TTK Healthcare TPA Private Limited

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IRDA License No. 16
 

CLAIM PROCEDURES - CASHLESS | REIMBURSEMENT

The step by step guide to claim procedures, both cashless and reimbursement. Please read them carefully and if any queries do contact our call center.

CASHLESS HOSPITALISATION

To avail cashless hospitalization treatment at network hospitals -

  • Step 1: TTK will provide the list of network hospitals offering cashless facility for treatment.
  • Step 2: The claimant needs to produce the TTK Healthcard at the hospital.
    Note: Incase the Healthcard is not yet issued, please contact our Toll Free No. and keep with you the policy no. at all times.
  • Step 3: Hospital sends Pre-authorization Request with the treatment details; past history and clinical notes along with estimate of hospitalization expense to TTK local office.
  • Step 4: TTK issues a letter authorizing treatment to the Hospital the approved amount upto the Sum Insured limits.

Note : TTK can also reject the authorization in the following conditions
1. Incomplete information
2. Improper support of documentation
In such events, please pay the hospital and submit the claim for reimbursement

  • Step 5: In case the treatment is taken at other non network centers, the Insured is reimbursed the cost of treatment, subject to the provisions of the Policy on the basis of Admit Card/Discharge Card, Diagnostic Reports and Bills/Prescriptions. (See Claims Process below)

Note: The above information may be treated as indicative and not exhaustive. For further details, please contact our local office or our customer care call center.

REMEMBER - TTK Healthcard issued to you is NOT a credit card, it is just complementary to your policy and only on verification of your coverage, and will you be given CASHLESS treatment. Your cashless treatment will begin at the hospital, only after the hospital receives Authorization confirming the same.

CLAIM REIMBURSEMENT

Some of the requirements to be complied with in the event of a claim are listed below:

  • Step 1: Please immediately intimate TTK Healthcare Services about the claim. Claim intimation can be done by the following methods
  • Step 2: At the time of intimation, the customer should provide the following

    a. TTK ID card No. or Policy Number
    b. Date of Hospitalization
    c. Ailment
    d. Approximate Date of Discharge
    e. Approximate Date of Claim submission.

  • Step 3: Download the Claim Form & Medical Certificate Form from our website and fill all columns. The Medical Certificate Form will be filled by the treating doctor.

  • Step 4: Send the filled and signed Claim and Medical Certificate Forms to closest TTK office by courier / hand delivery, along with the following papers
      1. Original Discharge Summary;
      2. All the Original Bills with break up.
      3. All Original Diagnostic Test Reports performed on patient during hospitalization;
      4. Policy copy (if available)
      5. All Medical Bills must accompany the prescription

Note : ICICI Lombard Individual health policyholders please submit/send your claim to - TTK Healthcare TPA Pvt Ltd, 3rd floor, AFL House, Lok Bharti Complex, Marol Maroshi Road, Andheri East, Mumbai 400 059. Phone: 022 2924 0700
  • Step 5: TTK will assess the validity of the claim based on the documents submitted, validate the policy, validate the treatment undergone and settle the claim within the claim settlement parameters. In case of claim is not adhering with parameters, the case would be rejected.

  • Step 6: TTK will correspond with you within 7 days of Claim receipt -
    • If Claim settled, Discharge Voucher will be sent
    • If Document Shortfall, request for the shortfall documents
    • If Claim rejected, Rejection Letter will be sent

Note: If any bills and receipts are not supported by valid documents the claimed amount of that bill would be disallowed.
  • Step 7:

    • Event of Settlement: Please sign the Discharge Voucher and send it back to local TTK office
    • Event of Shortfall: Please forward the requested documents for settlement of claim to local TTK office.
    • Event of Rejection: If you want us to re-open the case, please forward the request supported by valid documents. We will process the same after clarification from the Insurance Company.
    • Event of Disallowance: Please forward the necessary documentation not submitted before to process disallowance and for addendum settlement


Note: The above information may be treated as indicative and not exhaustive. For further details, please contact our local office or our customer care call center.
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