L&T Health Insurance Claims Procedure

If you are opting for cashless claim, you do not have to settle the bill if you are hospitalised in a network hospital. L&T will be represented by the TPA. The TPA will coordinate with the hospital and settle the bill. The cashless claim process for emergency and planned admissions are different.

Cashless Claims Procedure for Emergency Admission

If you have been admitted in a network hospital on an emergency, then you can contact the TPA of L&T within 24 hours of admission and check if cashless claim is applicable. If you are allowed to , then you will have to follow the following procedure to claim for emergency admission:

1. File the cashless pre-authorisation form that is available at the Cashless counter of the hospital. 
2. Intimate the TPA. You can notify your claims by calling the TPA at 1800-209-5846 for intimation. 
3. You will have to submit the pre-admission prescription and medical reports along with copy of the photo-ID and health card.Claims Process: 
4. The claim reference number will be sent to you after the TPA decides to approve the claim or reject you. 
5. The claim approval or rejection decision will be taken within 6 hours after receiving the documents. 
6. If the cashless claims are approved, you will have to clear out the uncovered expenses before you leave the hospital. 
7. If the claim is not approved, you will have to pay the bill and then file for a reimbursement for which you will get a response within 6 working days on receipt of the document.

Cashless Claims Procedure for Planned Admission

1. If you are getting any treatment in a network hospital, you must follow the following procedure to claim for planned admission: 
2. Select the hospital from the network hospital list. 
3. Intimate the TPA at least 72 hours before admitting. You can notify your claims by calling the TPA at 1800-209-5846 for intimation. 
4. Fill up the cashless pre-authorisation form that is available at the cashless counter at the hospital. 
5. You will have to submit the pre-admission prescription and medical reports, if any along with the copy of your photo- ID and health card.Claims Process: 
6. Once you have faxed the form, you will receive a claim reference number along with the approval or rejection intimation. 
7. You will receive the intimation within 6 hours from receiving the documents. 
8. If the claim is approved, you will have to only pay for the uncovered expenses before leaving the hospital. 
9. If the claim is not approved, then you must pay the entire bill and then claim reimbursement. You get a response for the reimbursement claim within 6 days from receipt of the documents. 

Reimbursement of Treatment Expenses

1. Reimbursement of claim is done if you cashless claim is rejected or if you are getting treated at a non-network hospital. Reimbursement can be availed for planned hospitalisation as well as emergency hospitalisation. The reimbursement for planned hospitalisation must be intimated to L&T at least 72 hours before hospitalisation and the emergency hospitalisation reimbursement is to be intimated within 24 hours of hospitalisation.The procedure for claiming for reimbursement is as follows:Claims Process:Once you have cleared out all the bill and have all the relevant documents, which you have submitted, the L&T TPA will intimate you the decision on if the reimbursement is approved or not within 6 days after receiving the documents. 
2. Submit the claim intimation. Intimate the TPA. You can notify your claims by calling the TPA at 1800-209-5846 for intimation. 
3. Get your claim reference number. 

1. Submit the claim form along with Policy number, name of the person who is availing the treatment, nature of the illness or disease or injury, address and name of the hospital or medical practitioner, date of admission and discharge, approximate of the claim expenses and relevant information, if any. 
2. You will have to complete the treatment procedure and settle the bill and then collect the medical bills.

Do's and Don'ts

While you are applying for a claim on your health insurance plan, do the following:

1. Obtain all necessary documents.
2. Forward the relevant reports for the claim.
3. Retain a copy of the hospital related documents for your record.

Don't do the following while you are applying for a claim:

1. Misrepresent or hide any information.
2. Providing incomplete information.
3. Hesitating to seek clarification on the deduction details.

*Note - Larsen & Toubro Limited has divested its complete stake in L&T General Insurance Company Limited. HDFC ERGO General Insurance Company Limited has bought stakes in L&T on June 3, 2016 through a share Purchase Agreement.

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

Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.