ManipalCigna Global Health Group Policy

The fact that Manipal Cigna Global Health Group insurance provides advantages to both employers and employees is its best feature. The Manipal Global Health Group Policy offers the same gains for all types and sizes of businesses, subject to certain terms and conditions, regardless of the size of your organisation. There are two ways you can submit a claim for your insurance coverage, so you should be aware of both of them.

Cashless Claim:

For Planned Hospitalization:

• Before being admitted to the hospital for treatment, the insured person needs to contact a network provider at least three days in advance.

• The Network Provider will send out the letter requesting authorisation.

• The Network Provider shall electronically transmit the pre-authorization form and all pertinent information to the 24 (twenty-four) hour authorization/Cashless department, along with the insured person’s and the treating physician’s contact information.

• The organisation will check the applicant’s eligibility for coverage under the Policy after receiving the pre-authorization form and all pertinent medical data from the Network Provider.

• The company must give the Network Provider the authorisation Letter if the request’s information is sufficient to determine the authorisation. When additional information or documents are needed, the company will ask the network provider for them. Once they have received the last few required documents, they will issue the authorisation. All authorisations will be granted within six hours of receiving the last set of complete paperwork.

• The Authorisation letter will include information regarding the Amount Sanctioned, any specific claim limitations, any applicable sub-limits, Co-pays or Deductibles, and non-payable items, if applicable.

• Only 15 days after the date of issuance shall the authorisation letter remain in effect.

In case of Emergency Hospitalization:

• The insured person may seek hospitalisation for medical care from a Network Provider.

• The Network Provider must submit the request for authorisation within 48 hours of the patient’s admission to the hospital but not later than the patient’s actual discharge.

• It is acknowledged and agreed that the company may continue to speak with the treating physician about the insured person’s condition until it receives our recommendations regarding the insured person’s eligibility for coverage.

• If an emergency requiring life-saving, limb-saving, sight-saving, or emergency medical attention arises, the Network Provider may choose to treat the Insured Person in the interim by accepting a nominal deposit or by treating him by their norms.

• After the preauthorization is issued, the Network Provider must return the deposit money to the insured person, except for a small sum to cover uninsured costs.

If the cost of hospitalization is greater than the amount permitted by the letter of authorization:

• To request an increase in the previously authorised limit, the Network Provider must include details of the specific circumstances that have necessitated the increase in the request.

• The company will confirm eligibility and assess the request for improvement based on the availability of additional limits.

• The company must decide whether to accept or reject these additional costs within 24 (twenty-four) hours of receiving the Network Provider’s request for an improvement.

2. Reimbursement Process:

You can use the Reimbursement Claim facility to choose a hospital of your choosing even if it is not empanelled with your insurance company. You can seek medical attention first, pay the bills, and then submit a claim for reimbursement to your insurance company.

The following are the key actions needed to submit a hospitalisation reimbursement claim with the majority of insurance companies:

• Tell your insurance company, i.e. Manipal Cigna, about the procedure and the hospital.

• Receive treatment and pay for it out of your pocket

• In the third step, the policyholder will need to submit a claim to your insurance provider.

• Distribute all hospitalization-related paperwork, including doctor’s prescriptions, health invoices, and medical bills.

• The insurance provider will check your documentation in Step 5. Your claim will be handled by the terms of your policy and the range of coverage.

List of Documents To be Submitted:

The following are the documents that you must submit to file a claim for your Manipal Cigna Global Health Group Policy.

• Claim Form Duly Filled and Signed

• Original pre-authorization request

• Copy of pre-authorization approval letter (s)

• Copy of Photo ID of Patient Verified by the Hospital

• Original copy of consultations

• Original discharge/death summary;

• Operation theatre notes(if any);

• Original Hospital main bill and break-up of the bill;

• Original investigation reports, X-Ray, MRI, CTFilms, and HPE;

• Medical Practitioner’s reference slips for investigations/pharmacy;

• Original pharmacy bills, prescriptions, and invoices;

• MLC/FIR report/post-mortem report (if conducted).

• Bills from registered service providers (Ambulance Cover)