Common use of Claims Documentation Clause in Contracts

Claims Documentation. The Company shall be provided with the following necessary information and documentation in respect of all claims at Insured Person’s expense within 30 days of the Insured Person’s discharge from Hospital (in the case of Pre-hospitalization Medical Expenses and Hospitalization Medical Expenses) or within 30 days of the completion of the Post- hospitalization Medical Expenses period (in the case of Post-hospitalization Medical Expenses). For those claims for which the use of Cashless Facility has been authorised, The Company will be provided these documents by the Network Provider immediately following the Insured Person’s discharge from Hospital: a. Claim form duly completed and signed by the claimant. Please provide mandatorily following information if applicable i. Current diagnosis and date of diagnosis; ii. Previous admission/Surgery if any. b. Age/Identity proof document of the Insured Person in case of cashless claim (not required if submitted at the time of pre-authorization request) and Proposer in case of Reimbursement claim. i. Self attested copy of valid Age proof (passport / driving license / PAN card / class X certificate / birth certificate); ii. Self attested copy of identity proof (passport / driving license / PAN card / voter identity card); iii. Recent passport size photograph. c. Cancelled cheque/ bank statement / copy of passbook mentioning account holder’s name, IFSC code and account number printed on it of Policyholder / nominee ( in case of death of Policyholder). d. Original discharge summary. e. Additional documents required in case of Surgery/Surgical Procedure. i. Bar code sticker and invoice for implants and prosthesis (if used);

Claims Documentation. The Company We shall be provided with the following necessary information and documentation in respect of all claims at Your/Insured Person’s Person‟s expense within 30 days of the Insured Person’s Person‟s discharge from Hospital (in the case of Pre-hospitalization Medical Expenses and Hospitalization Medical Expenses) or within 30 days of the completion of the Post- Post-hospitalization Medical Expenses period (in the case of Post-hospitalization Medical Expenses) or within 30 days of death or disability due to accident (in case of Personal Accident Cover). For those claims for which the use of Cashless Facility has been authorised, The Company We will be provided these documents by the Network Provider immediately following the Insured Person’s Person‟s discharge from Hospital: a. Claim form duly completed and signed by the claimant. Please provide mandatorily following information if applicable i. Current diagnosis and date of diagnosis; ii. Past history and first consultation details; GoActive; UIN: MAXHLIP18109V011718 rt iii. Previous admission/Surgery if any. b. Age/Age / Identity proof document of the document: Of Insured Person in case of cashless claim (not required if submitted at the time of pre-authorization request) and Proposer Policyholder in case of Reimbursement claim. i. Self attested copy of valid Age age proof (passport / driving license / PAN card / class X certificate / birth certificate); ii. Self attested copy of identity proof (passport / driving license / PAN card / voter identity card); iii. Recent passport size photograph. c. Cancelled cheque/ bank statement / copy of passbook mentioning account holder’s holder‟s name, IFSC code and account number printed on it of Policyholder / nominee ( in case of death of Policyholder). d. Original discharge summary. e. Additional documents required in case of Surgery/Surgical Procedure. . i. Bar code sticker and invoice for implants and prosthesis (if used);; f. Original final bill from Hospital with detailed break-up and paid receipt.