Health Insurance Claim Process - NM Financial Services

Claim Process

HDFC ERGO General Insurance

Navigating Claims Made Simple: Your Guide to a Hassle-Free Process

How to intimate health claim with HDFC ERGO General Insurance

Reimbursement

Emergency Cashless

Planned Cashless

Duly filled & signed claim form
All hospital bills in original including final hospital bill (with bill number signed & stamped by the hospital) with itemized bill & original receipts
Discharge card or discharge summary (original) or death certificate in case of death (in hospital)
All original investigation reports & medicine bills with doctor’s prescription.
Follow-up advice or letter for line of treatment after discharge from hospital from doctor.
In case the hospital is not registered, please get letters on the hospital letterhead mentioning the number of beds and availability of doctors and nurses round the clock.
In case of non-network hospital, you may have to get the hospital and doctor’s registration number in hospital letterhead and get the same signed and stamped by the hospital, if required.

Every claim should be intimated & file should be submitted within time, as non adherence can lead to delay in claim settlement.
The claim is decisioned only when all required & necessary documents are submitted.
NEFT & KYC details should be updated with the Insurer for easier & faster claim settlement.
Pre hospitalization expenses may be claimed along with main hospitalization expenses.
Unreasonable & Non medical expenses are not payable.

The claim file has to be submitted at the below mentioned addresses within 15 days of discharge

1st Floor, HDFC House, Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai - 400020

Cashless is available only in network hospitals of Insurer.
Dully filled pre-authorization form is to be submitted along with copy of cards/policy.
Insurer approves part of expected expenses known as Initial approval.
During discharge, on submission of final bill, Insurer approves final amount.
Care should be taken to reply to any query, if raised during the process. Unreasonable & Non medical expenses are not payable.

1st Floor, HDFC House, Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai - 400020

Cashless is available only in network hospital of Insurer.
Insurer should be approached well on advance, minimum 48 hrs prior to hospitalization.
Dully filled pre-authorization form is to be submitted along with its consultation letter.
Insurer approves part of expected expenses known as Initial approval. During discharge, on submission of final bill, Insurer approves final amount.
Care should be taken to reply to any query, if raised during the process. Unreasonable & Non medical expenses are not payable.

1st Floor, HDFC House, Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai - 400020

The treatment is to be intimated within prescribed timelines.
Post completion of treatment, documents are to be collected from hospital during discharge.
The claim file is to be prepared with ref to check list (The claim form part B is to be filled by hospital).
Post receiving of all required info, the claim will be processed within 30 days.
HDFC Ergo will inform about any deficiency within 7 days.
Duly filled claim forms along with all necessary documents are to be submitted within prescribed timelines.
If the claim is approved, amount will be transferred within 30 days.
If the claim is rejected, letter with details are to be shared with Insured.

To Register claim by calling on above contact point, you will need to provide the following information to the customer support executive:

Policy Number
Name of the Policy holder
Name of the Insured in respect of whom the claim is being made
Nature of Illness or Injury
Name and Address of the attending Medical Practitioner and Hospital
Date of Admission to Hospital or proposed date of admission to hospital for Planned Hospitalization
Date of Discharge
Email ID
Approximate Claim Amount
Any other Information, documentation or details requested by the company

Once the claim is registered, the customer support executive will provide you with a Claim Reference/Intimation Number.

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