Mediclaim Insurance Claim Form

What Is a Mediclaim Policy?

A Mediclaim policy is a healthinsurance contract that reimburses the insured for medical expenses incurred due to hospitalization, surgery, or other covered treatments. The core purpose is to reduce the outofpocket burden on policyholders and provide financial protection during illness.

Why a Claim Form Is Essential

The claim form is the official document through which you request reimbursement from the insurer. It acts as a record of the treatment received, verifies that the expenses are eligible, and triggers the processing workflow inside the insurance company.

Submitting a correctly filled form speeds up settlement, prevents payment delays, and reduces the likelihood of claim rejection.

Key Sections of a Standard Mediclaim Claim Form

StepbyStep Guide to Filling the Form

1. Gather Required Documents

• Original hospital discharge summary
• Itemised bill and receipts (including medicines, OT charges, nursing fees)
• Doctors prescription and diagnostic reports
• Policy document and health card
• Identity proof (Aadhaar, PAN, or passport)

2. Verify Policy Coverage

Check that the hospital is networkapproved (if you have a cashless plan) and that the treatment is covered under the sum insured and sublimits (e.g., prehospitalisation, posthospitalisation).

3. Complete the Form Accurately

• Policy Details: Copy the policy number exactly as it appears on your card.
• Insured Person: If the claimant is different from the policyholder (e.g., a family member), mention the relationship clearly.
• Hospital Information: Use the official name and registration number printed on the discharge summary.
• Treatment Details: Write the diagnosis code (ICD10) if required, and list each charge as shown on the hospital bill.
• Bank Details: Doublecheck the account number and IFSC to avoid payment bounce.

4. Attach Supporting Documents

Attach a photocopy of each document in the order mentioned in the forms checklist. Do not attach originals unless the insurer specifically requests them.

5. Sign and Date the Declaration

The declaration is a legal statement that the information provided is true. A false declaration can lead to claim denial or policy cancellation.

6. Submit the Claim

You can submit the claim in one of three ways:

• Online portal: Upload scanned copies (PDF, JPG) via the insurers website or mobile app.
• Email: Send the completed form and attachments to the designated claims email address.
• Physical submission: Deliver the packet to the nearest branch or authorized claim centre.

Common Mistakes to Avoid

Timeline for Claim Processing

Most insurers commit to a turnaround of 715 business days for cashless claims and 1530 days for reimbursement claims, provided all documents are in order. If there are discrepancies, you may receive a request for clarification, which can extend the timeline.

What to Do If Your Claim Is Rejected

Rejection letters include a reason code. Typical reasons include:

• Nonnetwork hospital (for cashless policies)
• Incomplete documentation
• Treatment not covered under the policy terms
• Exceeding sublimits

Steps to take:

1. Read the denial letter carefully.
2. Gather any missing documents or clarifications.
3. File an appeal within the stipulated period (often 15 days).
4. If needed, approach the insurance ombudsman or regulator.

Download a Sample Claim Form

Use the link below to download a generic Mediclaim claim form that you can adapt to your insurers specific format.

Quick Checklist Before Submission

• Policy number entered correctly
• All signatures present
• Hospital discharge summary attached
• Itemised bill with GST breakdown
• Prescription and diagnostic reports
• Bank account details verified
• Submission within 30 days of discharge