• Cashless Request Form – duly filled in by the Insured (available at the TPA desk in Network Hospitals)
• Copy of Health Card
• KYC document of the Insured / Patient
• Original Discharge Summary and other Investigation Reports will be retained by the Hospital

• All documents are to be submitted in original.
• Reimbursement claims can be lodged by visiting the nearest INLIC branch office.
• The Insurer / TPA may call for additional documents, on a case-to-case basis, to evaluate the merit of a claim.
• Enjoy the exclusive benefit of your insurance plan by availing cashless treatment at our network hospitals.
• TPA: MEDI ASSIST INSURANCE TPA PRIVATE LIMITED
• Senior Citizens – Health Claims Queries/Grievances: Call 1800 102 3330
• Cashless Claims – Public Notice
• This notice is for all customers of IndusInd Nippon Life Insurance who have availed health insurance benefits.
• As per the Master Circular on Health Insurance Business, all cashless claims will be processed strictly in line with applicable regulatory guidelines.

• Standard Reimbursement Claim Form Part A – to be filled by the Insured
• Standard Reimbursement Claim Form Part B – to be filled by the Insured and Hospital
• Discharge Summary from Hospital
• All Investigation Reports and Doctors' prescriptions
• Hospital bill, Hospital payment receipts, and Pharmacy bills with date
• A break-up of Investigation charges (under main hospital bill)
• MLC / FIR / Self-declaration for accidental injury or treatment
• KYC document of the Insured / Patient
• Bank details of the Insured – Personalized cancelled Cheque or Completed Bank Authorization Form, attested by the Bank, along with a self-attested copy of Passbook / Bank Statement with IFSC and Bank Account number mentioned thereon

• All documents are to be submitted in original.
• Reimbursement claims can be lodged by visiting the nearest INLIC branch office.
• The Insurer / TPA may call for additional documents, on a case-to-case basis, to evaluate the merit of a claim.

• Claim Form – Hospital Cash Benefit – to be filled by the Insured
• Copy of all Hospital records (Admission Notes, Discharge Summary, and Test / Investigation Reports)
• Attending Doctor's / Surgeon's certificate supporting hospitalization (including ICU admission, if any), diagnosis, and treatment
• Hospital bill and receipts for payment
• Copy of FIR (in case of accident)
• KYC document of the Insured / Patient
• Bank details of the Insured – Personalized cancelled Cheque or Completed Bank Authorization Form, attested by the Bank, along with a self-attested copy of Passbook / Bank Statement with IFSC and Bank Account number mentioned thereon

Additional documents in case of claim under Critical Conditions (25) Rider / Major Surgical Benefit in Wealth + Health Plans

• • Claim Form – Critical Illness (25) Rider - to be filled by the Insured
  • Claim Form – Major Surgical Benefit - to be filled by the Insured
  • Specialist Doctor’s certificate confirming the diagnosis and when the symptom first occurred / stating nature of operation performed

NOTES

Photocopies of all documents should be attested by an IndusInd Nippon Life Insurance (formerly Reliance Nippon Life Insurance) Official.

The Insurer / TPA may call for additional documents, on a case to case basis, to evaluate the merit of a claim.

• All documents are to be submitted in original.
• Reimbursement claims can be lodged by visiting the nearest INLIC branch office.
• The Insurer / TPA may call for additional documents, on a case-to-case basis, to evaluate the merit of a claim.

• Claim Form – to be filled by the Insured
• Certificate from Attending Medical Practitioner confirming the date of diagnosis
• Original and Copy of Policy Document
• All Medical Records including the following:
• Original Discharge / Death Summary Card
• Indoor case papers
• Copies of Hospital Bills, Pharmacy/Investigations Bills
• Investigation Reports
• Details of the treatment received by the Insured from the inception of the ailment
• Letter from Treating Consultant stating presenting complaints with duration and past medical history
• Histopathology / Cytology / FNAC / Biopsy / Immuno-histochemistry reports
• X-Ray / CT scan / MRI scan / USG /Radioisotope / Bone scan Reports
• Blood Tests
• Any other specific investigation done to support diagnosis such as PAP Smear / Mammography, etc.
• Death Certificate issued by local Municipal Corporation or Competent Authority (where applicable)
• KYC document of the Insured
• Bank details of the Insured - Personalized cancelled Cheque or Completed Bank Authorization Form, attested by the Bank, along with a self-attested copy of Passbook / Bank Statement with IFSC and Bank Account number mentioned thereon