TATA AIG Mediclaim Insurance India - FAQ's

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Question What does Cashless claim settlement mean?
AnswerCashless claim settlement refers to settlement of the approved claim amount by the Insurer directly with the hospital. The customer does not have to pay the hospital. This takes away/reduces the financial burden of the customer in times of medical emergency.

Question Is Cashless claim facility available in all hospitals/medical centers?
AnswerCashless claim facility is available in any of our 2500+ network hospitals across India. This list is available on our website at hospital/medical centers

Question How can I avail Cashless claim facility in case of a planned hospitalization?
Answer
  1. Check the list of our network hospitals. The list is available to you
    • As a part of the Welcome Kit
    • on our website Network of hospitals
    • Alternatively you can call up Service provider at 1800 103 5252 for the list
  2. Select the hospital from where you are going to avail the treatment
  3. Get estimates of the number of hospitalization days, surgical procedures to be performed/type of treatment to be availed and total cost of the treatment
  4. Carry a photo Identity proof of the Insured person availing the treatment
  5. Visit the Cashless/EMSL desk at the hospital with your Cashless Card
    • Fill up a Pre authorization form. The Cashless desk will send the form to our Claims Service Provider at 0124 4555071/72/73
    • We have provided a Pre authorization form to you along with the Welcome kit.
    • Claims form is available at Claims form
    • Forms would also be available at the Cashless/TPA desk of the hospital
  6. Call our Service provider & register the claim. Our service provider will provide a unique claim reference number to you
  7. On receipt of the Pre authorization form, our Service provider will co ordinate with the insurance company & confirm the claim status to you & your hospital. You would get the claim status within 6 hours of us receiving the Pre authorization form.
Question How can I avail Cashless claim facility in case of emergency hospitalization?
Answer
  1. Get hospitalized in any of our network hospitals & get estimates of the number of hospitalization days, surgical procedures to be performed/type of treatment to be availed and total cost of the treatment
  2. Visit the Cashless/TPA desk at the hospital with your Cashless Card
    • Fill up a Pre authorization form.
    • The Cashless desk will send the form to our Claims Service Provider at 0124 4555071/72/73
  3. Call our Service provider & register the claim. Our service provider will provide a unique claim reference number to you
  4. On receipt of the Pre authorization form, our Service provider will co ordinate with us & confirm the claim status to you & your hospital. You would get the claim status within 4 hours of us receiving the Pre authorization form.
  5. In case of hospitalization in a non network hospital you need to settle the bills with the hospital directly and submit a claim form and relevant documents to us for claim processing.
Question What happens to my claim if I get medical treatment at any of the non network hospitals?
AnswerYou will have to settle the bills with the hospital & then register a claim with EMSL, our claims service provider.

Question How can I get the claim in case I don't opt for Cashless facility or if I get hospitalized in a non network hospital?
Answer
  1. You need to settle all bills directly with the hospital /medical centers
  2. Call our Service provider at 1800 103 5252 for claim registration
  3. Our Service provider will register the claim & provide a unique claim reference number and also provide information on the list of documents required
  4. You need to fill up the claim form and send relevant documents to our Service Provider at the following address:
    E-Meditek (TPA) Services Ltd. Corporate Office at 45, Nathupur Road, DLF Phase III, Gurgaon 122002, Haryana.

    Please note:
    • Please mention your policy no/cashless card no in any correspondence sent to us
    • Claim form is sent to you as a part of the policy kit. In case you need the form you can download at Claims form
    • Or inform our Service provider and they will send it to your postal or email address as per your choice
  5. On receipt of the form & documents, our Service provider will co ordinate with us & confirm the claim status to you within 7 working days of submission of all documents
  6. Within 7 working days of the approval of the claim we will send the claim cheque to your communication address
Question How many times can I claim benefits under a Wellsurance policy?
AnswerThe limits are different for different benefits. Please refer to the below mentioned chart for a quick summary. Please go through the Policy Documents for details.
Product Benefit Maximum Limit
All Critical Illness Once during the entire term of the policy. On Renewal this benefit will be available for all Illnesses except for the one paid in the previous term/s
All Hospital Cash Maximum of 90 days during one policy term
All ICU Maximum of 15 days during one policy term
All Ambulance Will be paid for every hospitalization that occurs during one policy term
All Convalescence Will be paid after continuous hospitalization of 5 days for every occurrence of hospitalization during one policy term
Executive Major-Minor Surgeries All defined benefits can be claimed once during one policy term
Executive Kidney Dialysis, Chemotherapy Benefit paid once in lifetime of the policy holder
Woman Cosmetic reconstructive Surgery Only once during one policy term
Family Child Education benefit Only once during one policy term


Question What is the time frame within which the claim intimation has to be made?
AnswerClaim intimation needs to be made within 7 days of the incident. In case of any unavoidable situation where making a claim intimation was not possible by the customer in 7 days then it can be done within 30 days of the incident.

Question Can I get the claim amount if I have already registered a claim with another insurer?
AnswerYes, Wellsurance claims are paid over & above other policies.

Question Will Tata AIG honor my claim if I don't have original medical reports & bills, in case I have submitted original documents to another insurer?
AnswerYes, we will honor the claim basis submission of attested photocopies of all reports & bills.