Policy Dunia

Policies For All

Home » Blog » General Insurance » Apollo Munich Health Insurance Claim Procedure

Apollo Munich Health Insurance Claim Procedure

By

5/5 - (3 votes)

Apollo Munich Health Insurance Claim Procedure is based on different Apollo Munich Health Insurance plans. You need to keep copies of all documents submitted to Apollo Munich Health Insurance Co. Ltd. to get fast and efficient service during Claim settlement.

Intimation and Assistance:

  1. For intimation of claim, contact the company at least 48 hours prior to an event which might give rise to a claim. For any emergency situations, contact them 24 hours of the event.
  2. You can contact them through, Toll Free: 1800-102- 0333, Fax: 1800- 425- 4077 and get detailed information.
  3. Use the Claim Intimation Form for intimation of a claim.

In case you need to avail Inpatient hospitalisation services, you can go to any hospital of your choice, i.e. Apollo Munich network hospital or a hospital outside the network. The difference between the two is that with a network hospital you can use “Cashless Services”, whereas for a non network hospital, you will have to settle the bills and “Claim for Reimbursement“.

Hospitalisation in Non Network Hospitals:

Emergency Hospitalisation Planned Hospitalisation
  • Get admitted into the hospital.
  • Inform the company about the hospitalisation.
  • Settle the hospital bills in full and collect all the bills, reports and documents, at the time of discharge.
  • Place your claim with the company for processing and reimbursement.
  • Inform the Company about the planned hospitalisation 7 days prior to the admission.
  • Get admitted into the hospital.
  • Settle the hospital bills in full and collect all the bills, reports and documents, at the time of discharge.
  • Place your claim with the company for processing and reimbursement.

Hospitalisation in Network Hospitals:

Emergency Hospitalisation Planned Hospitalisation
  • Get admitted into the hospital.
  • Inform Apollo Munich within 24 hours of hospitalisation.
  • Coordinate with the hospital to have the details sent to the company for authorization for cashless service.
  • Please coordinate with your doctor and the hospital.
  • Send in all the details of your planned hospitalisation including the plan of treatment, cost estimates etc. to the company.
  • Also, indicate the address or fax number to where the authorisation is to be sent along with the mobile number to receive updates on your claims and authorisations.
  • This should be sent to the company at least 7 days prior to the admission.

Apollo Munich Health Insurance Claim Procedure for Reimbursement:

  1. For Reimbursement of Medical Expenses, you should send the duly signed claim form and all the documents such as Hospital Main Bill, Pharmacy Bill, ECG, Hospital Bill Payment Receipt, Doctor’s Prescription, etc., to the company within 15 days of the completion of the treatment.
  2. If there is any deficiency in the documents or information submitted by you, company will send the deficiency letter within 7 days of receipt of the claim documents.
  3. On receipt of the complete set of claim documents, company will make the payment for the admissible amount, along with a settlement statement within 30 days.
  4. Payment will be made in the name of the proposer, for items covered under your policy.

Apollo Munich Health Insurance Claim Procedure to avail Cashless facility:

  1. For any emergency hospitalisation, company must be informed within 24 hours after the treatment or Hospitalisation, then it  will provide cashless service by making payment to the extent of their liability directly to the Network Hospital.
  2. For any planned hospitalization, company must be given notice within at least 48 hours before the planned treatment or Hospitalisation, then it  will provide cashless service by making payment to the extent of their liability directly to the Network Hospital.
  3. If in case there is any deficiency in the documents or information sent, the same shall be communicated to the hospital within 6 hours of receipt of documents.
  4. Insured person is entitled for cashless only in their network hospitals.
  5. In case the treatment is not covered under Health insurance policy a rejection letter would be sent to the provider within 6 hours.

Apollo Munich Health Insurance Claim Procedure for Critical illness:

  1. You must intimate the company within 14 days of diagnosis of first occurrence of Critical Illness.
  2. You must submit a duly filled claim form along with specified documents within 45 days of completion of survival period for the Critical Illness against which the claim is made.
  3. If there is any deficiency in the documents or information submitted by you, company will send the deficiency letter within 7 days of receipt of the claim documents.
  4. Any additional information requested must be submitted to the company within 15 days of their request.
  5. On receipt of the complete set of claim documents, company will make the payment for the admissible amount, along with a settlement statement within 30 days.

Apollo Munich Health Insurance Claim Procedure for E-Opinion:

  1. Submit duly filled claim form along with the copy of all medical reports at any of Apollo Munich Branch Office.
  2. You need to select Company Panel Doctor from whom you would prefer to take the e-opinion.
  3. On receipt of the complete set of documents company will forward the same to the concerned doctor.
  4. The E-Opinion will be send to the member within 7 working days of the receipt of the complete set of documents.

Download (PDF, 50KB)

Download (PDF, 49KB)

Download (PDF, 50KB)

Apollo Munich Health Insurance Claim Form

For Claiming under Apollo Munich Health Insurance, you need claim form.

Download (PDF, 109KB)

Apollo Munich Health Insurance Claim Intimation Form:

For intimation of a claim under Apollo Munich Health Insurance, you need Claim Intimaton Form.

Download (PDF, 31KB)