An i Health Care member can avail of either a Cashless facility available in hospitals in the
i Health Care Hospital Network list, or a Member Reimbursement facility available in all non-
Network and Network hospitals. Below is a detailed description of both these processes.
Cashless process:
The step by step process of availing Cashless Insurance Service is as follows:
1. The Member can select a hospital from the panel of cashless hospital tie-ups as
denoted in the i Health Care Network Hospitals booklet mailed to the member and the
Hospital Network list available on this website. This list is indicative.
i Health Care might include hospitals not in this list /exclude hospitals in this list from its
Network without prior notification. For additional information on the Network list call the
Toll Free number 1800 209 8888.
2. Before Hospitalization, the Member produces the i Health Care card in the chosen
Hospital.
3. The Member Fills his insurance details in a Pre-Authorization form available in the
Hospital. The Hospital fills in details regarding the Diagnosis, Treatment plan, past
history and the expected of the cost of Treatment.(The pre-Authorization form is also
downloadable on the i Health Care website)
4. The Hospital faxes the signed and stamped form to i Health Care.
5. i Health Care evaluates the documents and classifies the case as Approved, Queried or
Rejected faxes an Authorization Letter regarding the same to the Hospital.
• If the illness is covered under the Member’s policy and the documentation is
complete i Health Care approves the case for cashless treatment maximally up to the
Sum Insured limit
• If the illness is covered but the documentation is incomplete i Health Care faxes a
query to the Hospital regarding the gaps in Documentation.
Once the query has been satisfactorily answered, i Health Care
Authorizes or
Rejects the Pre-Authorization form
• A pre-Authorization request is rejected if the insurance policy does not cover the
illness, in which case the person pays out of pocket.
6. In case the Hospitalization is a non-Emergency Planned hospitalization, it is advisable to
Complete all documentation and get admitted after the Authorization Letter from
i Health Care has been obtained. In case of an Emergency hospitalization, the said
procedure for obtaining Authorization can be done after admission to the Hospital.
The Cashless Authorization does not cover:
• Record/documentation charges
• Attendant/Visitor pass charges
• Extra bed charges for attendant etc
• Ambulance charges—unless covered under the policy
• Special nursing charges not authorized by the attending doctor
• Vitamins, tonic if not forming part of the room rent
• Service charges not forming a part of the room rent
• Sanitary items
• Charges for extra bed for attendant
• Bed retaining charges
• Charges for T.V, Laundry, radio etc
• Telephone/Fax charges
• Food and Beverages for the insured and attendant/ visitors
• Toiletries etc
• Purchase of Medicines not related to the treatment
• Stationery, Xerox or certifying charges
• Duty Medical Officer / Registrar / Resident Medical Officer charges
Member-Reimbursement Process:
The step by step process for availing Reimbursement from i Health Care is as follows.
1. The Member takes treatment in a Hospital of his choice
2. On discharge the Claim form is downloaded from i Health Care website and filled by
the Member and the treating Doctor.
3. The filled and stamped form is couriered to the i Health Care office along with the
following documents in original
• Claim form duly signed
• Original detailed discharge summary
• All Payment receipt(s) in original
• Copy of Health card and supporting Photo ID (wherever applicable)
• Original hospital bill(s) with break up—Interim bills and Final Bill
• Package break-up (if applicable)
• Original investigation reports and Bills
• Pharmacy bills with supporting prescription from the treating doctor
• Consultation Papers with Treatment details
• Indoor Case Sheet (wherever applicable)
4. i Health Care shall assess the validity of the claim depending on the completeness of
documentation and the coverage of the Policy of the Member.
5. In case the documentation is complete and the ailment is covered under the Policy, the
Member shall be reimbursed the amount deemed appropriate by the i Health Care
doctors evaluating the claim and the cheque for the same shall be sent to the Member
within 15 days of receipt of complete documents.
In case the documentation is incomplete the same shall be intimated to the Member
within 15 days, and the process continued, provided the said documents are sent
within the prescribed limit of the Claim Intimation period.
In case the said ailment is not covered under the Member’s Policy Terms and
Conditions, the claim request shall be rejected.
