Understanding Claims Processing

• Insured gets admitted to any network hospital by showing their health card or valid ID proof.
• The TPA desk/Claims staff at the Hospital is informed and policy document & other details are shared with them to initiate cashless process.
• Hospital sends cashless request to TPA.
• The request is approved based on the policy details.
• At discharge, the hospital sends the final bill and relevant details to the TPA.
• We approve cashless claims as per the policy terms and conditions.
• The patient gets discharged from the hospital.

• Retail Policyholders should call our toll-free number 1800 266 3202.
• Group Policyholders should call the respective TPA toll-free number mentioned on the e-card.
• We should be informed about the claim within 24 hours in case of emergency admission and 48 hours prior to hospitalization in case of planned admission.
• The insured visits the hospital, undergoes treatment, pays the hospital directly, and collects all relevant documents after discharge.
• At discharge, the hospital sends the final bill and relevant details to the TPA.
• Submit the duly filled reimbursement claim form along with the original claim documents to the address mentioned below for retail claims:

Magma General Insurance Limited
(Claims Hub), Srinilaya Cyber Spazio Suite 101,
102, Ground Floor, Road No. 2, Banjara Hills,
Hyderabad, Telangana – 500034

• For group claims all the documents to be submitted to the respective address mentioned on the E card.
• Once we receive the claim documents, the claim will be processed as per the policy terms and conditions, and the same will be communicated to you.

Cashless TAT

• TAT for initial cashless approval is within 1 hour*.
• TAT for Cashless Approval at the time of discharge is within 3 hours*

*TAT will be calculated from the submission of documents by the hospital.

• Reimbursement TAT
  Reimbursement claims TAT is within 15 days.**

**Settlement of claim within 15 days from the date of intimation (along with the requisite documents)

Document Submission checklist

• Claim form duly filled out and signed by the Insured.
• All treatment papers of the current ailment, including previous treatment papers, if any.
• Original Discharge Card from the hospital.
• Death summary in case of death of the Insured Person at the hospital.
• All original medical investigation reports (e.g., X-ray, ECG, blood tests, etc.).
• Original hospital bills and receipts.
• Original bills from the chemist, medical practitioner (doctor), and medical investigations, supported by the doctor’s prescription.
• NEFT details and a personalised cancelled cheque / passbook copy in the name of the proposer for electronic fund transfer.
• Valid photo ID proof and address proof of the patient.
• For accident cases: MLC (Medico Legal Certificate) / FIR (First Information Report).
• Copy of the latest valid address proof of the proposer (electricity bill, water bill, telephone bill, or updated bank statement) along with a copy of PAN Card and Aadhaar Card as per AML/KYC norms.
• As per Aadhaar regulations, submit a copy of the masked Aadhaar Card, ensuring the first 8 digits are masked and only the last 4 digits are visible.

Please retain a copy of the documents submitted to us for your future reference. The above list is indicative, and if any additional documents are required, our health claim team will contact you upon receipt of your claim documents.