Common use of In case of Emergency Hospitalisation Clause in Contracts

In case of Emergency Hospitalisation. i. The Insured Person may approach the Network Provider for Hospitalization for medical treatment. ii. The Network Provider shall forward the request for authorization within 48 hours of admission to the Hospital as per the process under Section VII.4 (a). iii. It is agreed and understood that we may continue to discuss the Insured Person’s condition with the treating Medical Practitioner till Our recommendations on eligibility of coverage for the Insured Person are finalised. iv. In the interim, the Network Provider may either consider treating the Insured Person by taking a token deposit or treating him as per their norms in the event of any lifesaving, limb saving, sight saving, Emergency medical attention requiring situation. v. The Network Provider shall refund the deposit amount to You barring a token amount to take care of non-covered expenses once the pre-authorization is issued. Note: Cashless facility for Hospitalization Expenses shall be limited exclusively to Medical Expenses incurred for treatment undertaken in a Network Hospital for Illness or Injury which are covered under the Policy and shall not be available to the Insured Person for coverage under Worldwide Emergency Cover (Section II.8) For all Cashless authorisations, You will, in any event, be required to settle all non-admissible expenses, Co-payment and / or Deductibles (if applicable), directly with the Hospital. The Network Provider will send the claim documents along with the invoice and discharge voucher, duly signed by the Insured Person directly to us. The following claim documents should be submitted to Us within 15 days from the date of discharge from Hospital –  Claim Form Duly Filled and Signed  Original pre-authorisation request  Copy of pre-authorisation approval letter (s)  Copy of Photo ID of Patient Verified by the Hospital  Original Discharge/Death Summary  Operation Theatre Notes(if any)  Original Hospital Main Bill and break up Xxxx  Original Investigation Reports, X Ray, MRI, CT Films, HPE  Doctors Reference Slips for Investigations/Pharmacy  Original Pharmacy Bills  MLC/FIR Report/Post Mortem Report (if applicable and conducted) We may call for any additional documents as required based on the circumstances of the claim There can be instances where We may deny Cashless facility for Hospitalization due to insufficient Sum Insured or insufficient information to determine admissibility in which case You/Insured Person may be required to pay for the treatment and submit the claim for reimbursement to Us which will be considered subject to the Policy Terms &Conditions. We in our sole discretion, reserves the right to modify, add or restrict any Network Hospital for Cashless services available under the Policy. Before availing the Cashless service, the Policyholder / Insured Person is required to check the applicable/latest list of Network Hospital on the Company’s website or by calling our call centre.

In case of Emergency Hospitalisation. i. The Insured Person may approach the Network Provider for Hospitalization for medical treatment. ii. The Network Provider shall forward the request for authorization within 48 hours of admission to the Hospital as per the process under Section VII.4 (a). iii. It is agreed and understood that we may continue to discuss the Insured Person’s condition with the treating Medical Practitioner till Our recommendations on eligibility of coverage for the Insured Person are finalised. iv. In the interim, the Network Provider may either consider treating the Insured Person by taking a token deposit or treating him as per their norms in the event of any lifesaving, limb saving, sight saving, Emergency medical attention requiring situation. v. The Network Provider shall refund the deposit amount to You barring a token amount to take care of non-covered expenses once the pre-authorization is issued. Note: Cashless facility for Hospitalization Expenses shall be limited exclusively to Medical Expenses incurred for treatment undertaken in a Network Hospital for Illness or Injury which are covered under the Policy and shall not be available to the Insured Person for coverage under Worldwide Emergency Cover (Section II.8) For all Cashless authorisations, You will, in any event, be required to settle all non-admissible expenses, Co-payment and / or Deductibles (if applicable), directly with the Hospital. The Network Provider will send the claim documents along with the invoice and discharge voucher, duly signed by the Insured Person directly to us. The following claim documents should be submitted to Us within 15 days from the date of discharge from Hospital –  • Claim Form Duly Filled and Signed  • Original pre-authorisation request  • Copy of pre-authorisation approval letter (s)  • Copy of Photo ID of Patient Verified by the Hospital  • Original Discharge/Death Summary  • Operation Theatre Notes(if any)  • Original Hospital Main Bill and break up Xxxx  Bill • Original Investigation Reports, X Ray, MRI, CT Films, HPE  • Doctors Reference Slips for Investigations/Pharmacy  • Original Pharmacy Bills  • MLC/FIR Report/Post Mortem Report (if applicable and conducted) We may call for any additional documents as required based on the circumstances of the claim There can be instances where We may deny Cashless facility for Hospitalization due to insufficient Sum Insured or insufficient information to determine admissibility in which case You/Insured Person may be required to pay for the treatment and submit the claim for reimbursement to Us which will be considered subject to the Policy Terms &Conditions. We in our sole discretion, reserves the right to modify, add or restrict any Network Hospital for Cashless services available under the Policy. Before availing the Cashless service, the Policyholder / Insured Person is required to check the applicable/latest list of Network Hospital on the Company’s website or by calling our call centre.

In case of Emergency Hospitalisation. i. The Insured Person may approach the Network Provider for Hospitalization for medical treatment. ii. The Network Provider shall forward the request for authorization within 48 hours of admission to the Hospital as per the process under Section VII.4 (a). iii. It is agreed and understood that we We may continue to discuss the Insured Person’s condition with the treating Medical Practitioner till Our recommendations on eligibility of coverage for the Insured Person are finalised. iv. In the interim, the Network Provider may either consider treating the Insured Person by taking a token deposit or treating him as per their norms in the event of any lifesaving, limb saving, sight saving, Emergency medical attention requiring situation. v. The Network Provider shall refund the deposit amount to You barring a token amount to take care of non-covered expenses once the pre-authorization is issued. Note: Cashless facility for Hospitalization Expenses shall be limited exclusively to Medical Expenses incurred for treatment undertaken in a Network Hospital for Illness or Injury which are covered under the Policy and shall not be available to the Insured Person for coverage under Worldwide Emergency Cover (Section II.8) For all Cashless authorisations, You will, in any event, be required to settle all non-admissible expenses, expenses above specified Sub-limits (if applicable), Co-payment and / or Deductibles (if applicable), directly with the Hospital. The Network Provider will send the claim documents along with the invoice and discharge voucher, duly signed by the Insured Person directly to us. The following claim documents should be submitted to Us within 15 days from the date of discharge from Hospital –  • Claim Form Duly Filled and Signed  • Original pre-authorisation request  • Copy of pre-authorisation approval letter (s)  • Copy of Photo ID of Patient Verified by the Hospital  • Original Discharge/Death Summary  • Operation Theatre Notes(if any)  • Original Hospital Main Bill and break up Xxxx  Bill • Original Investigation Reports, X Ray, MRI, CT Films, HPE  • Doctors Reference Slips for Investigations/Pharmacy  • Original Pharmacy Bills  • MLC/FIR Report/Post Mortem Report (if applicable and conducted) We may call for any additional documents as required based on the circumstances of the claim There can be instances where We may deny Cashless facility for Hospitalization due to insufficient Sum Insured or insufficient information to determine admissibility in which case You/Insured Person may be required to pay for the treatment and submit the claim for reimbursement to Us which will be considered subject to the Policy Terms &Conditions. We in our Our sole discretion, reserves the right to modify, add or restrict any Network Hospital for Cashless services available under the Policy. Before availing the Cashless service, the Policyholder / Insured Person is required to check the applicable/latest list of Network Hospital on the Company’s Our website or by calling our Our call centre.