Hospitalisation Insurance Benefit Claims Process

Helpline Numbers

24*7 toll-free ClaimCare Cell: 1800-103-6363

 

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. Please refer to the diagrammatic representation of the claims process:

 

 

 

 

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 and Pre-Authorization Forms

 

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 prior to availing treatment and in any case within 4 days of hospitalization in case of a network hospital.

 

The below mentioned documents would need to be submitted to the company inorder to process the claim. 

 

  1. Duly filled & signed original claimant application form
  2. Photocopy of the policy certificate
  3. Duly attested original claim file documents from hospital authority
  4. All original investigation reports validating the diagnosis for which the LA has been hospitalized.
    Original discharge summary for the patient detailing the onset, duration & progression of clinical symptoms & diagnosis
  5. Original detailed bill breakup for the expenses incurred with all invoices
  6. Copy of MLC/FIR as applicable
  7. Letter from Competent authority detailing history of circumstances surrounding injury or clearly mentioned in discharge summary
  8. Photocopy of health card
  9. Photocopy of additional photo ID proof

 

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.

 

Pre & Post Hospitalisation treatment

 

In case of Pre Hospitalisation treatment all supporting claim papers / documents as listed above should be submitted within 7 days after discharge from the hospital.

 

In case of post Hospitalisation treatment, all supporting claim papers / documents as listed above should also be submitted within 7 days after completion of such treatment (up to 60 days or actual period which ever is less) to the Company. All documents must be duly attested by the insured person.


 

Despatch your claim documents to:

 

ICICI Prudential Life Insurance Company Limited
Ground & First Floor,
Trade Point,
Kamla Mills Compound
Pandurang Budhkar Marg,
Lower Parel, Mumbai - 400013