Claim Process - Apollo Munich Health Insurance

  1.  Intimation
  2.  Availing Treatment
  3.  Compilation / Submission of Claim File

How to intimate health claim with Apollo Munich Health Insurance

Planned Treatment - At least 48 Hrs prior to hospitalization
Emergency Treatment - Within 24 Hrs of hospitalization
E-Mail
customerservice@apollomunichinsurance.com
Claim Helpline
1800-102-0333
Nearest Branch

Details required for Registration/ Intimation of Claim

To Register claim by calling/FAX on above contact point, you will need to provide the following information to the customer support executive:-
  • Your contact details
  • Name of the Insured
  • Policy number
  • Date and time of problem
  • Nature of problem
  • Location of problem
Once the claim is registered, the customer support executive will provide you with a Claim Reference/Intimation Number.

Points to Remember

  • Every claim should be intimated & file should be submitted within time, as non adherence can lead to delay in claim settlement.
  • The claim is decisioned only when all required & necessary documents are submitted.
  •  NEFT & KYC details should be updated with the Insurer for easier & faster claim settlement.
  •  Pre hospitalization expenses may be claimed along with main hospitalization expenses.
  •  Unreasonable & Non medical expenses are not payable.
  • Every claim should be intimated & file should be submitted within time, as non adherence can lead to delay in claim settlement.
  • The claim is decisioned only when all required & necessary documents are submitted.
  •  NEFT & KYC details should be updated with the Insurer for easier & faster claim settlement.
  •  Pre hospitalization expenses may be claimed along with main hospitalization expenses.
  •  Unreasonable & Non medical expenses are not payable.

The claim file has to be submitted at the below mentioned addresses within 15 days of discharge.

 

The claim file has to be submitted at the below mentioned addresses within 15 days of discharge.
Courier Address
Claims Department, Apollo Munich Health Insurance Co., Ground Floor, Srinilaya - Cyber Spazio, Road No. 2, Banjara Hills, Hyderabad-500034, Andhra Pradesh. OR Claims Department, Apollo Munich Health Insurance Company Ltd., 2nd & 3rd Floor, iLABS Centre, Plot No. 404-405, Udyog Vihar, Phase-III, Gurgaon- 122016, Haryana.




List of Documents

List of claim submission documents are as below

  • Claim form consist of two parts (Part A to be filled by Insured and Part B to be filled by Hospital).
  • Original bills (including but not limited to pharmacy purchase bill, consultation bill, diagnostic bill) and any attachments there to like receipts or prescriptions in support of any amount claimed which will then become Our property.
  • All reports and records, including but not limited to all medical reports, case histories/indoor case papers, investigation reports, treatment papers, discharge summaries
  • A precise diagnosis of the treatment for which a claim is made.
  • A detailed list of the individual medical services and treatments provided and a unit price for each.
  • Prescriptions that name the Insured Person and in the case of drugs: the drugs prescribed, their price and a receipt for payment. Prescriptions must be submitted with the corresponding Medical Practitioner’s invoice
  • All pre and post investigation, treatment and follow up (consultation) records pertaining to the present ailment for which claim is being made
  • All investigation, treatment and follow up records pertaining to the past
  • Treating doctors certificate regarding missing information in case histories e.g. Circumstance of injury and Alcohol or drug influence at the time of accident
  • Copy of settlement letter from other insurance company or TPA
  • Stickers and invoice of implants used during surgery
  • Copy of MLC (Medico legal case) records and FIR (First information report), in case of claims arising out of an accident
  • Regulatory requirements as amended from time to time, currently mandatory NEFT (to enable direct credit of claim amount in bank account) and KYC (recent ID/Address proof and photograph) requirements
  • Legal heir certificate

Process of Claim

01
The treatment is to be intimated within prescribed timelines.
02
Post completion of treatment, documents are to be collected from hospital during discharge.
03
The claim file is to be prepared with reference to check list. (The claim form part B is to be filled by hospital)
06
Post receiving of all required info, the claim will be processed within 30 days.
05
Apollo will inform about any deficiency within 7 days.
04
Duly filled claim forms along with all necessary documents are to be submitted within prescribed timelines.
07
If the claim is approved, amount will be transferred within 30 days.
08
If the claim is rejected, letter with details are to be shared with Insured.
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