdfclife.com
CARE Insurance helpline details:
1800-102-4488
customerfirst@careinsurance.com
Star Health Insurance helpline details:
1800-425-2255 / 1800-102-4477
support@starhealth.in
CARE Insurance helpline details:
1800-102-4488
customerfirst@careinsurance.com
Star Health Insurance helpline details:
1800-425-2255 / 1800-102-4477
support@starhealth.in
Lombard helpline details:
1800 2666
customersupportba@icicilombard.com.
Bike Insurance helpline details:
1800-425-2255 / 1800-102-4477
support@starhealth.in
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Note: *MyPolicyJunction acts only as a facilitator and claims settlement shall be at the sole discretion of the insurer.
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Claim Process
Cashless Claims Reimbursement Claims
Cashless Claims Reimbursement Claims
Floater Individual
Cashless Claims Reimbursement Claims
1
Inform the insurer
To start the process of claim, the nominee needs
to inform the insurance company at the earliest.
2
Submit Your Claim
The nominee can avail the claim form either
from the nearest branch of the insurance company or can download
it from the insurance company’s website. The nominee can either
fill the physical form and submit along with the required original
documents or fill the form online
and file the claim.
3
Submit the Required Documents
The following information should be kept handy for the processing of claim:
a. Name of the policyholder
b. Policy number
c. Date of birth of the insured
d. Place of death
e. Cause of death
1
Submit Your Claim
- In a planned hospitalization, the policyholder should inform insurers about the approaching claim.
- In emergency hospitalization, the policyholder should intimate the insurance agency or TPA within 24 hours.
- When choosing a cashless claim, ensure your treatment is at a network hospital of your insurance company.
- You need to fill a cashless claim request form and submit it to the insurance company by email, post or fax.
Intimate Your Claim
- In a planned hospitalization, the policyholder should inform insurers about the approaching claim.
- In emergency hospitalization, the policyholder should intimate the insurance agency or TPA within 24 hours.
- If the policyholder chooses some other hospital apart from the network hospitals of the insurance company, then a reimbursement claim can be made.
- In the reimbursement claim process, the policyholder needs to take care of the bills at the hospital.
- You should fill a reimbursement claim request form and submit it to the insurance company by email, post or fax.
2
Submit Your Documents
Essential Documents to be submitted are:
You should provide additional documents during the process if in case required/asked by the insurer.
- KYC
- Claim Form
- Doctor's Prescription
You should provide additional documents during the process if in case required/asked by the insurer.
3
Insurer Approval
The insurance company will approve the documents you've submitted.
4
Hospitalization
At the time of hospitalization, you should show the ID card of the insured, provided by the
insurance company, for identification.
5
Final Approval
If the submitted documents by the customer are intact, then final approval will be given by the
insurer to continue ahead with the claim.
6
Settlement
When the formalities are finished, the insurance company will settle the bills with the hospital
as per the terms and conditions of the policy.
Any expenses which are not covered in the policy will not be reimbursed.
7
Rejected
If the information and documents given by the customer are not correct, then there could be
chances for a claim to be rejected. Some of the common reasons behind a claim to be rejected could
be:
1) Customer attempts to claim during the waiting period or for a sickness excluded from the policy (Cosmetic surgery, OPD claims, or if there is a permanent exclusion).
2) Fraudulent claims by the customer.
1) Customer attempts to claim during the waiting period or for a sickness excluded from the policy (Cosmetic surgery, OPD claims, or if there is a permanent exclusion).
2) Fraudulent claims by the customer.
- Call the 24 hour help-line for assistance - 1800 425 2255/1800 102 4477
- In case of Planned hospitalization informs 24 hours prior to admission in the hospital.
- In case of emergency hospitalization information to be given within 24 hours after hospitalization
- Cashless facility wherever possible in network hospital
- In non-network hospitals payment must be made up-front and then reimbursement will be effected on submission of documents, subject to admissibility of the claim
| Scenario | Claim No. | Claim made by Family Member | Sum Insured under the Policy (Rs.) | Deductible Limit under the Policy (Rs.) | Hospitalization Amount (Rs.) | Deductible Limit applied for Claim (Rs.) | Claim Payable (Rs.) | Balance Sum Insured available for next Claim (Rs.) |
|---|---|---|---|---|---|---|---|---|
| Silver Plan - Illustration (Family Size: 2 Adults + 3 Children) | ||||||||
| 1 | 1 | 1 | 10,00,000 | 3,00,000 | 3,00,000 | 3,00,000 | 0 | 10,00,000 |
| 2 | 3 | 6,00,000 | 3,00,000 | 3,00,000 | 7,00,000 | |||
| 3 | 4 | 9,00,000 | 3,00,000 | 6,00,000 | 1,00,000 | |||
| Scenario | Claim No. | Claim made by Family Member | Sum Insured under the Policy (Rs.) | Defined Limit Policy (Rs.) | Hospitalization Amount (Rs.) | Defined Limit Claim (Rs.) | Claim Payable (Rs.) | Balance Sum Insured available for next Claim (Rs.) |
| Gold Plan - Illustration (Family Size: 2 Adults + 3 Children) | ||||||||
| 1 | 1 | 1 | 10,00,000 | 3,00,000 | 3,00,000 | 3,00,000 | 0 | 10,00,000 |
| 2 | 3 | 6,00,000 | 0 | 6,00,000 | 4,00,000 | |||
| 3 | 4 | 6,00,000 | 0 | 4,00,000 | 0 | |||
| 2 | 1 | 1 | 10,00,000 | 3,00,000 | 6,00,000 | 3,00,000 | 3,00,000 | 7,00,000 |
| 2 | 4 | 5,00,000 | 0 | 5,00,000 | 2,00,000 | |||
| 3 | 2 | 3,00,000 | 0 | 2,00,000 | 0 | |||
- Call the 24 hour help-line for assistance - 1800 425 2255/1800 102 4477
- In case of Planned hospitalization informs 24 hours prior to admission in the hospital.
- In case of emergency hospitalization information to be given within 24 hours after hospitalization
- Cashless facility wherever possible in network hospital
- In non-network hospitals payment must be made up-front and then reimbursement will be effected on submission of documents, subject to admissibility of the claim
| GOLD PLAN | |||||||
|---|---|---|---|---|---|---|---|
| Scenario | Claim No. | Sum Insured under the policy (Rs.) | Defined Limit under the policy (Rs.) | Hospitalization Amount (Rs.) | Defined Limit applied for claim (Rs.) | Claim Payable (Rs.) | Balance Sum Insured available for next claim (Rs.) |
| 1 | 1 | 10,00,000 | 3,00,000 | 3,00,000 | 3,00,000 | 0 | 10,00,000 |
| 2 | 6,00,000 | 0 | 6,00,000 | 4,00,000 | |||
| 3 | 6,00,000 | 0 | 4,00,000 | 0 | |||
| 2 | 1 | 10,00,000 | 3,00,000 | 6,00,000 | 3,00,000 | 3,00,000 | 7,00,000 |
| 2 | 5,00,000 | 0 | 5,00,000 | 2,00,000 | |||
| 3 | 3,00,000 | 0 | 2,00,000 | 0 | |||
| SLIVER PLAN | |||||||
| Scenario | Claim No. | Sum Insured under the policy (Rs.) | Deductible Limit under the policy (Rs.) | Hospitalization Amount (Rs.) | Deductible Limit applied for claim (Rs.) | Claim Payable (Rs.) | Balance Sum Insured available for next claim (Rs.) |
| 1 | 1 | 10,00,000 | 3,00,000 | 3,00,000 | 3,00,000 | 0 | 10,00,000 |
| 2 | 6,00,000 | 3,00,000 | 3,00,000 | 7,00,000 | |||
| 3 | 9,00,000 | 3,00,000 | 6,00,000 | 1,00,000 | |||
- Cashless Facility is available only at Network Hospitals. The Insured Person can avail of this Cashless Facility at the time of admission into a Network Hospital, by presenting the health card provided by the Company under this Policy along with a valid photo identification document (Voter ID card / Driving License / Passport / PAN Card or any other identification documentation as approved by the Company).
- For availing Cashless Facility, the Policyholder / Insured Person shall submit a pre-authorization form to the Company for approval. Only upon due approval from the Company, Cashless Facility can be availed at any Network Hospital.
- In addition to the foregoing, in order to avail of the Cashless Facility, the following procedure must be followed:
- Pre-authorization: The Policyholder or Insured Person must call the Company’s call center and request authorization for the proposed treatment by way of submission of a completed pre-authorization form at least 48 hours before the commencement of planned Hospitalization or within 24 hours of admission to Hospital, if the Hospitalization is required in an Emergency.
- The Company will process the request for authorization after having obtained accurate and complete information in respect of the Illness or Injury for which Cashless Facility is sought to be availed. The Company will confirm in writing authorization or rejection of the request to avail Cashless Facility for the Insured Person’s Hospitalization.
- If the request for availing Cashless Facility is authorized by the Company, then payment for the Medical Expenses incurred in respect of the Insured Person shall not have to be made to the extent that such Medical Expenses are covered under this Policy and fall within the amount authorized in writing by the Company for availing Cashless Facility. Payment in respect of Co-payments (if applicable) or any other costs and expenses not authorized under the Cashless Facility be made directly by the Policyholder or Insured Person to the Network Hospital. All original bills and evidence of treatment for the Medical Expenses incurred in respect of the Hospitalization of the Insured Person and all other information and documentation specified in Clause 6.1.4 shall be submitted to the Network Hospital immediately and in any event before the Insured Person’s discharge from Hospital.
- If the Company does not authorize the Cashless Facility due to insufficient Sum Insured or if insufficient information is provided to the Company to determine the admissibility of the Claim, payment for the treatment will have to be made by the Policyholder or Insured Person to the Network Hospital, following which a Claim for reimbursement may be made to the Company and the same will be considered by the Company subject to the Policy.
- It is agreed and understood that the Company may, in its sole discretion, modify or add to the list of Network Hospitals or modify or restrict the extent of Cashless Facility that may be availed at any particular Network Hospital. For an updated list of Network Hospitals and the extent of Cashless Facility available at each Network Hospital, the Policyholder or Insured Person can refer to the list of Network Hospitals available on the Company’s website or at the call centre.
The Company shall be given intimation of Hospitalization at its call center or in writing at least 48 hours before the commencement of a planned Hospitalization or within 24 hours of admission to Hospital, if the Hospitalization is required in an Emergency. It is agreed and understood that in all cases where intimation of a Claim has been provided under this provision, all the information and documents specified in Clause 6.1.4 below shall be submitted (at the Policyholder or Insured Person’s expense) to the Company immediately and in any event within 15 days of Insured Person’s discharge from Hospital.
Policyholder’s or Insured Person’s duty at the time of Claim
- The Policyholder or Insured Person shall check the updated list of Network Hospitals before submission of a pre-authorization request for Cashless Facility; and
- It is agreed and understood that as a Condition Precedent for a Claim to be considered under this Policy
- All reasonable steps and measures must be taken to avoid or minimize the quantum of any Claim that may be made under this Policy.
- Notification of Claim and submission or provision of all information and documents shall be made promptly and in any event in accordance with the procedures and within the timeframes specified in Clause 6 of the Policy.
- The Insured Person will, at the request of the Company, submit himself for a medical examination by the Company's nominated Medical Practitioner as often as the Company considers reasonable and necessary. The cost of such examination will be borne by the Company.
- The Company’s Medical Practitioner and representatives shall be given access and co- operation to inspect the Insured Person’s medical and Hospitalization records and to investigate the facts and examine the Insured Person.
- The Company shall be provided with complete documents and information which the Company has requested to establish its liability for the Claim, its circumstances and its quantum.
1
Inform your Insurer
In claim of damage, that is to say, due to an accident, most importantly, as a policyholder, you
should,
- Inform your insurance company, and present the duly filled claim form.
- Inform the police to enable them to depute a surveyor.
- Try not to move the vehicle from the accident spot without the police or insurance company authorisation.
2
Damage Assessments
The insurance company will send a surveyor to survey the damage. The surveyor will set up a report
and give it to the insurer, and you will get a copy.
3
Send your Car for Repairs
To benefit from the Cashless claim service, you want to get your car repaired exclusively at the
network garages of your insurer. One benefit of a Cashless claim is that you don't need to pay for
the repairs forthright to the garage for the covered damages; the insurance company will pay just
for the repairs covered in your policy directly to the garage.
3
Send your Car for Repairs
Considering the surveyor's report, you can send the vehicle to the garage and set it up for
repair. You can get your vehicle fixed at any garage in the reimbursement claim process.
4
Submit the Bills
After the repair is finished, you should present the duly signed bills and documents by the garage
to the surveyor, who this way will send it to the insurance company.
5
Bill Reimbursement
Taking into account that every one of the documents is set up, the insurance provider will
reimburse your bills, which are covered in your policy. You'll need to pay for the services which
aren't covered in your policy.
Required Documents Checklist
Here’s a list of documents you may need to submit the insurer to make a claim. You may or may not need all of them based on your situation.
Death certificate Issued by Local Authorities
Original policy documents
Nominee ID and residence proof
Insured age proof
Discharge form (executed and witnessed)
Medical certificate as proof of time & cause of death
Police FIR for unnatural death
Copy of post-mortem report for unnatural death
Hospital records/certificate for death due to illnesses
Cremation certificate
Employer certificate, if any
Claim form
Doctor's prescription for treatment
Hospital discharge certificate
Final hospital bill in original Medical examination reports
Medicine bills with prescriptions
Final payment receipt for reimbursement
Cancelled cheque of the insured bank for reimbursement
Medico-Legal Certificate/FIR for Accidents
Duly completed and signed claim form, in original
Medical Practitioner’s referral letter advising Hospitalization
Medical Practitioner’s prescription advising drugs / diagnostic tests / consultation
Original bills, receipts and discharge card from the Hospital / Medical Practitioner
Original bills from pharmacy / chemists
Original pathological / diagnostic test reports / radiology reports and payment receipts
Indoor case papers
First Information Report, final police report, if applicable
Post mortem report, if conducted
Any other document as required by the Company to assess the Claim
The Company will only accept bills/invoices which are made in the Insured Person’s name
The Company shall condone delay on merit for delayed Claims where the delay is proved to be for reasons beyond the control of the Policyholder or the Insured Person
Duly filled and signed claim form
KYC
Vehicle RC Copy
Insurance policy Copy
License copy of the driver driving the vehicle at the time of the accident.
Settlement of Claim
As per the Insurance Regulatory and Development Authority (IRDA) of India, the insurance companies are required to settle the claim within 30 days from the date the nominee submits the claim form along with all the required documents. In case if the claim is accepted, the payment is made to the nominee and in case it is rejected, the same is required to be communicated to the claimant stating the reasons. Wherein, if the claim requires further investigation, the insurer is obligated to complete the process within 6 months from receiving the written intimation of the claim.