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Claims Process

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

 

THE GUIDE TO EASY CLAIMS WITH ICICI Pru HOSPITAL CARE II
 
The claims can be under two scenarios:
- Planned Hospitalisation 
- Emergency Hospitalisation 
 
It can either be in a 'Network Hospital' or in 'Non-Network Hospital' depending on the need and location of the claim.
 
THE CLAIMS PROCESS 
 
On issuance of the policy, as part of the Welcome Kit, you will receive the following:

 

  1. Health Card (a card which has your policy number and contact information of ICICI Prudential and it can be utilized only in Network Hospitals)
  2. Claims and Pre-Authorization Forms


 
When there is a need for hospitalization, 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

 

  • Your Policy Number (as mentioned on the health card)
  • Name of insured person who is hospitalized.
  • Nature & Details (location, date of accident or commencement     of sickness)
  • Name & Address of Hospital, where life insured is admitted

 
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.

 

24*7 ClaimCare Cell: 1800-103-6363

 
Photocopies or duplicates of the following documents will be needed to process the claim:

 

  1. Copy of policy certificate
  2. Claimant's Statement form
  3. Duly filled claim form (provided along with the welcome kit or available on our website)
  4. Treating Doctor's Certificate
  5. Copy of Indoor Case Papers
  6. Hospital Discharge Card/Summary
  7. Medical evidence in form of diagnostic reports, prescriptions, bills with breakup, any other document to support hospitalization / surgery.

 

Besides the above, if required, ICICI Prudential may request for additional documents / information, if any, for processing the claim.
 

  1. CASHLESS Hospitalisation in a NETWORK HOSPITALS

 

a. PLANNED HOSPITALISATION

Step 1: Call and inform ICICI Prudential (on the help line number provided on the reverse of the health card) about the planned hospitalization 4 days prior to the treatment, before admitting into the hospital.
Step 2: Download the pre-authorization form from here or you could even visit any of our branches.
Step 3: To gain access to the network hospitals, just show your health card and also submit a duly filled pre-authorization form at the treating hospital.
Step 4: The forms shall be scrutinized and further processed and the cashless facility will be activated. We will inform you about the cashless facility being activated through SMS. Also the status of the case will be updated on the website.
Step 5: On discharge, you need to sign the required documents at the hospital.
Step 6: ICICI Prudential will pay the amount to hospital.


b. EMERGENCY HOSPITALISATION

Step 1: In case of emergency, first admit the patient in the Hospital and then inform ICICI Prudential, within 24 hours. You can call up on the number provided on the reverse of the health card.
Step 2: As it's an emergency, you have the facility of collecting the pre-authorization form from the treating hospital or you could even download the pdf format from the website.
Step 3: Show your health card to the network hospital and also submit the pre-authorization form to the treating hospital.
Step 4: The forms shall be scrutinized and further processed and the cashless facility will be activated.
Step 5: On discharge, you need to sign the required documents.
Step 6: ICICI Prudential will pay the hospital.

The Cashless Settlement Scenario:

  • Hospital bill amount is more than your eligible amount: ICICI prudential settles the eligible amount with the hospital and balance bill amount is payable by you.
  • Hospital bill is less than eligible amount: ICICI Prudential settles the claim with the hospital and the balance eligible amount is paid to you

 

 

2.   HOW TO CLAIM IN CASE OF HOSPITALISATION IN NON-NETWORK HOSPITALS

 

While it's suggested that you choose a network hospital, you are at liberty to choose a Non-network hospital also. In case you avail treatment in a non-network hospital, ICICI Prudential will pay you the eligible amount as per the plan opted by you.
Step 1: Get admitted to the hospital and take the complete treatment.

Step 2: Settle the relevant bills in full, on discharge.
Step 3: Collect all the treatment papers along with the doctor's prescriptions, investigation reports, Hospital Discharge card, photocopies or duplicates of medical bills and receipt of hospital Bills and copy of FIR (if any, in case of an accident).
Step 4: Lodge your claim by filling in the claim form (you can collect the claims forms your nearest ICICI Prudential branch or the website.) and attach all the required documents, within 60 days from the date of discharge.

 

The claim will be processed within 7 working days from the date of receiving all the required documents.

 

 

 PROCESS AT A GLANCE:

 

 

Despatch your claims documents to:

 

ICICI Prudential Life Insurance Company Limited
Vinod Silk Mills Compound,

Chakravarthy Ashok Nagar,

Kandivali (E)
Mumbai - 400101

 

 

UIN no. 105N108V01

 

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