ManipalCigna Health Insurance Claims Procedure

Cashless Claim:

In cashless claim, as the name suggests, the patient or policyholder is not required to pay the main hospital bill as Manipal Cigna will settle the bill with the hospital directly. They may still however need to pay for other charges not covered by the health insurance policy.

Cashless Claims Procedure for Emergency Admission

Emergency hospital visits are seldom planned and can cause enough worry without adding financial burden to the equation. During the time of admission, the patient should check if the hospital falls in the cashless claim network. If so, then the below procedure needs to be followed:

1. Intimate Manipal Cigna of the emergency hospital admission within 48 hours by calling on the toll free number which is 1800-102-4462. Reach out to the hospital insurance help desk and provide key details such as Manipal Cigna health card and valid photo ID. The hospital should then fill in the details of the cashless claim and send it over to Manipal Cigna along with details of medical history, an estimated cost and the line of treatment to be provided. This claim needs to be certified by the attending doctor. Manipal Cigna may request for additional documents as and when necessary
2. Along with the submitted documents, Manipal Cigna may require additional supporting documents. The claim will be reviewed upon receipt of the required documents and if approved, the hospital bill will be paid by Manipal Cigna. There may be some additional expenses that may not be covered by the insurance policy. In such cases, the expenses will have to be borne by the patient or policyholder.
3. If for any particular reason a claim is not approved by Manipal Cigna then the bills and other expenses need to be borne by the patient and a request for reimbursement can be filed. Rejection of a cashless claim does not void a reimbursement claim. In cases of rejection, a rejection letter stating the reasons for rejection will be issued.

Cashless Claims Procedure for Planned Admission

If the patient or policyholder plans on admitting themselves for a particular treatment in a hospital that is on the cashless claim network then they need to follow the below procedure for claiming the cashless facility

1. Firstly they need to select the hospital they plan to admit themselves into from the cashless claim network
2. Then they must intimate Manipal Cigna about the admission at least 3 days prior to admission by calling the toll free number 1800-102-4462
3. The cashless request form must then be filled in by the patient or policyholder and faxed to Manipal Cigna along with other relevant details such as photo id and the Manipal Cigna Health Card. The hospital insurance help desk will then forward the insurance claim along with the necessary medical documents and a certificate from the attending doctor.
4. Manipal Cigna will then review the submitted documents and in some cases request for further documents. Upon the receipt of all required documents, Manipal Cigna will review the documents and approve the claim. If the claim is rejected for some reason, the rejection letter stating the reasons of rejection will be issued to the policyholder. In such cases, the policyholder will have to pay for the hospital expenses and file for a reimbursement claim

Reimbursement of Treatment Expenses

Certain times, the cashless claim may be rejected for a variety of reasons. Lack of documents or the hospital the patient is being admitted into not falling in the cashless claim network are the primary reasons for rejection of cashless claims. In such cases, the hospital expenses need to be borne by the policyholder and they can then file a claim for reimbursement of expenses incurred. Patients or policyholders need to follow the below procedure to make reimbursement claims.

1. Firstly the sooner one intimates Cigna TK of the admission or treatment, the better the chances are of successful reimbursement. Claim intimations can be done by calling on the toll free number which is 1800-102-4462
2. Patients or policyholders must provide key information such as policy numbers while making intimations along with details of their health card
3. The claim form can be downloaded from the official website or use the claim form provided in the policy packet or can collect the form from their nearest Manipal Cigna Branch.
4. The claim form needs to be duly filled in along with the necessary documents such as original bills, discharge summaries, prescription receipts and investigative reports and mailed or faxed to the Manipal Cigna Branch.

Documents Required

Documents required while applying for reimbursement claims are as follows

1. The duly filled claim form along with the certificate from the attending doctor
2. Discharge summary along with other related documents such as the original hospital bills, pre and post hospitalization reports including investigative reports, results and their receipts and their corresponding receipts for prescriptions purchased outside the hospital, prescriptions notes from the attending doctor and other documents as mentioned in the claim form

Claims Process

1. The claim processing team review the documents submitted. If there is a need for additional documents, the same will be requested by ManipalCigna and upon their receipt the claims will be assessed
2. The claims if approved will be paid by ManipalCigna to the policyholder either through a cheque or DD or through online transfer of funds.

GST rate of 18% applicable for all financial services effective July 1, 2017.