Health Insurance Claim:
CLAIM REPORTING PROCEDURE
1. PROCEDURE IF TREATMENT REQUIRED FROM PANEL HOSPITAL:
If a qualified doctor advises hospitalization due to a valid reason, then any of our panel hospital can be approached for treatment on credit basis against Health Card/Letter of Authority. The employee is required to submit a copy of-
- Health Card/Letter
- CNIC of the patient (for adult patients only) The hospital will provide required hospitalization services to the insured patient as advised by the attending doctor according to the entitlement of the employee as mentioned on the health card/letter.
2. PROCEDURE IF TREATMENT REQUIRED FROM NON-PANEL HOSPITAL:
We strongly urge the use of panel hospitals especially in non emergency cases.
- The hospitals on our panel are selected based on scientific methods and their facilities and general level of care are regular monitored to ensure quality.
- Reasonable discounts have also been taken from these hospitals that are passed to the patients in the billing.
- If an insured wishes to utilize the services of a hospital not on our panel, then he is required to take our prior approval by sending us the history, findings & procedure to be done on the prescription paper of the attending doctor and its complete detail of charges about 3 days before the scheduled procedure. This can be faxed /emailed to Health Insurance Department.
- In emergency situations, an insured can go to a non-panel, but he has to inform us within 24 hours of such hospitalization.
- Then these claims can be submitted after filling & signing the Claim Form and a deductible will be applicable according to the policy terms & conditions and payment will be made according to the charges of our nearest panel hospital/hospital of the same standard whatever decided by the insurance company.
- Reimbursement claims must be submitted within 30 days after discharge the patient from the hospital.
- Total claim settlement time for a reimbursement claim from the receiving date is 15 working days provided that all the mandatory documents are attached with the claim & there is no further query in the claim.
- The company reserves the right to decline the claim and to exclude the employee from the policy if a false claim is launched.
REQUIRED DOCUMENTS (WITH CLAIM)
A claim should be lodged with the following documents:
- Completely filled Claim Form duly signed and stamped by the attending physician.
- Original itemized Hospital Bill (in case of hospitalization).
- Doctor’s Prescriptions (photocopy acceptable).
- Laboratory reports (photocopy acceptable).
- Original Pharmacy payment receipts.
- Discharge summary (photocopy acceptable).
- Birth Certificate (in case of delivery).
The documents should be forwarded through HR department.
Grievance Handling procedure: If an insured /client has grievance regarding settlement or refusal of his/her claim due to any reason, he/she can send in writing request(email) for the review of the claim through their HR at firstname.lastname@example.org