Payment of Claims

     • बीमाधारक निर्धारित प्रोफार्मा में सीधे टीपीए को दावा फॉर्म जमा करेगा। 

          • रि-इम्बर्समेंट फोटो के लिए संबंधित कर्मचारी (यदि उसके पास पहचान पत्र नहीं है) द्वारा चिपकाया जाएगा, जिसे विधिवत रूप से इलाज करने वाले डॉक्टर / डीडीओ द्वारा सत्यापित किया जाएगा ताकि रोगी की पहचान की पुष्टि की जा सके। 

• अगर कोई पहचान पत्र पॉलिसी धारक द्वारा प्राप्त नहीं किया गया है, तो कोई कैशलेस सुविधा प्रदान नहीं की जाएगी।

     • दावे का भुगतान अस्पताल में या बीमित व्यक्ति को टीपीए / जीआईएफ के माध्यम से किया जाएगा क्योंकि टीपीए द्वारा पूर्ण दावा प्रस्तावों की प्राप्ति की तारीख से 30 दिनों के भीतर मामला सामान्य रूप से हो सकता है।

• The insured will submit the claim form directly to the TPA in the prescribed proforma.
  • For Re-imbursement photo will be pasted by the concerned employee (if he doesn’t possess the identity card) which will be duly verified by the treating doctor/ DDO so as to confirm the identity of the Patient.
• No cashless facility will be provided if the identity cards have not been obtained by the policy holder.
• Payment of claim shall be made through TPA/GIF to the Hospital or to the Insured Person as the case may be normally within 30 days from the date of receipt of completed claim proposals by the TPA.

A Government servant is examined for medical fitness before he is allowed to report on duty in the Government. Thus, no medical examination of the Government servant or any member of his family shall be made a condition for issue of mediclaim policy.

Except for TPA aproved private hospitals where the Government servant and his family may take cashless treatment, the expenditure incurred in a Government hospital / private hospital(where cashless facility is not available) shall be reimbursed within a period of a fortnight of submission of the claim.

The term pre-existing disease will not be applicable in such policies.

Insured person will obtain and furnish the TPA with all original bills, receipts and other documents upon which a claim is based.