TATA AIG Health Insurance allows both cashless claims as well as reimbursement claims. Cashless claims are only possible when the treatment is done through one of the 3000 plus network hospitals whereas in case the treatment is being done in a non- network hospital, all the bills have to be first cleared and then the reimbursement can be claimed. The TPA or Third Party Administrator has to be informed who will settle the claim with the hospital and help you with the formality. Tata AIG Health Insuranceplans has a low incurred claims ration which means they have a good claim settlement ratio as well. They make good profit and hence the company does not load premiums on their buyers.
In case of Cashless Claims:
In such cases, the patient or the family member does not have to worry about paying the bill if the policy holder is undergoing treatment in one of the network hospitals. The TPA will be coordinating with the hospital directly. In case of planned hospitalization, TATA AIG needs to be informed 48 hours before admission and in case of emergency hospitalization, the company should be notified within 24 hours. The TPA will then contact the hospital with regards to the payment procedure. The TPA can be contacted with our Toll Free Number. Once the TPA has gone through the documents, the confirmation would be sent to the hospital by email or fax and would also be communicated to the policy holder by sms or call. The claim will then be settled as per terms and conditions.
In case of Non- Cashless Treatment:
As mentioned earlier, this kind of reimbursement is needed when the treatment of the policyholder is being done outside of the network hospitals. All the hospital bills have to first cleared and it is essential that all the documents pertaining to the tests, reports, final discharge summary, doctor consultation notes and any additional document provided by the hospital is properly collected. The TPA has to be notified 48 hours before planned hospitalization and 24 hours within emergency hospitalization. The TPA can be contacted at Toll Free Number. While submitting the documents, one also needs to submit the duly filled claim form, along with the report from the attending doctor. Prescription bills and disability certificate, of any, should also be submitted. In case of an accident, the salary slip of the last three months of the policy holder has to submitted and also documents pertaining to any other insurance that can settle the claim in a similar manner. In case of unnatural death like suicide or murder, the copy of the FIR, the police inquest report and the original death certificate of the patient.
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The claim processing team will of course check the documents and they could still ask for additional documents if necessary. TATA AIG health insurance has one of the shortest periods for claim review and the approval or rejection of the claim is communicated as soon as possible. If all the documents are verified correctly, then the amount is usually reimbursed within 30 days and the claim is settled as per the terms and conditions of the policy.