We are empanelled with the three TPA’s

• Vipul Med Corp
• Paramount
• United Healthcare

DOCUMENTS REQUIRED FOR CLAIMING HOSPITALIZATION EXPENSES

1) Claim Form – Part A: Duly completed by the insured on the prescribed format – Original
2) Claim Form – Part B: Duly completed and signed by the hospital authorities – Original
3) UHCP TPA ID Card – Photocopy
4) Photo ID proof (Employee ID card, Aadhar card etc.) – Photocopy
5) Cancelled Cheque of Employee’s Bank Account – Original (Cancelled Cheque, with Employee name printed under place of signature)
6) Delay Letter in case of late submission of claim
7) Discharge Card/Summary – Original (Gives the summary of diagnosis and treatment in hospital)
8) Death Summary (Instead of Discharge Summary) – Original (Only in case of death of patient during Hospital stay)
9) Indoor Case Papers (ICP)
10) Police FIR/Medico Legal Certificate (MLC) (Mandatory for All Road traffic accidents – Duly attested by Police)
11) Hospital Main Bill with bill no. & break up – Original (With detailed break up of various heads like Room Rent/OT charges/Nursing etc.)
12) Hospital Payment receipt with receipt number – Original (With seal & signature of hospital)
13) All Payment Receipts with receipt number – Original (For consultation/surgeon charges, if charged outside the main hospital bill)
14) Investigation bills cum receipt – Original
15) Prescriptions – Original (On Doctor’s letterhead, mentioning duration and dosage for medicines and advice for diagnostic tests)
16) Pharmacy bills cum receipt/Cash Memo – Original
17) Investigation Reports – Original (Reports for all tests done along with images like USG, X-Ray, ECG, etc. and Blood reports)
18) Sticker for the Implants used, along with supporting invoice – Original (For Implants used in Cataract, Heart Valve, CABG, Abdominal, Knee replacement surgeries)