Common use of Re-imbursement Facility Clause in Contracts

Re-imbursement Facility. (i) It is agreed and understood that in all cases where intimation of a Claim has been provided under Reimbursement Facility and/or the Company specifically states that a particular Benefit is payable only under Reimbursement Facility, all the information and documentation specified in Clause 6.4 and Clause 6.5 shall be submitted to the Company at Policyholder’s / Insured Person’s own expense, immediately and in any event within 15 days of Insured Person’s discharge from Hospital. (ii) The Company shall give an acknowledgement of collected documents. However, in case of any delayed submission, the Company may examine and relax the time limits mentioned upon the merits of the case. (iii) In case a reimbursement claim is received after a Pre-Authorization letter has been issued for the same case earlier, before processing such claim, a check will be made with the Network Provider whether the Pre-authorization has been utilized. Once such check and declaration is received from the Network Provider, the case will be processed. (iv) For Claim settlement under reimbursement, the Company will pay the Policyholder. In the event of death of the Policyholder, the Company will pay the nominee (as named in the Policy Certificate) and in case of no nominee, to the legal heirs or legal representatives of the Policyholder whose discharge shall be treated as full and final discharge of its liability under the Policy. (v) ‘Date of Loss’ under Reimbursement Facility is the ‘Date of Admission’ to Hospital in case of Hospitalization & actual Date of Loss for non-Hospitalization related Benefits.

Re-imbursement Facility. (i) It is agreed and understood that in all cases where intimation of a Claim has been provided under Reimbursement Facility and/or the Company specifically states that a particular Benefit is payable only under Reimbursement Facility, all the information and documentation specified in Clause 6.4 5.1 and Clause 6.5 5.3 shall be submitted to the Company at Policyholder’s / Insured PersonMember’s own expense, immediately and in any event within 15 30 days of Insured PersonMember’s discharge from Hospital. (ii) The Company shall give an acknowledgement of collected documents. However, in case of any delayed submission, the Company may examine and relax the time limits mentioned upon the merits of the case. (iii) In case a reimbursement claim is received after a Pre-Authorization letter has been issued for the same case earlier, before processing such claim, a check will be made with the Network Provider whether the Pre-authorization has been utilized. Once such check and declaration is received from the Network Provider, the case will be processed. (iv) For Claim settlement under reimbursement, the Company will pay the PolicyholderInsured Member. In the event of death of the PolicyholderInsured Member, the Company will pay the nominee (as named in the Policy CertificateCertificate of Insurance) and in case of no nominee, to the legal heirs or legal representatives of the Policyholder Insured Member whose discharge shall be treated as full and final discharge of its liability under the Policy. (v) ‘Date of Loss’ under Reimbursement Facility is the ‘Date of Admission’ to Hospital in case of Hospitalization & actual Date of Loss for non-Hospitalization related Benefits.

Re-imbursement Facility. (i) It is agreed and understood that in all cases where intimation of a Claim has been provided under Reimbursement Facility and/or the Company specifically states that a particular Benefit is payable only under Reimbursement Facility, all the information and documentation specified in Clause 6.4 5.4 and Clause 6.5 5.5 shall be submitted to the Company at Policyholder’s / Insured Person’s own expense, immediately and in any event within 15 30 days of Insured Person’s discharge from Hospital. (ii) The Company shall give an acknowledgement of collected documents. However, in case of any delayed submission, the Company may examine and relax the time limits mentioned upon the merits of the case. (iii) In case a reimbursement claim is received after a Pre-Authorization letter has been issued for the same case earlier, before processing such claim, a check will be made with the Network Provider whether the Pre-authorization has been utilized. Once such check and declaration is received from the Network Provider, the case will be processed. (iv) For Claim settlement under reimbursement, the Company will pay the Policyholder. In the event of death of the Policyholder, the Company will pay the nominee (as named in the Policy CertificateSchedule) and in case of no nominee, to the legal heirs or legal representatives of the Policyholder whose discharge shall be treated as full and final discharge of its liability under the Policy. (v) ‘Date of Loss’ under Reimbursement Facility is the ‘Date of Admission’ to Hospital in case of Hospitalization & actual Date of Loss for non-Hospitalization related Benefits.

Re-imbursement Facility. (i) It is agreed and understood that in all cases where intimation of a Claim has been provided under Reimbursement Facility and/or the Company specifically states that a particular Benefit is payable only under Reimbursement Facility, all the information and documentation specified in Clause 6.4 5.4 and Clause 6.5 5.5 shall be submitted to the Company at Policyholder’s / Insured Person’s own expense, immediately and in any event within 15 30 days of Insured Person’s discharge from Hospital. (ii) The Company shall give an acknowledgement of collected documents. However, in case of any delayed submission, the Company may examine and relax the time limits mentioned upon the merits of the case. (iii) In case a reimbursement claim is received after a Pre-Authorization letter has been issued for the same case earlier, before processing such claim, a check will be made with the Network Provider whether the Pre-authorization has been utilized. Once such check and declaration is received from the Network Provider, the case will be processed. (iv) For Claim settlement under reimbursement, the Company will pay the Policyholder. In the event of death of the Policyholder, the Company will pay the nominee (as named in the Policy Certificate) and in case of no nominee, to the legal heirs or legal representatives of the Policyholder whose discharge shall be treated as full and final discharge of its liability under the Policy.the (v) ‘Date of Loss’ under Reimbursement Facility is the ‘Date of Admission’ to Hospital in case of Hospitalization & actual Date of Loss for non-Hospitalization related Benefits.