Documents that need to be submitted for a hospitalization reimbursement claim(before 30 days from the date of discharge)are:

1. Original signed claim form and please mentioned your randstad depute id in claim from.

2. Copy of the Medi Assist ID card.

3. Patient Govt ID proof copy.

4. Cancelled cheque leaf for crediting the proceeds thru NEFT--employee name printed should must/bank passbook copy/bank
statement copy.

5. Original hospital final bill along breakup individual breakup also must.

6. Original receipts for payments made to the hospital.

7. Complete breakup of the hospital bill.

8. Original detailed discharge summary/Day care summary.

9. All original investigation reports and films.

10. All original medicine bills with relevant prescriptions.

11. Original Implant invoice and sticker if any.

Fracture claims:/RTA:

- Self-explanatory letter
- FIR/MLC/AR copy
- First consultation reports if treatment taken in other hospital initially
- Ethanol status(Male)
- Implant stickers.

Partial claim:

- Settlement letter.
- Self-explanatory letter about partial claim.
- Pervious TPA claim documents copy along attested seal and sign from concern tpa.

Maternity claims:

- GPLA status with treating doctor justifying letter along hospital letter pad
Cataract claims:

 In case of cataract,PTCA,Fracture cases implant stickers/invoice are mandatory

 A scan reports is mandatory.

Fever claims:

 Need durg chart/indoor case sheet paper copy

Pre and post claim:

 Original signed claim form and pls mentioned your randstad depute id in claim from.

 Copy of the Medi Assist ID card

 Patient Govt ID proof copy.

 Cancelled cheque leaf for crediting the proceeds thru NEFT--employee name printed should must.

 Original discharge summary/Day care summary--COPY ONLY FOR PRE AND POST CLAIM

 All original investigation reports and films

 All original medicine bills with relevant prescription

 No.Document Required in details:

 1 Duly Completed Claim form-need to mentioned randstad depute id in form claim.

 2Main hospital bills in original(with bill no;signed and stamped by the hospital)with all charges itemized and the original receipts.

 3 Discharge card(original).

 4 Attending doctors’bills and receipts and certificate regarding diagnosis(if separate from hospital bill).

 5 Original reports or attested copies of bills and receipts for medicines,investigations along with doctors prescription in original
and laboratory.

 6 Follow-up advice or letter for line of treatment after discharge from hospital,from doctor.

 7 Break up with details of pharmacy items,materials,investigations even though it is there in the main bill.

 8 In case the hospital is not registered,please get a letter on the hospital letterhead mentioning the number of beds and
availability of

 doctors and nurses round the clock.

 9In case of non-network hospitalization,please get the hospital and doctor’s registration number in hospital letterhead and get
the

 same signed and stamped by the hospital.

 10.The procedure for lodging the claim shall be as under:

Upon the happening of any event giving rise or likely to give rise to a claim under this policy:

a)The Insured shall give immediate notice thereof in writing to the Company.

b)The Insured shall deliver to the Company,within 30 days from the date of completion of treatment,a detailed statement in
writing as

per the claim form together with bills,vouchers and any other material particular,relevant to the making of such claim.

c)The Insured shall tender to the Company all reasonable information,assistance and proofs in connection with any claim here
under.

Documents dispatch Address:

Mr Premnathrao.S

MEDI ASSIST INSURANCE TPA PRIVATE LIMITED

2nd Floor,RWD Atlantis Building,

24,Nelson Manickam Road,

Aminjikarai,Chennai-600029

Mob:9940522680

Note:COPIES NOT ALLOWED FOR MAIN CLAIM