Claims intimation and processing
You have to provide complete and accurate information asked by the company at the earliest to ensure faster claim settlement. Please refer to the policy document for details.
Claims Helpline
Contact our 24*7 ClaimCare Cell at 1800 - 103 - 6363 to know more about the claims process.
The claims can be under two scenarios:
Planned Hospitalisation
- Emergency Hospitalisation
Claims can either be in a ‘Network Hospital’ or in ‘Non-Network Hospital’ depending on the need and location of the claim.
On issuance of the policy, as part of the Welcome Kit, you will receive the following:
- Health Card - a card with your unique policy number and 24*7 toll-free number. (This card can be utilized only in Network Hospitals)
- Claims Form
When there is a need for hospitalization (includes day care procedures), you can inform ICICI Prudential about hospitalisation by calling on the contact number provided on the health card. You need to provide following information when you call ICICI Prudential about the claim
- Name of insured person
- The Policy Number (as mentioned on the health card)
- Nature & Details (location, date of accident or commencement of sickness, etc.)
- Name & Address of Hospital for treatment
All the above information can be provided to ICICI Prudential immediately or 4 days prior to availing treatment in case of Planned Hospitalization. In case of Emergency Hospitalization the customer needs to inform ICICI Prudential within 24 hours of hospitalization in Network Hospitals.
The below mentioned documents would need to be submitted to the company in order to process the claim.
Duly filled & signed original claimant application form.
- Photocopy of the policy certificate.
- Duly attested original claim file documents from hospital authority.
- All original investigation reports validating the diagnosis for which the insured has been hospitalized.
- Original discharge summary for the patient detailing the onset, duration & progression of clinical symptoms & diagnosis
- Original detailed bill breakup for the expenses incurred with all invoices
- Copy of MLC/FIR as applicable
- Letter from competent authority detailing history of circumstances surrounding injury or clearly mentioned in discharge summary.
- Photocopy of health card
- Additional acceptable photo ID proof (copy)
All the documents need to be attested by self as well as competent medical authority from the provider where the treatment was sought.
From time to time in select circumstances further document requirements may be triggered by way of
- First OPD consultation papers
- Indoor case papers for hospitalization
- Certificate from competent medical authority validating medical facts
Please note additional documents may be warranted / asked for at the time of claims adjudication in exceptional circumstances. |
