Common use of Claims Documentation Clause in Contracts

Claims Documentation. We or the associated TPA shall be provided the following necessary information and documentation in respect of all claims at the Insured Person’s expense within 30 days of the Insured Person’s discharge from the Hospital: (i) Claims for Pre-hospitalization Medical Expenses and Post- hosptialization Medical Expenses to be submitted to us within 30 days of the completion of the post- Hospitalisation treatment (ii) For those claims for which the use of Cashless Facility has been authorised, We will be provided these documents by the Network Provider immediately following the Insured Person’s discharge from the Hospital: (1) Duly completed claim form; (2) Photo ID and Age proof; (3) Health Card, policy copy, photo ID, KYC documents; (4) Original discharge card / day care summary / transfer summary; (5) Original final Hospital bill with all original deposit and final payment receipt; (6) Original invoice with payment receipt and implant stickers for all implants used during Surgeries i.e. lens sticker and Invoice in cataract Surgery, stent invoice and sticker in Angioplasty Surgery; (7) All previous consultation papers indicating history and treatment details for current ailment; (8) All original diagnostic reports (including imaging and laboratory) along with Medical Practitioner’s prescription and invoice / bill with receipt from diagnostic center; (9) All original medicine / pharmacy bills along with the Medical Practitioner’s prescription; (10) MLC / FIR copy – in Accidental cases only; (11) Copy of death summary and copy of death certificate (in death claims only); (12) Pre and post-operative imaging reports – in Accidental cases only; (13) Copy of indoor case papers with nursing sheet detailing medical history of the Insured Person, treatment details and the Insured Person’s progress;