ManipalCigna Health Insurance Claim Settlement Process

While bringing the best-suited plans to you, the ManipalCigna Health Insurance team works towards making the claim process a simple and hassle-free process for you. With a huge network of hospitals and an excellent claim management team, the company is committed to deliver the best service. The ManipalCigna Health Insurance claim settlement ratio speaks in favour of this very commitment.

 

At Bajaj Markets, things are not very different. Our team is dedicated towards providing you just the right service when it comes to claims, so you can rest assured when it comes to managing the financial blow.  All you have to do is follow some easy steps, intimate the insurer on time and avail cashless treatment or reimbursement of your medical costs.

ManipalCigna Health Insurance Cashless Claim

With the option of cashless claims available with your ManipalCigna Health Insurance, you can take a sigh of relief. With cashless claims, you need not fetch for funds last-minute when a medical emergency strikes you. With this option all your medical bills are directly settled by ManipalCigna Health Insurance with hospitals. Under this facility, you just have to head to your nearest network hospital, register for a cashless claim and you are good to go. In case of planned hospitalisation, report to the hospital TPA 48 hours prior to hospitalisation, while intimate the team within 24 hours of hospitalisation in case of an emergency.

 

Here’s how you go about it:

 

• Hospital TPA shall submit your pre-authorisation form and medical details to the insurer.
• Insurer shall assess your claims and approve of the commencement of hospitalisation procedures.
• Cashless amount is added during the hospitalisation, if need be, after submitting necessary documents.
• Hospital TPA submits final bill and discharge summary to the insurer at the time of discharge.
• Insurer provides final approval post claim assessment.
• Once your final approval is in place, pay the non-payable expenses. listed as per IRDA and you are good to go!

Documents Required for Filing Cashless Claim

Here’s the list of documents required to file a cashless claim:

 

• Completely filled and duly signed claim form
• Copy of photo ID of patient / KYC documents if needed
• Policy number
• Documents related to your treatment

ManipalCigna Health Insurance Reimbursement Claim

In case your cashless claims are rejected, you need not panic. Just file for a reimbursement and you are good to go. Unlike cashless claims, the expenses in case of reimbursement claim are to be managed by the policyholder initially, post which they are settled by the insurer. The best part, you need not fetch for a network hospital when it comes to reimbursement claims, just get your treatment done at a nearest hospital and file a claim.

 

Here’s how you can file your ManipalCigna Health Insurance reimbursement claim-

 

• Download claim form and keep the list of expected documents handy.
• Submit all the documents to the nearest branch of the insurer to take this forward.
• On processing, the reimbursement claim amount is transferred to your account.

Documents Required for Filing Reimbursement Claim

Here’s the list of necessary claim documents that you need to submit for reimbursement claim:

 

• Completely filled and duly signed claim form
• Original Hospital Discharge summary
• Copy of photo ID of patient / KYC documents if needed
• PAN card if claimed amount is more than 1 Lakh
• Operation theatre notes in case of surgery
• Doctors consultation letters/ reference slip for investigation.
• Original medical examination reports , X Ray, MRI, CT films, HPE, ECG
• Original Hospital Bill (main and break up)
• Original Pharmacy Bills
• FIR report if needed
• Implant invoices, stickers for Lenses, stents if applicable.
• Original cancelled cheque with pre-printed name of proposer

Please refer to the claim form for list of documents.

How to Check ManipalCigna Health Insurance Claim Status?

You can check the Manipal Cigna Health Insurance claim status online through a very easy and quick process-

 

• Head to claim section on the ManipalCigna Health Insurance website.
• Simply enter your policy number and date of birth.
• Now hit ‘submit’ to check your claim status.

Why Your ManipalCigna Health Insurance Claims May Get Rejected?

While you follow the steps and produce the necessary documents, there are instances you may have a miss, resulting in claim rejection. Read on to understand the reason why claims may get rejected:

 

• Misinterpreted details

In the details shared by you are found to be incorrect or false, the claim stands rejected.

 

• Excluded conditions

In case you have filed a claim for a medical condition that is not covered by the plan as per the policy document.

 

• Invalid policy

In case your policy is expired or exhausted, it would not be helpful.

 

• Delay in intimation

In case you fail to inform the insurer regarding the medical emergency or planned hospitalisation, your insurer may reject your claim.

 

• Waiting period

If you file a claim for a condition that has a particular waiting period, the claim will not be processed.

 

Note: Kindly refer policy wordings to check complete list of policy exclusions.

Things to Keep in Mind while Filing a ManipalCigna Insurance Claim

While you got an idea of which scenarios got result in claim rejection, it is important to ensure that you keep a few things in mind so that the claim request is processed. Here, we bring to you, certain factors that you must consider, when filing a claim:

 

• Go through the exclusions thoroughly

Every health insurance policy has certain exclusions they do not cover for. In case the claims are filed for excluded scenarios, the claims are not approved. Hence, it is important to check the exclusions before making a claim so that the claim amount is covered by the insurance plan.

 

• Check your documents

Along with the pre-authorisation form, hospital bills and health reports, there may be some other documents that you need to keep handy. These include valid ID proof, policy document and a cancelled cheque in case of reimbursement claims. Make sure you have these handy.

 

• Keep an eye for your claim amount

All your claims are acceptable up to the available sum insured limit as per your health insurance plan. In case your claim exceeds the said sum insured limit, you would have to take care of the excess.

 

• List of hospitals

Cashless claim settlement is possible only at the insurance company’s network hospital. Hence, ensure you check the list when filing the claim to understand the nature of your claim – whether cashless or reimbursed.

 

• Validity of your plan

It is important to check the validity of your health insurance policy when filing a claim as your claim will not get settled if the policy is lapsed.

 

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