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| EASY HEALTH INDIVIDUAL HEALTH INSURANCE PLAN / EASY HEALTH FAMILY FLOATER INSURANCE PLAN |
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Supporting Documentation & Examination
The Insured Person shall provide Us with any documentation and information We or Our TPA may request to establish the circumstances of the claim, its quantum or Our liability for the claim within 10 days of the earlier of our request or the Insured Person’s discharge from Hospitalisation or completion of treatment. Such documentation will include but is not limited to the following in English:
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1.Our claim form, duly completed and signed for on behalf of the Insured Person. |
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2.Original Bills (including but not limited to pharmacy purchase bill, consultation bill, diagnostic bill) and any attachments thereto like receipts or prescriptions in support of any amount claimed which will then become Our property. |
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3.All reports, including but not limited to all medical reports, case histories, investigation reports, treatment papers, discharge summaries. |
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4.A precise diagnosis of the treatment for which a claim is made. |
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5.A detailed list of the individual medical services and treatments provided and a unit price for each. |
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6.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 Doctor’s invoice. |
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- The Insured Person additionally hereby consents to:
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1.The disclosure to Us of documentation and information that may be held by medical professionals and other insurers. |
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2.Being examined by any Medical Practitioner We authorise for this purpose when and as often as We may reasonably require. |
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- Claims Payment
We shall be under no obligation to make any payment under this Policy unless We have been provided with the documentation and information We or Our TPA has requested to establish the circumstances of the claim, its quantum or Our liability for it, and unless the Insured Person has complied with his obligations under this Policy.
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We will only make payment to or at Your direction. If an Insured Person submits the requisite claim documents and information along with a declaration in a format acceptable to Us of having incurred the expenses, this person will be deemed to be authorised by You to receive the concerned payment. In the event of the death of You or an Insured Person, We will make payment to the Nominee (as named in the Schedule).
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Cashless service: If any treatment, consultation or procedure for which a claim may be made is to be taken at a Network Hospital, then We will provide a cashless service by making payment to the extent of Our liability direct to the Network Hospital as long as We are given notice that the Insured Person wishes to take advantage of a cashless service accompanied by full particulars at least 48 hours before any planned treatment or Hospitalisation or within 24 hours after the treatment or Hospitalisation in the case of an emergency (namely a sudden, urgent, unexpected occurrence or event, bodily alteration or occasion requiring immediate medical attention).
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This Policy only covers medical treatment taken wholly within India, and payments under this Policy shall only be made in Indian Rupees within India.
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We are not obliged to make payment for any claim or that part of any claim that could have been avoided or reduced if the Insured Person could reasonably have minimised the costs incurred, or that is brought about or contributed to by the Insured Person failing to follow the directions, advice or guidance provided by a Medical Practitioner.
- Fraud
If any claim is in any manner dishonest or fraudulent, or is supported by any dishonest or fraudulent means or devices, whether by You or any Insured Person or anyone acting on behalf of You or an Insured Person, then this Policy shall be void and all benefits paid under it shall be forfeited.
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