Claim Process in LIC Jeevan Arogya

The Claim Process in LIC Jeevan Arogya

When insured has been hospitalised:

If the insured individual has been hospitalised for a certain specific illness, he/she will be required to inform the servicing branch of LIC immediately so that they can commence the claim procedure accordingly. In case the insured is not able to do so, his/her relative can approach the LIC branch and intimate them about the incident. Within a timeframe of 30 days (from the day of discharge), the servicing LIC branch should be informed about the said hospitalisation along with the mandatory claim forms.

Required claim forms:

In order to claim benefits under LIC Jeevan Arogya, the insured will be required to submit the corresponding claim forms along with the documents of treatment and discharge. Before the forms are submitted, the insured will also be required to attest the photocopies of the documents. Following are the mandatory claim forms under LIC Jeevan Arogya:

1. Claim intimation form: The fundamental form intimating the servicing LIC branch, this form is the first document that needs to be submitted by the insured. The claim intimation form necessitates the following information:
   1. Accurate policy number
   2. Third party administrator (TPA) details (in case it is required)
   3. Hospitalisation details
   4. Full name, residential address, and contact number of the insured
   5. Other important details surrounding the principal insured
2. Hospital treatment form: This form will be filled by the hospital officials with details of the treatment that the claimant has underwent. Thereafter, this form will be required to be submitted to LIC by the insured individual. The form essentially provides a detailed summary of the treatment and stay of the insured in the hospital including number of days, details of ICU (if required), and so on. The health card provided by LIC and attested by hospital officials must also be attached with this form.
3. Claim forms for HCB/MSB/OSB/day care benefits: The insured individual will be required to fill the information in this form in order to claim benefits under LIC Jeevan Arogya. The information needed in this form includes claimant details (who went through the treatment), duration of the hospitalisation, and claimant's bank details. The claimant will also be required to sign in the required spaces of the form.

Mandatory Documents Along with Claim Forms

Along with the claim forms, the claimant will also be required to submit certain documents for proof. They are:

1. Invoices and receipts from the hospital
2. Discharge card or certificate from the hospital
3. Cash memos
4. Medical test reports along with a prescription from the doctor
5. A certificate from the surgeon mentioning the nature of the surgery performed
6. Certificates from attending doctors, specialists, or consultants
7. If the claim is an accident benefit claim, then FIR and other supporting documents will be required
8. Proof of identification of the insured

LIC Jeevan Arogya Claim Procedure

1. The claim forms along with supporting documents are submitted by the insured to the servicing branch first.
2. The forms are thereafter sent to the Health Insurance department of LIC's concerned divisional office.
3. The Health Insurance department officials then verify the forms and documents after which they are sent to the Third Party Administrator (TPA) to further process the claim.
4. After careful scrutinisation of the documents by the TPA, the claim is admitted and processed further.
5. The final decision about whether or not the claim will be accepted is made by LIC.
6. The final step towards processing claims is taken by LIC officials wherein they intimate the partner bank and release the claim amount.
7. In case the claim is rejected by LIC, the insured gets an intimation from the insurer (LIC).

Self-attestation on all the documents related to the claim process is a mandate.