| Cashless Claims Process (Planned Admission) | |
|---|---|
| Step 1 | Get admitted to any one of Cholamandalam MS network hospitals, currently they have 6500+ hospitals across India hospital list at Chola Health Insurance Call at : Toll Free 1800 208 5544 The insured should approach the hospital 48 hours in advance and provide his/her policy details/e-cards along with govt. issued photo ID card like Driver’s License/Aadhaar to TPA/Insurance desk. |
| Step 2 | The hospital validates the claim and sends the pre-authorization request to Chola MS. Chola MS shall review, confirm and approve the claim as per policy terms and conditions. |
| Step 3 | The hospital and the insured will be intimated in case of any additional information that is required. |
| Step 4 | Settlement of the claim shall be done by Chola MS to the hospital. |
| Cashless Claims Process (Emergency Hospitalisation / Admission) | |
|---|---|
| Step 1 | Get admitted to any one of Oriental Insurance network hospitals, currently they have 6500+ hospitals across India…hospital list at Chola Health Insurance Call at : Toll Free 1800 208 5544 In case of emergency hospitalization, contact any of our Network Hospitals within 48 hours of hospitalization along with his/her policy details/e-cards along with govt. Issued photo ID card like Driver’s License/Aadhaar. |
| Step 2 | The hospital validates the claim and sends the pre-authorization request to Chola MS. Chola MS shall review, confirm and approve the claim as per policy terms and conditions. |
| Step 3 | The hospital and the insured will be intimated in case of any additional information that is required. |
| Step 4 | Settlement of the claim shall be done by Chola MS to the hospital. |
| Reimbursement Claims Process | |
|---|---|
| Step 1 | In case of hospitalization, notify us within 48 hours of admission at our Network or non-Network Hospital. |
| Step 2 | Pay directly at the hospital after getting admitted. |
| Step 3 | Submit the claim with all the relevant documents and claim form. |
| Step 4 | Chola MS shall review, confirm and approve the claim as per policy terms and conditions. |
| Step 5 | Settlement of claim : Upon approval of claim by us, payment of the reimbursement claim will be made to the policy holder either through EFT or through cheque/DD. |
Cholamandalam MS has an extensive network of 6,500+ network hospitals across India. One must get admitted to a network hospital in order to avail cashless treatment for their illness. One can get the Cholamandalam MS network hospital list online.
There is no upper limit on the number of claims during the policy period. However, the total cumulative claim amount cannot exceed the Policy Sum Insured, unless the chosen plan has a Sum Insured Refill benefit, which provides additional coverage even after filing a claim.
When an insured is hospitalized and stays in hospital for more than 24 hours solely for receiving treatment it is termed as inpatient treatment. Out-patient treatment is when insured visits a clinic/hospital or a consultation room for diagnosis and treatment based on the advice of medical practitioner. In out-patient hospitalization patient is not admitted under a day care or as an in-patient.
It is strongly advised to have Health Insurance on your own as well because of reasons of continuity. Firstly, if you change your job, you might not necessarily get Health Insurance from your new employer. In any case you will be exposed to health costs in the transition period between jobs. Secondly, the track record that you have built in Health Insurance at your old employer will not transfer to the new company policy. Covering pre-existing diseases will be a problem in most group insurance policies. In the recent years, many employers are mandating employees to share a part of the Health Insurance premium and claim amount (copayments) in order to prevent frivolous and fraudulent claims. Therefore to avoid the above problems, it is advisable to take a private policy in addition to your company provided group Health Insurance Policy.
Till the age of 55 years, Medical checkup is not required for buying Individual Healthline Insurance. Above 55 years a medical checkup is required at the time of first purchase of the policy. Medical checkups are usually not needed for renewal of policies.
Health Insurance covers all diagnostic tests like X-ray, MRI, Blood Tests etc., as long they are associated with the patients stay in the hospital for at least 24 hours. Any diagnostic tests which have been prescribed in Out Patient Department are generally not covered.
When you get a new Health Insurance Policy, there will be a 30 day waiting period starting from the policy start date, during which period any hospitalization charges will not be payable. However, this is not applicable to any emergency hospitalization occurring due to an accident. This 30 day waiting period is not applicable when the policy is renewed. Some specific ailments have a specific waiting period of one or two years. Some of the covers have specific waiting periods.
A pre-existing disease is any condition, ailment or injury or related condition(s), for which the insured person had signs or symptoms, and /or were diagnosed, and / or received medical advice / treatment within 36/48 months prior to 1st health insurance policy issued by Us under which the insured person was covered.
Under cashless hospitalization, the insured person does not settle the hospitalization expenses at the time of discharge from hospital. The settlement is done directly by us for treatment that the insured person is eligible to receive under the terms of his/her policy. This is for your convenience. However, it is important to note here that prior approval is required from us before admission into the hospital. In some cases, you may have to pay for all or part of the treatment if it is not fully covered under the terms of the policy. However, in case of emergency hospitalization, you can obtain approval post-admission. Please note that the cashless facility is available only at our Network Hospitals.
Under Individual Healthline Insurance, the age, the amount of cover (Sum Insured) and the plan of benefits that you choose are the factors that decide the premium. Usually, younger people are considered healthier and thus pay lower annual premium. Older, people pay a higher Health Insurance premium as their risk of health problems or illness is higher.
The premium paid on a health insurance policy is eligible for deduction under Section 80D of the Income Tax Act. So save with your policy now!
A waiting period is the length of time you, the insured, will have to wait before the benefits under the health policy can be utilised.
A deductible is a cost-sharing requirement. It states that the insurer will not be liable for a specified amount in case of indemnity policies. This is applicable for a specified number of days/hours in case of hospital cash policies which apply before any benefits are payable by the insurer. Remember that a deductible does not reduce your sum insured.
In planned hospitalization the treatment is planned well in advance. The intimation of such hospitalization and authorization from us has to be taken minimum 3 days prior to the date of hospitalization. E.g. Cataract, pace maker implantation, total knee replacement etc are examples for which the hospitalisation can be planned.The insured person should at least 3 days prior to admission to the hospital approach the network provider for hospitalization for medical treatment.
In emergency hospitalization the patient is admitted to the hospital in an emergency situation, for e.g. Severe abdominal pain, accident, heart attack etc. In such event, we should be intimated within 48 hours of admission to the hospital.
You should carry the health card provided by the company with this policy, along with a valid photo identification proof (voter id card / driving license / passport / pan card / any other identity proof as approved by the company).
We shall settle claims, including its rejection, within 7 (seven) working days of the receipt of the last ‘necessary’ document but not later than 30 days.
You should submit the post-hospitalization claim documents at your own expense within 15 days of completion of post-hospitalization treatment or period, whichever is earlier. We shall receive pre and post- hospitalization claim documents either along with the inpatient hospitalization papers or separately and process the same based on merit of the claim derived on the basis of documents received.
It refers to payment of the Medical Expenses incurred by the insured while undergoing Specified Day Care Procedures/ Treatment (as mentioned in the Day Care Surgeries list), which require less than 24 hours Hospitalization.
Co-payment is a cost-sharing requirement under a health insurance policy, where the Policy Holder / insured will bear a specified percentage of the admissible costs.
A ‘Free Look Period’ is a period of 15 days from the date of receipt of the policy that a policyholder, in this case you, have to review the entire health insurance plan. If you disagree with any of the terms or conditions mentioned in the policy, you have the option of returning the policy by stating the reasons for the objection. Following this, you are entitled to a refund of the premium paid, provided no claim has been made under this mediclaim insurance policy (subject only to a deduction of the expenses incurred by the company on medical examination and the stamp duty charges). Please note that this facility is not applicable on renewal and portability cases.
Sub limit defines the capping of insurance amount, for specific surgeries and medical procedures, which reduces the premium of the plan. You can also opt for an add on cover by paying extra premium to remove the sub- limits under the policy.
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