|Step 1||Get admitted to any one of Future Generali network hospitals, currently they have 5100+ hospitals across India…hospital list at Future Generali Health Insurance
Call at : Toll Free 1800 103 8889
Call at : Toll Free 1800 209 1016
Before you seek medical treatment we request that you contact us 2-3 days in advance. This will allow our team to help you follow the next few steps. In case of emergency, you can contact us within 24 hours of admission to the hospital.
|Step 2||Your Identification : At the network hospital you will need to show your Future Generali Health Insurance health card and valid photo ID*, along with your policy number, to be able to use your insurance. This will give the network hospital the details they need to contact us for the cashless hospitalization process.
* - Passport / PAN card / voter’s ID for identification purposes
|Step 3||Hospital sends cashless hospitalization request form : The network hospital will send us the preauthorization request form which has details of medical history, line of treatment and estimated treatment cost.|
|Step 4||Future Generali Health Insurance contacts Hospital : Wherever the information provided in the request is sufficient to ascertain the authorization, we will issue the authorization Letter to the network hospital. Wherever additional information or documents are required we will call for the same from the Network hospital and upon satisfactory receipt of last necessary documents the authorization will be issued.|
|Step 5||At the time of Discharge : Hospital will send us the final request for authorization of any residual amount along with final hospital bill and discharge summary. You will be discharged from the hospital upon receipt of final authorization letter from us. Any inadmissible expenses, copayments, deductions will have to be paid by you.|
|Step 6||Payment to the network hospital made by Future Generali Health Insurance : Once the Hospitalization is done, hospital will send the original claim documents to us. The claim will be assessed by us and payment will be made to the network hospital|
|Step 1||Call at : Toll Free 1800 103 8889
Call at : Toll Free 1800 209 1016
Before you seek medical treatment we request that you contact us 2-3 days in advance. This will allow our claims service associate to help you follow the next few steps. In case of emergency, you can contact us within 24 hours of admission to the hospital.
|Step 2||Avail treatment at the hospital : You can avail treatment at hospital and settle all hospitalization expenses. Collect original hospital bill, receipts, discharge summary, investigation reports, pharmacy bills and other documents from hospital at the time of discharge from hospital.|
|Step 3||Submit the claim documents : You have to download the claim form from our website. Copy of this form is also included in the policy kit provided to you. Alternatively, you can contact your Health advisor or visit nearest Future Generali Health Insurance branch. Submit the claim documents at nearest Future Generali Health Insurance branch or Corporate office. The documents should be submitted within 15 days from discharge from the hospital.|
|Step 4||We assess the claim : Wherever the information provided in the claim documents is sufficient to ascertain the admissibility of claim, we will approve the claim. Wherever additional information or documents are required we will call for the same from you and upon satisfactory receipt of last necessary documents the claim will be settled by us.|
|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.|
Future Generali has an extensive network of 5,100+ 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 Future Generali Health Insurance network hospital list which is available "Hospital list link"
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.
The minimum age required for entry is 1 day. There is no limit of Maximum age for entry. Children will be covered as dependents up to 25 years of age. There is no exit age in this policy.
In case of an Individual policy, each Insured person under the policy will have a separate sum insured for them. Individual plan can be bought for self, lawfully wedded spouse, children, parents, siblings, parent in laws, grandparents and grandchildren, son in-law and daughter in-law, uncle, aunty, nephew & niece.
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.
Hospitalization under Ayurveda, Unani, Siddha, or Homeopathy (AYUSH ) are covered provided that the treatment has been undergone in a government hospital or in any institute recognized by government and / or accredited by Quality Council of India / National Accreditation Board on Health for that Alternative treatment.
Future Generali under this policy will pay the Reasonable and Customary Charges incurred for an organ donor’s treatment for the harvesting of the organ donated provided that :
If an Insured Person suffers an Illness or Injury during the Policy Period in respect of which a claim has been admitted under Hospitalisation medical expenses then at the Insured Person’s request We will arrange a maximum of two e-opinions (in a Policy Year) from a Medical Practitioner selected by the Insured Person from Our panel. The e-opinion will be based only on the information and documentation provided to the Medical Practitioner by or on behalf of the Insured Person.
If the Sum Insured and Cumulative Bonus (if any) is exhausted due to claims incurred and paid during the Policy Year or incurred during the Policy Year and accepted as payable, then it is agreed that a Restore Sum Insured (equal to 100% of the Sum Insured) will be automatically available for the particular Policy Year, provided that:
The PPC details are as per the table below :
|Age Band||Upto 50 years||Above 50 years||From 18 years to 50 years||Above 50 years||From 18 years to 50 years||Above 50 years|
|Medical tests||Not Required||Required||Required||Required||Required||Required|
You can port your existing health insurance policy to Future Generali’s Health plan. The below supporting documents will be required:
Change in Sum Insured /Plan can be done at renewals only. No increase/decrease in Sum Insured/Plan is allowed during the currency of the policy. Increase in Sum Insured can be allowed up to two slabs higher, whereas increase in Plan can be allowed up to one plan higher. For age group above 60 years, increase in Plan would not be allowed. For age group up to 50 years increase in sum insured up to Rs 10Lacs (within Vital Plan) can be allowed without medical examination (in case of no claim / no health declaration). For Superior/Premiere Plan (Sum Insured above 10 lakhs), medical examination is required irrespective of age. For age group above 50 years increase in sum insured can be allowed with medical examination. Decrease in Sum Insured allowed up to one slab lower only, in case of no claim in any preceding Health Total policies.
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.
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.
The following KYC documents are required from the insured person/proposer in cases of reimbursement -
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.
The following details are to be provided to the company at the time of intimation of claim: • Policy number • Name of the policyholder • Name of the insured person in whose relation the claim is being lodged • Nature of illness / injury • Name and address of the attending medical practitioner and hospital • Date of admission • Any other information as requested by us
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.
We will not be liable to pay for any claim arising out of an injury/ accident/ condition that occurred during the grace period.
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 may investigate claims at our own discretion to examine validity of claim. Such investigation shall be concluded within 15 days from the date of assigning the claim for investigation and not later than 6 months from the date of receipt of claim intimation. Verification carried out, if any, will be done by individuals or entities authorised by us to carry out such verification / investigation(s) and the costs for such verification / investigation shall be borne by the us.
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.
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