Scribd
Upload
28 views1 page

GMC Claim Checklist

The document is a checklist for submitting insurance claims, detailing required documents such as signed IRDA claim forms, hospital bills, and identification proofs for both the employee and patient. It includes specific requirements for various types of claims, including maternity and road traffic accidents. Each item must be completed and submitted to ensure the claim is processed correctly.

Uploaded by

aravindhanrece
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
28 views1 page

GMC Claim Checklist

The document is a checklist for submitting insurance claims, detailing required documents such as signed IRDA claim forms, hospital bills, and identification proofs for both the employee and patient. It includes specific requirements for various types of claims, including maternity and road traffic accidents. Each item must be completed and submitted to ensure the claim is processed correctly.

Uploaded by

aravindhanrece
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
You are on page 1/ 1

Employee ID : Corporate Name : Phone number :

Patient Name : Insurance card number : Email ID :


CLAIM DOCUMENT CHECKLIST

Sr. No Description Document Status


1 IRDA Claim Form PART A duly signed by the Insured
2 IRDA Claim Form PART B duly signed & stamped by the Hospital
3 Original Cancelled Cheque copy of Employee with the name of the Account Holder Printed on
the Cheque Leaf.
4 Copy of Insurance Card of employee and patient.
5 Copy of Aadhar card of employee and patient

6 Copy of Pan Card of the employee


7 Original detailed Discharge Summary / Daycare summary from the hospital in case of Day
Care Treatment / Death Summary in Case of Death Claim (signed & stamped by doctor and
hospital)
8 Original Final Hospital bill with a detailed breakup of each Item/charges (Bill number is
mandatory) (signed & stamped by Hospital))
8. A Original Payment Receipt against Main Hospital bill Payment (Receipt number is mandatory)
(signed & stamped by Hospital)) (both Deposit / Refund)
a) Receipt Of Payments made at the Hospital by Credit Card: Please attach the Xerox Copy of
9 the Credit Card Payment Slip as received from the Vendor
Original copy of Implant Invoice along with Payment Receipts and implant Labels /Stickers for
10 Stents/Mesh/IOL (If applicable)
INDOOR CASE PAPERS: Complete xerox set of indoor case papers with admission/emergency
11 notes, daily doctor notes,OT notes(for surgical cases) nursing chart including TPRBP chart and
drug chart.
12 Original bills of Doctor’s prescription, original Payment Receipts Doctor’s prescription, original
doctor’s prescriptions, and ALL investigation / Laboratory Reports & films required.
Original medicine bills specifying Patient Name and date of purchase along with supporting
13 Prescriptions. (Batch number & date of Expire are mandatory)
Original copy of First Consultation letter and subsequent Prescriptions.
14 In case of No / Delay Intimation & Delay in the submission of the claim, a letter from the
insured is required stating the reason for the same.
OTHER DOCUMENTS (AS PER NATURE OF CLAIM)
15
A Original copy of Obstetric history (Gravida, Para, Living children, Abortions) from
treating doctor. (Maternity Claim)
B Original Sonography/Ultra Sound FILM & Report in Case of Maternity Claim
Original A−Scan Report along with IOL Sticker and Tax paid invoice in case of Cataract
C Claim
Copy of the First Information Report (FIR) from the Police Department / Copy of the
D Medico−Legal Certificate (MLC) in case of Road Traffic Accident (RTA)

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy