Fgh check list
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This document outlines the claim submission process and required documents for hospitalization and pre/post-hospitalization reimbursement claims with FGH health insurance. For hospitalization claims, documents like claim forms, health ID cards, medical reports, bills, and receipts must be submitted within 30 days of discharge. Pre/post claims require documents like prescriptions, bills, and receipts for medicines, consultations, and diagnostic tests within 30 days of the last post-hospitalization period. All original documents should be sent to the specified health claims department address for processing.
![Hospitalization Claim
[ Reimbursement claim must be intimated to FGH Call Center within 48 hours of Admission and
claim documents must be submitted within 30 days from the date of discharge from hospital. ]
1. Claim Form duly signed by the claimant or family member.
2. Xerox of Health ID Card of claimant.
3. First Prescription / Consultation Letter (Photocopy) from your Doctor.
4. Original Hospital Discharge Card.
5. Original pre numbered hospital bill with hospital seal and signature indicating complete
details of break up and hospitalization period.
[E.g. if Rs.1,000/ has been charged towards medicines in the bill, please ensure that the names
of the medicines, the unit price and the quantity used are mentioned. Similarly If Rs.2,000/ has
been charged towards Laboratory Investigations, please ensure that the names of the
investigations, the number of times each investigation has been performed and the rate is
mentioned]. In this way, clear break ups have to be mentioned for OT Charges, Doctors
Consultation and Visit Charges, Operation Theatre Charges Consumables, Transfusions, Room
Rent, etc.]
6. Original pre numbered paid receipt with revenue stamp, hospital seal and signature
towards the final hospital bill with complete details of break up indicating hospitalization
period.
7. Original or Photocopy of all Laboratory & Diagnostic Test Reports. E.g. XRay, E.C.G,
Ultrasound, MRI Scan, Haemogram etc. (Please note that you do not have to enclose the films
or plates, a printed report for each investigation is sufficient).
8. If you have purchased medicines in cash and if this has not been reflected in the hospital
bill please enclose a prescription from the doctor and the supporting medicine bill from the
Chemist.
9. If you have paid cash for Diagnostic or Radiology tests and it has not been reflected in the
Hospital bill, please enclose a prescription from the doctor advising the tests, the actual test
reports and the bill from the diagnostic centre for the tests.
10. In case of a Cataract Operation, Please enclose the IOL Sticker.
11. For Accident Cases Only A declaration statement by the claimant or his/her family
member explaining how the accident occurred. (The First Information Report FIR Copy and
Medico Legal Certificate MLC if available should also be attached).
12. Copy of valid Hospital Registration Certificate. (If treatment is taken in a non-network
hospital)
13. PAN Card & Aadhar card copy of all members in the policy (Applicable for Retail policies
only and if not submitted earlier)](https://image.slidesharecdn.com/fgh-checklist-210511173956/85/Fgh-check-list-2-320.jpg)
![Pre / Post Hospitalization Claim
[Post hospitalization documents should be submitted within 30 days of the last date of post
Hospitalization period.]
1. You are entitled to claim for relevant Pre & Post hospitalisation expenses if the same is
included in your policy.
2. Pre & post hospitalization expenses are payable only if the main hospitalisation claim is
payable under the policy and must be related to the ailment for which hospitalisation was taken.
For Pre & Post Hospitalisation expenses, please provide the following documents:
1. Medicines : Please provide the doctors prescription advising medicines and the relevant
chemist bill.
2. Doctors Consultation Charges : Please provide the Doctors prescription and the doctors
bill and receipt.
3. Diagnostic Tests : Please provide the Doctors prescription advising tests, the actual test
reports and the bill and receipt from the diagnostic centre.
PLEASE ENSURE THAT:
1. ONLY ORIGINAL DOCUMENTS ARE ENCLOSED, DUPLICATES OR PHOTOCOPIES WILL NOT BE
ENTERTAINED. (EXCEPT WHEREVER MENTIONED).
2. CLAIM DOCUMENTS MUST BE PUT IN AN ENVELOPE AND SUPERSCRIBED HEALTH
INSURANCE CLAIM CARD NO. _______________________ (Claimant ID Card Number)
Please send all documents to the following address:
Health Claims Department
Future Generali Health
Office Number3, 3rd Floor, Building A,
GO SQUARE, Survey No. 249+250, AundhHinjewadi Link Road, Near Mankar Chowk,
Wakad, Pune 411 057 [Maharashtra]
You can intimate your claim at below mentioned numbers or Email id.](https://image.slidesharecdn.com/fgh-checklist-210511173956/85/Fgh-check-list-3-320.jpg)
Fgh check list
- 2. Hospitalization Claim [ Reimbursement claim must be intimated to FGH Call Center within 48 hours of Admission and claim documents must be submitted within 30 days from the date of discharge from hospital. ] 1. Claim Form duly signed by the claimant or family member. 2. Xerox of Health ID Card of claimant. 3. First Prescription / Consultation Letter (Photocopy) from your Doctor. 4. Original Hospital Discharge Card. 5. Original pre numbered hospital bill with hospital seal and signature indicating complete details of break up and hospitalization period. [E.g. if Rs.1,000/ has been charged towards medicines in the bill, please ensure that the names of the medicines, the unit price and the quantity used are mentioned. Similarly If Rs.2,000/ has been charged towards Laboratory Investigations, please ensure that the names of the investigations, the number of times each investigation has been performed and the rate is mentioned]. In this way, clear break ups have to be mentioned for OT Charges, Doctors Consultation and Visit Charges, Operation Theatre Charges Consumables, Transfusions, Room Rent, etc.] 6. Original pre numbered paid receipt with revenue stamp, hospital seal and signature towards the final hospital bill with complete details of break up indicating hospitalization period. 7. Original or Photocopy of all Laboratory & Diagnostic Test Reports. E.g. XRay, E.C.G, Ultrasound, MRI Scan, Haemogram etc. (Please note that you do not have to enclose the films or plates, a printed report for each investigation is sufficient). 8. If you have purchased medicines in cash and if this has not been reflected in the hospital bill please enclose a prescription from the doctor and the supporting medicine bill from the Chemist. 9. If you have paid cash for Diagnostic or Radiology tests and it has not been reflected in the Hospital bill, please enclose a prescription from the doctor advising the tests, the actual test reports and the bill from the diagnostic centre for the tests. 10. In case of a Cataract Operation, Please enclose the IOL Sticker. 11. For Accident Cases Only A declaration statement by the claimant or his/her family member explaining how the accident occurred. (The First Information Report FIR Copy and Medico Legal Certificate MLC if available should also be attached). 12. Copy of valid Hospital Registration Certificate. (If treatment is taken in a non-network hospital) 13. PAN Card & Aadhar card copy of all members in the policy (Applicable for Retail policies only and if not submitted earlier)
- 3. Pre / Post Hospitalization Claim [Post hospitalization documents should be submitted within 30 days of the last date of post Hospitalization period.] 1. You are entitled to claim for relevant Pre & Post hospitalisation expenses if the same is included in your policy. 2. Pre & post hospitalization expenses are payable only if the main hospitalisation claim is payable under the policy and must be related to the ailment for which hospitalisation was taken. For Pre & Post Hospitalisation expenses, please provide the following documents: 1. Medicines : Please provide the doctors prescription advising medicines and the relevant chemist bill. 2. Doctors Consultation Charges : Please provide the Doctors prescription and the doctors bill and receipt. 3. Diagnostic Tests : Please provide the Doctors prescription advising tests, the actual test reports and the bill and receipt from the diagnostic centre. PLEASE ENSURE THAT: 1. ONLY ORIGINAL DOCUMENTS ARE ENCLOSED, DUPLICATES OR PHOTOCOPIES WILL NOT BE ENTERTAINED. (EXCEPT WHEREVER MENTIONED). 2. CLAIM DOCUMENTS MUST BE PUT IN AN ENVELOPE AND SUPERSCRIBED HEALTH INSURANCE CLAIM CARD NO. _______________________ (Claimant ID Card Number) Please send all documents to the following address: Health Claims Department Future Generali Health Office Number3, 3rd Floor, Building A, GO SQUARE, Survey No. 249+250, AundhHinjewadi Link Road, Near Mankar Chowk, Wakad, Pune 411 057 [Maharashtra] You can intimate your claim at below mentioned numbers or Email id.