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Health Claims

Here is an indicative list of documents required for all kinds of claims:

  • In-patient Treatment/Daycare Procedures
    • Duly filled and signed Claim Form.
    • Photocopy of ID card / Photocopy of current year policy.
    • Original Detailed Discharge Summary / Day care summary from the hospital. Original consolidated hospital bill with bill no. and break up of each Item, duly signed by the Insured.
    • Original payment Receipt of the hospital bill with receipt number
    • First Consultation letter and subsequent Prescriptions. Original bills, original payment receipts and Reports for investigation supported by the note from the attending Medical Practitioner/ Surgeon demanding such test.
    • Surgeons certificate stating nature of Operation performed and Surgeons Bills and Receipts
    • Attending Doctors/ Consultants/ Specialist's/ Anesthetist Bill and receipt and certificate regarding same
    • Original medicine bills and receipts with corresponding Prescriptions.
    • Original invoice/bills for Implants (viz. Stent /PHS Mesh/ IOL etc.) with original payment receipts.
    • Hospital Registration Number and PAN details from the Hospital
    • Doctors registration Number and Qualification from the doctor
  • Road Traffic Accident
    In addition to the In-patient Treatment documents:
    • Copy of the First Information Report from Police Department / Copy of the Medico-Legal Certificate.
  • In Non-Medico legal cases
    • Treating Doctor’s Certificate giving details of injuries (How, when and where injury sustained)
  • In Accidental Death cases
    • Copy of Post Mortem Report (if conducted) & Death Certificate
  • For Death Cases
    In addition to the In-patient Treatment documents:
    • Original Death Summary from the hospital.
    • Copy of the Death certificate from treating doctor or the hospital authority.
    • Copy of the Legal heir certificate, if the claim is for the death of the principle insured.
  • Pre and Post-hospitalisation expenses
    • Duly filled and signed Claim Form.
    • Photocopy of ID card / Photocopy of current year policy.
    • Original Medicine bills, original payment receipt with prescriptions.
    • Original Investigations bills, original payment receipt with prescriptions and report.
    • Original Consultation bills, original payment receipt with prescription.
    • Copy of the Discharge Summary of the main claim.
  • Ambulance Benefit
    • Duly filled and signed Claim Form.
    • Photocopy of ID card / Photocopy of current year policy.
    • Original Bill with Original Payment Receipt.
    • Treating Doctor’s consultation prescription indicating Emergency Hospitalization.
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  • Reimbursement of Organ Donor Expenses
    In addition to the documents of general hospitalization
    • Organ Function test / blood test proving organ failure.
    • Treatment Certificate issued by the Transplant Surgeon of the hospital concerned.
  • Hospital Cash Allowance- Same as In-patient Hospitalisation treatment
  • Restoration/Reinstatement of the Sum Insured- Same as In-patient Hospitalisation treatment
  • Recovery Benefit- Same as In-patient Hospitalisation treatment
  • Nursing Allowance- In addition to the In-patient Treatment documents:
    • Duly signed prescription for Private Nursing requirement and its necessity from the treating Medical Practitioner
    • Original Bill with Original Payment Receipt of Nursing charges from the utilized Nursing Burrow/Private Nurse
  • We may call for additional documents/ information as relevant to the claim.
    Applicable to all claims under the policy:
    • In the event of the original documents being provided to any other Insurance Company or to a reimbursement provider, the Company shall accept verified photocopies of such documents attested by such other Insurance Company/ reimbursement provider.

How can I indemnify or claim benefits under the policy?

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The expenses or benefits can be claimed or indemnified either by reimbursement or by availing cashless services at our empanelled hospitals. Click here to know the complete claims process.

Is cashless facility available across all hospitals?

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The cashless facilities are available only at the hospitals which are in our network. Please click here to see our complete of hospital network.

What preliminary information is needed for claim intimation?

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Following information is required for claim intimation:

  • Policy Holder's Name
  • Membership Number & Policy Number
  • Hospital details
  • Diagnosis and Treatment details
  • Approximate claim amount
  • Date of admission

What is the maximum time allowed to file reimbursement claims?

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From the date of discharge, the claim needs to be filed within a maximum of 15 days with our TPA. Please click here to know the complete process of reimbursement claims.

What documents are to be submitted in case of a reimbursement claim?

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Below is the list of indicative documents which need to be submitted in case of a reimbursement claim. Please note that the TPA or the company is fully authorized to ask for more documents basis the nature of claim.

  • Claim form duly completed in all respects
  • Original Bills, Receipt and Discharge certificate / card from the Hospital.
  • Original Cash Memos from Hospital(s)/Chemist(s), supported by proper prescriptions.
  • Original Receipt and Pathological test reports from a Pathologist supported by the note from the attending Medical Practitioner / Surgeon demanding such Pathological tests.
  • Surgeon’s certificate stating nature of operation performed and Surgeons’ original bill and receipt.
  • Attending Doctor’s / Consultant’s / Specialist’s / - Anesthetist’s original bill and receipt, and certificate regarding diagnosis.
  • Medical Case History / Summary.
  • Original bills & receipts for claiming Ambulance Charges
  • Any additional documents or information, as may be deemed necessary by the Company or TPA.

If I avail cashless facility, will you pay the entire amount or will I be required to bear part of the bill at the hospital?

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Yes, we will pay the entire admissible amount for the medical expenses incurred subject to the maximum sum insured amount. You might have to pay for the non-medical and expenses not covered to the hospital prior to your discharge from hospital.

In case of cashless treatments, in whose favor are cheques settled or who gets the payments?

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The cheques are sent to the hospital to whom approvals for cashless are given.

Who is your Health TPA?

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Vipul MedCorp TPA Pvt. Ltd. is our appointed TPA. Vipul MedCorp TPA Pvt. Ltd, a company promoted by Vipul group is engaged in the managed healthcare facilitation & has obtained a license from IRDA for TPA activities (Health) and offers its clients a wide array of services.

Vipul MedCorp TPA Private Limited
515, Udyog Vihar Phase V
>Gurgaon, Haryana – 120016
Toll free number - 1800 102 7477

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Trade Logo displayed above belongs to Liberty Mutual and used by the Liberty General Insurance Limited under license. For more details on risk factors, terms & conditions please read sales brochure carefully before concluding a sale.

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