Frequently Asked Questions (FAQs)

Mid-term additions are not allowed, except due to marriage or child-birth. In case of any corrections in Name, DOB, Gender etc please contact HR immediately.

No, you won’t receive a Physical card. However, you can download the E-cards from the E-cards option on the portal.

Please carry a complete set of photocopied documents when you lodge your claim. The relevant original documents will be returned to you after verification. However, the TPA will stamp the original documents. Please note that normally, the original doctor prescription, medicine bills and discharge summary along with the hospital bills will be retained by the TPA. Only X-ray films, ECG, other medical records will be returned to you as a special case after verification / approval of the TPA's medical team.

Yes. According to the Insurance Company, the claim will not be settled (unless prior intimation to Insurance company) if there are any alterations in the name, it must be intimated to your respective Insurance Co. & Requisite Endorsement for the change in name needs to be passed by Insurance company

Co-payment is the insured's contribution to the claim. It is as per policy terms and conditions.

The following details should be provided by the insured while intimating a claim:
Name of Employee
Name of Patient
Employee code
Company name
Hospital Name with full address
Approx expenses
Date of admission
Ailment
Contact Details

The following is the list of documents required for claim submission:

  • Original hospital final bill
  • Original pre-numbered receipts for payments made
  • Complete breakup of the hospital bill
  • Original Discharge Card/Summary
  • All original investigation reports
  • All original medicine bills with relevant prescriptions
  • Original signed claim form
  • Govt. approved Photo ID card copy of claimant
  • TPA Card copy
  • Intimation mail copy/ Claim Registration no.
  • Paginated copy of Indoor Case papers
  • FIR/MLC copy in case of Road accidents. If MLC is not applicable then written confirmation from Doctor/Hospital that the patient was not under influence of alcohol or drugs
  • Cancelled Cheque of a/c of Employee (with Printed Name of the Employee on the Cheque leaf)

PRE-HOSPITALISATION: Relevant medical expenses incurred during the period up to (normally) 30 days prior to hospitalization on disease/illness/injury sustained will be payable.

POST-HOSPITALISATION: Relevant medical expenses incurred for the period of (normally) 60 days after hospitalization on disease/illness/injury sustained will be payable. Please check your policy for the coverage and the number of days.

If hospitalization is less than 24 hours, the claim is not reimbursable unless for some specific treatments like dialysis, chemotherapy, eye surgery, dental surgery, lithotripsy, tonsillectomy and D&C.

No. On the contrary you need not send intimation email if you are opting for cashless. For cashless you need to visit TPA desk at hospital and need to arrange for documents to be faxed to TPA.

TPA functions for 24 hours, however hospital’s cashless desk may be closed. You may certainly deposit and initiate cashless claim the next day.

A Pre Authorization form is a form for prior approval that is required to be taken from the TPA to grant cashless treatment in a network hospital.

You can connect with us at hcm@edelweissfin.com
Name : Health Claim Management Team
Phone :022-68591840

Claim intimation (with particulars relating to policy number, name of the insured person for whom the claim is made, nature of illness/injury and name and address of the attending medical practitioner/hospital/nursing home) should be submitted within 7 (seven) days from the date of hospitalization/injury.

The final claim form along with the hospital receipt, bills, cash memos and the list of documents as listed in the claim form should be submitted to the TPA within 30 (thirty) days from the date of discharge from the hospital.

After receiving all the required documents, it takes 15 working days to process the claim and 7 working days after that for payment.