Although a cashless hospitalization facility is available in Group health insurance, you may sometimes need to use hospitals that are not in the Medi Assist network. Reimbursement claims may be filed in the following circumstances:
- Hospitalization at a non-network hospital
- Post- and pre-hospitalization expenses/domiciliary expenses that are not covered by your policy
- Denial of preauthorization for specific reasons.
- In such cases, you can claim reimbursement after discharge.
In order to make a reimbursement claim for all covers under Group Health Insurance, follow the following steps:
Step 1: Intimate the insurer about the claim
Please call the Toll-free (24*7) number 1800-103-2292 to intimate the claim to the insurer.
Alternatively, you can:
(a) Login to the website of the Insurance Company and intimate the claim at https://www.bharti-axagi.co.in/contact-us
(b) Send an email to the Company customersupportba@icicilombard.com
(c) Post/courier to Company ICICI Lombard General Insurance Company Ltd., ICICI Lombard House, 414, Veer Savarkar Marg, Prabhadevi, Mumbai – 400025
(d) Directly Contacting ICICI Lombard GIC office but in writing.
In all the above, the intimations are directed to a central team for prompt and immediate action
Step 2: Insurer sends claim form
Upon the notification of the claim, the Company will dispatch the claim form to the Insured/Covered person. Claim forms will also be available with the Company offices and on its website.
Step 3: Fill and send back the claim form along with the required documents
The Company will process the claims and make claim payments.
If there is any deficiency in the documents/ information submitted by the Insured person, the Company will send the deficiency letter within 7 days of receipt of the claim documents.
Step 4: Company settles a claim
On receipt of the complete set of claim documents to the Company’s satisfaction, the Company will send an offer of settlement, along with a settlement statement within 30 days to the insured. Payment will be made within 7 days of receipt of acceptance of such a settlement offer.
Claim Service Guarantee
Notwithstanding the above, upon the receipt of all required documents and processing of the claim, the offer of settlement will be made to the Insured in any case not later than 30 days maximum. Settlement (payment) of claim will be made within 7 days of receipt of acceptance in response to offer of settlement, failing which penal interest (in compliance with applicable regulations) at a rate of 2% higher than bank rate (prevailing as on the date of the beginning of the financial year in which the claim is reviewed) will be paid, The period of 7 days mentioned above is included in the maximum period of claim settlement (30 days) stated above.
Please note:
(a) The Company shall be under no obligation to make any payment under this Policy unless all the premium payments are received in full and all payments have been realized.
(b) The Company will only make payment as per the Policyholder/ Insured’s direction. In the case of Insured’s unfortunate demise, the Company will only make payment to the Nominee (as named in the Policy Schedule/ Certificate of Insurance).
(c) This Policy only covers medical treatment taken in India, and payments under this Policy shall only be made in Indian Rupees within India.
(d) The Company is not obliged to make payment for any claim or that part of any claim that could have been avoided or reduced if the Insured/ Insured Person could reasonably have minimized the costs incurred, or that is brought about or contributed to by the Insured/ Insured Person failing to follow the directions, advice or guidance provided by a Medical Practitioner.
