He/She will be entitled to cashless services by producing ID card, policy copy & will be given all stay and discharge in case of hospitalization, subject to terms & condition of the insurance policy.

AML will not guarantee the availability, quality & outcome of the treatment. Selection of network or non-network hospital is insured’s prerogative.

Step – 1
Insured intimates AML at least 3 working days prior to hospitalization as per the format annexed along with the Doctor’s  advice for hospitalization, prescription/ consultation, all tests reports past-medical history and any other relevant document(s) as requested by AML

Step – 2
AML issues an authorization / denial letter to hospital/Nursing Home for covered services as per policy terms & conditions to network hospital.

Step – 3
Cashless treatment is extended / denied by network hospital based on AML authorization letter.

Step – 4
At the time of discharge, insured signs the claim form, all the relevant bills & keeps all original documents including photocopy of ID card with network hospital. Emergency Admission

Step – 1
Insured approaches network hospital & submits the copy of ID card within 24hrs of admission.

Step – 2
Network hospital forwards request letter (Annexure) to AML within 24hrs of hospitalization.

Step – 3
AML issued an authorization / denial letter for covered services as per Mediclaim policy terms & conditions.

Step – 4
Cashless treatment is extended / denied by network hospital for covered services as per the agreement.

Step – 5
At the time of discharge, insured/proposer signs the claim form and all the relevant bills & keeps all original documents including photocopy of ID card with network hospital.

• “Cashless Service” may be denied in some of the situations as listed below.

1. In case of any doubt in the policy terms with respect to the present ailment.
2. The Ailment/Condition etc. not being covered under the policy.
3. The Insured amount not being sufficient to cover the hospitalization expenses.
4. If the request for preauthorization is not received by AML in time.
5. If the information sent to AML is insufficient to confirm coverage.
6. In case of a very short stay at the hospital, authorization for Cashless Services may be denied due to insufficiency of time to process the same.
7. In Case where certain important clearances cannot be obtained from the insurance company due to weekends and holidays.
   
   Denial of cashless facility does not mean denial of treatment & does not stop the insured from getting necessary medical attention or hospitalization, it means that the insured will have to pay all charges  at the hospital. Insured may send all related documents in original & lodge claim with us for reimbursement. The claim will be processed as per terms & conditions of the policy.

1. Obtain authorization letter from AML 3 working days prior to admission for planned hospitalization.
2. Produces the ID card & authority to the network hospital for availing cashless treatment.
3. In case authority letter has not been obtained, please ensure that it is obtained by the network hospital as soon as possible.
4. Avail cashless treatment facility at network hospital till the authorized limit only. Pay for any expenses above the authorized limit & those not covered under the package.
5. Submit all original documents to the network hospital & sign the claim from at the time of discharge.
6. Produce ID card within 24hrs to network hospital in case to emergency hospitalization & submit all information to AML for verification regarding cashless hospitalization.
7. Submit all documents to the nearest AML office within 7days from date of fitness certificate from treating doctor, in case of non-networking hospital.
8. Make payment for any  inadmissible bill as per the terms & conditions of Mediclaim policy.
9. Intimate AML: - a) At least 3 working days prior to hospitalization for planned admission b) within 24 hrs of hospitalization for emergency admission.
10. Co-Operate with AML for early processing & settlement of claim.

1. Don’ts insist on self-advised / unwarranted investigation or evaluation or Health Check – up.
2. Don’ts carry back any original documents at the time of discharge.
3. Don’ts forget to sign the claim form
4. Don’ts insist on admission at network hospital without authorization letter from AML.
5. Don’ts forget to pay for all inadmissible expenses like ambulance charges, diet, telephone expenses, private nurse charge, food supplements like bournvita registration / admission  charges, attendant pass, extra bed for attendant, bed retaining charge expenses on Luxury items like radio/TV/air condition, laundry charges, expenses on vitamins or tonics if not related to the treatment, sanitary items, food & beverage for attendant, photocopying /certifying charges, vaccination, expenses on spectacles, hearing aids etc.
   

1. Intimation of the claim should be given immediately whether it is cashless OR reimbursement claim
2. After discharge from the hospital and if the treatment is completed then claim file with all Documents in Original to be submitted immediately.
3. If the treatment is continued for more than 60 days, then claim file with all documents in Original to be submitted immediately after completion of 60 days.
4. Please do not forget to sign each bill / receipt / paper for proper authentication.
5. Please keep a photocopy of all relevant documents for your record.
6. Claim Form can be obtained from our AML Office / Website OR The Insurance Company.