DESCRIPTION OF THE DOCUMENT REQUIRED FOR CLAIM PROCESSING

1) Claim form

• Employee should sign on Page 1 & 2 of the claim form
• Medical certificate needs to be filled in addition to the claim form by the treating doctor; the doctor should sign and affix his seal on the certificate. (The doctor certificate is not necessary in the case of pre and post hospitalization claim and domiciliary out-patient claims)
• The Treatment summary from the treating doctor should be submitted for all Domiciliary Out-patient Claims.

Note: There are separate claim forms for “Hospitalization” and “Domiciliary Out-patient ” care. The correct claim from should be used while submitting these claims.

2) Detailed discharge summary from the treating doctor:

• Discharge Summary should have details like: Date of admission, date of discharge, diagnosis, patient past history, duration of the ailment, treatment given, advise, condition of the patient
• In the case of death, death summary from the hospital with death certificate from the corporation is to be submitted.

3) Main bill with the breakup and payment receipt:

• Bills and receipts should be properly numbered
• Incase Doctor charges any amount separately (which is not a part of Hospital Final Bill) the bill in the proper format with the bill number should be obtained from the Doctor (Letter Head of Doctor will not be accepted)

4) Test / Scan /Investigations:

For all tests/scans/Investigations, all bills for should be accompanied by the

Original report

Doctor’s requisition for taking the test

Necessary bills of the tests taken

5) Pharmacy bills:

• All pharmacy bills should be accompanied by the prescription. In the absence of prescription, the doctor should sign and seal behind the bills
• If the medicines are included in the hospital bill, the breakup of the bills should be provided by the hospital with details.

6) Consultation bill:

• Any consultation bill equal to or more than INR 5000 should be signed by the doctor on one rupee revenue stamp.
• If it is in the proper bill format (with the bill no and all other details) it need not be affixed by the revenue stamp.

7) Surgery:

• In case of surgery, surgery certificate to be attached

Other Important Documents / Information

A) If the employee opts for cashless treatment, the main bill will be paid directly to the hospital by TTK. The customer can claim only pre and post hospitalization bills.

Note: Pre and Post hospitalization claims will be processed only after the settlement of the Main Hospitalization Claim

B) Please note that it is mandatory to submit the Claim Form along with other relevant documents for claiming reimbursement. Please ensure that Employee ID,Vidal Health TPA ID, email ID and contact umber is mentioned on the Claim Form.

C) All Pre and Post hospitalization claims (including maternity claims) should be submitted only after the main hospitalization claim.

• Pre hospitalization bills has to be submitted within 30 days of discharge along with main bill or separately (*pre hospitalization period is 30 days before admission)
• Post hospitalization bills have to be submitted within 67 days of discharge. (*Post hospitalization period is 60 days from the date of discharge)

D) Incase of Injury/Accidents, the following details should be provided:

• Circumstances of Injury should be mentioned by the Doctor
• Pre-operative Reports
• FIR / MLC copy incase of Road Traffic Accident.

E) Incase of Polycystic Ovaries / Ovarian Cyst / Chocolate Cyst / Hysteroscopy / Laparoscopy:

• Employees need to get the details of Marital/ Obstetric history from the treating Doctor.

F) Please update the new born child’s details in Vidal Health TPA site within 45 days. Incase of hospitalization immediately after the birth of the child the details should be updated in the site prior to sending the pre-authorization request.

Note: On a case to case basis, additional documentation may be required post medical review by Doctors for processing the claims.