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UB AROGYADAAN PREMIUM CHART - 2021-22

Submit claims in soft copy During the COVID 19 Lockdown period

* INSURANCE COMPANY NAME

* CCN NO

Do not have the Claim No registered ? Click here to initmate the claim first.

POLICY NO

Special characters are not allowed (Ex: OG-10-FDS/234 as OG10FDS234)

Corporate name (applicable for corporate policies)

Special characters are not allowed (Ex: ABC-ABC as ABCABC)

Employee ID (applicable for corporate policies)

Special characters are not allowed (Ex: FA-123 as FA123)

* GOOD HEALTH ID

Special characters are not allowed (Ex: GH-01/02-03 as GH010203)

* NAME OF THE INSURED

* NAME OF THE PATIENT

* GOOD HEALTH ID OF THE PATIENT

Special characters are not allowed (Ex: GH-01/02-03 as GH010203)

* AGE OF THE PATIENT

* RELATIONSHIP WITH THE INSURED

* MOBILE NO

* please enter proper mobile no as it is used for OTP verification

* EMAIL ID

* please enter proper email id as it is used for OTP verification

Claim Document Checklist for scanned copy submission

Filled in and signed Claim Form

Good Health TPA ID Card Copy

Patient AADHAR Card Copy

Insured AADHAR Card Copy

Cancelled Cheque copy Click here for sample.

Policy Copy

Discharge Summary

Consolidated Bill

Payment Receipts for all payment made

Pharmacy Bills

All Lab/investigation reports

Prescriptions

Bill Break up for all Bills submitted

MRI / X-Ray films / Reports

Any other relevant document for the processing of the claim

Are all the documents self attested Click here for sample.

BROWSE Files (FOR DOCUMENTS UPLOAD)

Special characters are not allowed. Allowed only _

DECLARATION BY THE INSURED

DURING SUBMISSION OF SOFT COPIES OF REIMBURSEMENT CLAIM DOCUMENTS

I, , aged years, enrolled in Good Health Insurance TPA Limited (TPA)vide GHITL card ID hereby accept the following conditions:

1. I herewith understand that TPA or insurer is not liable to pay by mere submission of my claim documents.
2. The TPA/insurer reserves the right to process the claim as per terms and conditions of the policy.
3. The insurer reserves its right to settle the claim either on soft copies itself or following submission of hard copies.
4. The TPA or insurer reserves its right to recover the settled amount in case of any misrepresentation of facts or fraud is committed by me.
5. I agree to submit the original documents as soon as the lock down is lifted or whenever the TPA /insurer summons for the same even after settlement of the claim.

**** submitted on 07-07-2022 21:54:54 from IP ADDRESS 192.168.250.1

I agree to all the above

OTP

Please note you will be able to upload the document only after successful verification of your contact details

REIMBURSEMENT / MEMBER CLAIM SUBMISSION PROCEDURE DURING LOCKDOWN PERIOD

In view of current lockdown situation and emphasis by Ministry / DFS on expeditious settlement of Health Claims, as per insurer’s instructions, the insured can submit soft copies of the claim documents.

Important Instructions for submitting the claim documents:

1. The maximum size of the document should not exceed 10 MB in PDF/JPG/TIFF format.

2. Each and every page of the document should be self-attested by the insured after writing the declaration as “submitted to Good Health Insurance TPA Limited for health insurance reimbursement purpose”Click here for sample. Click here for sample1. Click here for sample2.

3. Claim settlement is subject to policy terms and conditions and insurer’s instructions.

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