Reimbursement Claims

CLIENT CHECK LIST - SUBMISSION OF REIMBURSEMENT CLAIMS

The following documents are mandatory to process any type of Reimbursement Claim.

For Outpatient Claims /Procedures/ Investigation / Lab test/ Daycare Claims:

□ Claim Form duly filled & signed by the patient & the doctor (Must be endorsed by the hospital/ clinic/ doctors stamp)

□ Doctors prescription for medicines

□ Original Medical Bills / Invoices

□ Membership ID card copy

□ Reports for investigations done (if applicable)

□ Medicines and surgical appliances bills if purchased from outside pharmacy

□ For Dental Claims: detailed cost breakup/ treatment/ specification of tooth number

□ For Optical Claims: Prescription has to be from a Ophthalmologist

For Inpatient Claims:

□ Claim Form duly filled & signed by the patient & the doctor (Must be endorsed by the hospital/ clinic/ doctors stamp)

□ Pre-Authorization Approval

□ Doctors prescription for medicines

□ Original Medical Bills / Invoices

□ Membership ID card copy

□ Reports for investigations done

□ Medicines and surgical appliances bills if purchased from outside pharmacy

□ Detail Medical Report & Results

□ Discharge Summary / card - For Inpatient claim

Important Notice: If the above documents are not in order at the time of submission GEMS reserves the right to decline the claim and ask for necessary documents. Claims received are acknowledged by stamping received date, and signature of the receiving person.

Dear Member,

Please read this carefully before submitting your claims

Do's

If the treatment is obtained from a Non Provider or Outside the country of residence, PLEASE ENSURE THAT

• You carry a claim form and approval while visiting hospital/clinics outside network.
• You carry claim form while on vacation or Business trip
• You send the pre-approval request for inpatient/day care admission if it is planned outside our provider network or outside the country of residence to our helpdesk team
• You collect all original invoices and investigation reports from the clinic/hospital
• You collect the Medical report and Discharge Summary for inpatient and Day care admission case.
• You get the claim form duly filled and signed by treating doctor
• You complete details of the member requested in the claim form
• You submit the claims within 30 days from date of treatment
• You collect the original medicine prescription and detailed invoices for medications
• You collect detailed break up of all services (Medication/investigations/Hospital charges)
• You submit a copy of Member ID card

In case of Emergency admission, it is not mandatory to call immediately, but within 24 to 48 hours of admission our Helpdesk should be intimated about the case.

Please DO NOT

• submit claims without claim form
• credit card receipt as invoice for the visit
• submit claims without investigation reports
• submit photocopies of invoices, claim form and reports