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Claim Process

(Please note, this is general list and actual requirements may vary on case to case basis)

Claim need to be intimated immediately at our office during business hours or email us by using the below procedure

Office Landline + 91 22 675 33 333

Or

Email at claims@aksharrisk.com, synergy@aksharrisk.com, wecare@aksharrisk.com, with a copy to general@aksharrisk.com, miral@aksharrisk.com

Claim Intimation Form

Please fill the require below details at the time of intimation

Health / Accident Insurance (Group or Individual)

General Guidelines :

  • Hospital Room rent & nursing charges is payable up-to 1% of Sum Insured per day and 2% of Sum Insured per day for ICU expenses.
  • Reasonable and Customary and Medically Necessary expenses.
  • 24 Hrs Hospitalization is compulsory accept prescribe Day Care procedure as mentioned in the policy.
  • Doctor's bill should be part of the Main Hospital bill. If the Doctor issue seperate bill then only Rs. 10,000/- will be paid, if the bill is paid in cash & Rs. 15,000/- will be paid, if the bill is paid by cheque.
  • Cataract limit is restriced to Maximum Rs. 24,000/- per eye, As per policy.

Please Note :

  • Hospital prior intimation is compulsory within 24 hours of Hospitalization or before discharge and claim file has to be submitted within 4 Days to Akshar or respective insurace co or TPA if available, from the date of discharge.
  • Post Hospitalization claim has to be submitted seperately within 4 days after completion of treatment.
  • The below sets of rules have to be followed strictly as instructions from the Insurer.
  • Failure to follow the same will automatically result in REJECTION of your valid claim due to Non Intimation or Late submission of documents.

Process for Cashless Hospitalisation :

  • Step 1 Hospitalization in Cashless Network Hospital by paying a nominal deposit Amount, approx 15% of the Total bill amount.
  • Step 2 Pre Authorization form to be dully filled by the treating doctor in hospital & fax the same to the TPA & inform the same to Akshar office by using the above initmation tool.
  • Step 3 TPA will sanction the cashless facility according to the Policy Terms & Conditions.
  • Step 4 Hospitalization – Examination by doctor – admission – Pathological tests – Surgical or medical treatment - discharge.
  • Step 5 At the time of discharge fax the final bill to the TPA & the amount will be settled by the TPA to hospital as per the policy Terms & Conditions.
  • Step 6 In case of any Pre or Post Hospitalization expenses incurred than it will be settled as per the Reimbursement claim Procedure.

Process for Reimbursement Hospitalisation :

  • Step 1 Hospitalization.
  • Step 2 Intimation by family to TPA and Akshar office simultaneously on Contact details mentioned above by Email or phone. (WITHIN 24 HOURS OF HOSPITALIZATION) or by using the above claim intimation tool.
  • Step 3 Team Akshar will contact you to proceed accordingly.
  • Step 4 Hospitalization – Examination by doctor – admission – Pathological tests – Surgical or medical treatment – discharge.
  • Step 5 Submission of claim form & all papers / reports / bills / Cash Memo to Akshar by courier on address stated below. (WITHIN 4 DAYS OF DISCHARGE) or call us for claim file pick up.
  • Step 6 Akshar will review and scrutinize the documents & review the case, & forward it to TPA for processing .
  • Step 7 The claim will be settled by the Insurance Co via NEFT.

Document check-list for Claim submission. The below list of documents is Indicative.

  • Claim Form dully filled up & signed by the beneficiary.
  • Insurance Co / TPA Member ID Card No or Policy No.
  • Complete set of Policy copies (last 5 years)
  • Original Discharge Summary / Discharge card (In case of Day Care Procedure to provide Day care card / Summary) / with Date & Time mentioned etc & also In-house / Inpatient report.
  • Original Death summary (In case of Death Claims)
  • Original Main Hospital pre-printed numbered bill Payment Receipt.
  • Original pharmacy bill with Batch no’s with Doctor's prescriptions.
  • Original Investigation bills along with diagnostic reports supported by doctor prescriptions.
  • Indoor Case Paper (ICP) for prolonged hospitalization and claims worth Rs 1 Lac and above.
  • Policy FIR / Medico Legal Certificate (MLC), wherever applicable (example. Road traffic accidents /serious injuries etc.)
  • NEFT / KYC documents as per below
    • Cancelled Original Cheque (Name of Insured Person should be mentioned)
    • Photo Identity proof (Insured & Claimant) Pan Card copy.
    • Address Proof (Insured) Aadhar Card / MTNL / Electricity bill copy (any one)

Points to remember :

  • Please retain copies of all the documents submitted to us for future reference.
  • For implant used in Cataract Heart Valve surgeries, CABG, Abdominal Surgeries Keene replacement surgeries, please submit the copy / original of tax invoice / bill from the hospital of the vendor for the prosthetic device used along with Sticker.
  • For faster disposal of claim if possible kindly enclose the complete set of policies for last five years.

Travel Claims

We thank you for choosing us for your Travel Insurance Policy requirements and we wish you a safe and pleasant trip!

Please Contact the insurance companies 24 hours service toll-free number or send a mail to the id mentioned in your policy papers. The Service Centre is equipped to provide you with the necessary guidance in your situation, and will direct you on claims procedure.

Simultaneously, also use our above Claim intimation tool, so even we can help you to speed up the claim process.

Note: Failure to call the number in respect of Medical Accident & Sickness Claims (Travel) shall invalidate your claim, if any.

In case of OPD treatment (where hospitalization is not required), Please self-pay all bills and when you come back to India, contact Akshar and we will process the same for reimbursement.

We invite your attention to the following table, which will help you in the event of any, accident or sickness.