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    2-GMC Claim Check - List

    Uploaded by

    Chayan Halder
    This document provides a checklist of documents required to submit a reimbursement claim for a group mediclaim (hospitalization) policy. The checklist includes 20 items needed for the claim, such as the employee code, name, designation, employer name, date of admission and discharge, claim form signed by the employee, original hospital bills and receipts, diagnosis details from hospital, bills from doctors and laboratories, and identity proof documents. Instructions are given to arrange the documents in the listed sequence and for HR to check that all documents are in order before sending to the insurance department.

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    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd

    2-GMC Claim Check - List

    Uploaded by

    Chayan Halder
    23 views2 pages
    This document provides a checklist of documents required to submit a reimbursement claim for a group mediclaim (hospitalization) policy. The checklist includes 20 items needed for the claim, such as the employee code, name, designation, employer name, date of admission and discharge, claim form signed by the employee, original hospital bills and receipts, diagnosis details from hospital, bills from doctors and laboratories, and identity proof documents. Instructions are given to arrange the documents in the listed sequence and for HR to check that all documents are in order before sending to the insurance department.

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    2-GMC Claim Check_list

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    This document provides a checklist of documents required to submit a reimbursement claim for a group mediclaim (hospitalization) policy. The checklist includes 20 items needed for the claim, such as the employee code, name, designation, employer name, date of admission and discharge, claim form signed by the employee, original hospital bills and receipts, diagnosis details from hospital, bills from doctors and laboratories, and identity proof documents. Instructions are given to arrange the documents in the listed sequence and for HR to check that all documents are in order before sending to the insurance department.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    23 views2 pages

    2-GMC Claim Check - List

    Uploaded by

    Chayan Halder
    This document provides a checklist of documents required to submit a reimbursement claim for a group mediclaim (hospitalization) policy. The checklist includes 20 items needed for the claim, such as the employee code, name, designation, employer name, date of admission and discharge, claim form signed by the employee, original hospital bills and receipts, diagnosis details from hospital, bills from doctors and laboratories, and identity proof documents. Instructions are given to arrange the documents in the listed sequence and for HR to check that all documents are in order before sending to the insurance department.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    of 2

    Group Mediclaim ( Hospitalization) Policy Reimbursement Claim Check List

    Sr.No Particulars Of Employee


    1 Employee Code
    2 Name Of Employee
    3 Designation & Cader
    4 Name Of The Employer
    5 Mediclaim Category-
    6 Date Of Joining
    7 Date Of Marriage
    8 Patient’S Name
    9 Date Of Admission & Discharge D.O.A D.O.D
    Sr.No List Of Documents Attached Yes/No
    1 Claim Form Duly Signed By Employees With Contact Number

    2 Summary Of Medical Expenses Incurred

    Original Discharge Card/Certificate Of Hospital Specifying Doa / Dod With Time –


    3
    Diagnosis & Treatment

    4 Whether Hospitalised For 24 Hours?

    5 Original Hospital Bill

    Original Hospital Payment Receipt (With Revenue Stamp If Applicable)


    6

    Form “C” (Certificate of Registraion as per the Nursing Homes Acat). If Form "C" Is Not
    7
    Available Kindly Arrange Following form from Hospital.

    a Annexure –“A” Form

    9 Original Bills Of Chemist With Prescription.

    10 If Medicine Are Supplied By Hospital Give Details Of Name Of Medicines-Qty.--Amount

    11 Original X-Ray Report With Original Payment Receipt and Prescription.

    12 Original Pathology Report With Original Payment Receipt and Prescription.

    13 All Original Consulting Papres With Doctors” Bill & Receipt

    14 Anesthetist’S Bill & Receipt

    15 If In Case Of Accident-Following Certificte

    16 Fitness Certificate From Doctor-

    17 Certificate From Treating Dr. For Influence Of Intoxicating Agent At The Time Of Incident ?

    18 Mode & Circumstances Of Accident And Or Any Mlc Or Fir Copy

    Copy of Cancel cheque for salary account and Photo ID Proof of Employee (Adani I-Card,
    19
    Aadhar card, DL, or Election card).

    20 PAN card if the claim amount is more than Rs.50,000/-

    Note:
    Please Arrange The All Documents As Per The Above Sequence
    Hr. Dept: Please Ensure That All The Documents Are In Oder Prior To Send To Insurance Department

    Prepared By Checked By

    ________________________________ ________________________________
    Name , Ext.No & Sign Of Employee Name , Ext.No & Sign Of Executive (HR)

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