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The Documents Required To File A Claim For Reimbursement of Medical Expenses

To file a reimbursement claim for medical expenses, the document requires the insured to upload several documents to the app including an original claim form, bills, reports, prescriptions, and receipts, and send hard copies to the address provided within 30 days. The documents needed are an original claim form, cancelled cheque, discharge summary, hospital bill, pharmacy bills and receipts, investigation reports, prescriptions, implant details if used, and an MLC for accidents.

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109 views1 page

The Documents Required To File A Claim For Reimbursement of Medical Expenses

To file a reimbursement claim for medical expenses, the document requires the insured to upload several documents to the app including an original claim form, bills, reports, prescriptions, and receipts, and send hard copies to the address provided within 30 days. The documents needed are an original claim form, cancelled cheque, discharge summary, hospital bill, pharmacy bills and receipts, investigation reports, prescriptions, implant details if used, and an MLC for accidents.

Uploaded by

abhinav
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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1.

The documents required to file a claim for reimbursement of medical expenses

To file a reimbursement claim, you are required to upload the below list of documents in
the app and also forward the hardcopy of the same to us within 30 days.

 Original Claim form (signed by the Insured and the Treating Doctor)
 Cancelled Cheque
 Discharge summary (with details of complaints and the treatment availed)
 Original Final Hospital bill (detailed break-up) along with interim bills
 Original Pharmacy bill & Payment receipts - supported by doctor prescriptions
 Investigation reports (E.g. Original Blood report, X-ray, Sonography, CT Scan,
MRI, etc.)
 Prescriptions and Consultation papers as relevant to the case

 Implant sticker / invoice, if used (E.g. lens details in cataract case, stent details
in angioplasty)
 Medico Legal Certificate (MLC) and / or FIR for all accident cases
 For miscellaneous charges - detailed bills with supporting prescription of the
Treating Doctor

2. Address to send the documents:

ICICI Lombard Healthcare


ICICI Lombard GIC Ltd, ICIC Bank tower,
Plot no 12, Financial District, Nanakram Guda
Gachibowli, Hyderabad-500084

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