Orlando Harmon
Medi Assist is a Third-Party Administrator (TPA) that acts as an intermediary between the insurance provider and the policyholder. It offers cashless treatment at any hospital of the policyholder's choice, regardless of whether it is part of the insurer's network or not. To claim medical insurance with Medi Assist, policyholders must first notify Medi Assist in advance of their upcoming claim by logging into their Medi Assist portal or app and clicking the 'Reimbursement' tile. They must then fill in the required details and upload the necessary documents, including a copy of their photo ID, KYC documents, and doctors' consultation letters. Policyholders can track their claims in real-time and, if approved, the amount is reimbursed either via NEFT or cheque.
| Characteristics | Values |
|---|---|
| Cashless treatment | Available at any hospital of your choice, regardless of whether it is part of the insurer’s network or not |
| Contacting Medi Assist | Call center: 040-68178555, WhatsApp Chatbot: +91 70266 69449, Email: [email protected] |
| Cashless requests | To be sent by the hospital to Medi Assist at least 48 hours prior to the date of admission for all elective procedures; cashless requests for emergency treatments need to be shared within 48 hours of admission |
| Reimbursement claims | Pay the hospital bills first and get them compensated from the insurance company later; notify Medi Assist in advance of an upcoming claim by logging into the portal or app and clicking the 'Reimbursement' tile |
| Documents required | Reimbursement claim form, copy of government ID proof of patient, PAN card of proposer, cancelled cheque, passbook copy, bank statement, copy of the Medi Assist ID card, current and previous years' policy copies, covering letter stating your complete address, contact numbers and email address, original hospital bills and documents |
| Tracking claims | Via claim number, Medi Assist ID, email address or mobile number |
| Claim status | Updated via SMS and email |
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What You'll Learn
- Cashless treatment: Available at any hospital, regardless of the insurer's network
- Reimbursement claims: Pay hospital bills first, then get compensated by the insurance company
- Claim submission: Upload documents online and send original copies within 15 days
- Claim tracking: Check the status of your claim through SMS, email, or the Medi Assist portal
- E-card: Generate and print your e-card through the Medi Assist online portal
Cashless treatment: Available at any hospital, regardless of the insurer's network
Cashless hospitalization is a facility provided by the insurance company where the policyholder can undergo necessary treatment without paying the hospital directly for the medical expenses. Typically, cashless hospitalization can be availed only at a hospital that falls within your insurer network upon approval of your pre-authorization application.
However, Medi Assist now offers the option of cashless treatment at any hospital of your choice, regardless of whether it is part of the insurer's network or not. This means that customers can access medical care even at non-network hospitals. All requests for cashless treatment at a non-network hospital must be initiated by the hospital by sending a cashless request to Medi Assist at [email protected].
Upon receipt of the request from the hospital, the Medi Assist team will request certain mandatory documents, such as KYC documents and a brief MOU, which will form the basis for authorizing the cashless request. Medi Assist will then evaluate the credentials of the hospital and scrutinize the documents. The cashless facility will only be extended if the documentation is satisfactory and approved by the insurance company.
It is important to note that cashless requests for emergency treatments at non-network hospitals must be shared within 48 hours of admission. Additionally, cashless treatment will only be provided if the hospital fulfills the criteria prescribed by the insurance company that issued the policy. In the event of non-acceptance of cashless treatment by the non-network hospital, neither Medi Assist nor the insurance company will be held responsible.
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Reimbursement claims: Pay hospital bills first, then get compensated by the insurance company
If you are planning hospitalisation, you can send prior intimation to Medi Assist to plan your treatment. This includes choosing a network hospital, opting for discounted packages, and planning for cashless treatment. Cashless treatment can be availed only at a Medi Assist network hospital and upon approval of your pre-authorization application.
If you are seeking reimbursement for medical insurance claims, you will need to pay the hospital bills first and then get compensated by the insurance company. Here is a step-by-step guide to making a reimbursement claim:
- Notify Medi Assist in advance of your upcoming claim: Log into your Medi Assist portal or app and click the 'Reimbursement' tile. Fill in the required details and click 'Intimate'.
- Upload documents: Scan and upload the required documents, including the original signed reimbursement claim form, a copy of your government ID, PAN card, and Medi Assist ID card. You may also need to provide bank account details and a covering letter with your contact details.
- Await confirmation: Medi Assist will review your documents and confirm if any additional information is required.
- Send hard copies: Courier the hard copies of your bills and documents to your nearest Medi Assist office within 15 days of claim submission.
- Track your claim: You can track the status of your reimbursement claim in real-time using the Medi Assist Portal or MAven app.
It typically takes 15 working days to process the claim and another 7 working days for payment. It is important to note that reimbursement claims may be filed in specific circumstances, such as the denial of pre-authorization for cashless treatment at a network hospital.
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Claim submission: Upload documents online and send original copies within 15 days
As a Medi Assist member, you can submit your claim online through the Medi Assist Portal. To do this, log into your account and click the 'Reimbursement' tile. You will then need to fill in the required details and click 'Intimate'.
Before submitting your claim, you will need to notify Medi Assist in advance of your upcoming claim. To do this, log into your account and click the 'Reimbursement' tile. Fill in the required details and click 'Intimate'. You will then need to present your Medi Assist E-card at the hospital during admission, along with any other legally accepted identity card. Alternatively, you can log into your account and click 'Generate E-Card' to instantly generate and print out an e-card for any beneficiary.
Once you have submitted your claim online, you will need to send the original documents to Medi Assist within 15 days of the claim submission. You can courier the documents to your nearest Medi Assist branch. Some of the documents you will need to submit include:
- Original signed reimbursement claim form (Part 'A' should be filled and signed by the claimant, and Part 'B' should be filled and signed by the Hospital Authority with a seal)
- Copy of government ID proof of the patient and PAN card of the proposer
- Cancelled cheque or passbook copy or bank statement (containing IFSC, account number, and account holder name) of the proposer
- Copy of the Medi Assist ID card/current policy copy and previous years' policy copies (if any)
- Covering letter stating your complete address, contact numbers, and email address (if available)
You can check the status of your claim through SMS and emails on the registered contact details.
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Claim tracking: Check the status of your claim through SMS, email, or the Medi Assist portal
Medi Assist offers multiple ways to track the status of your claim. You can use the online portal, send an SMS, or check your email.
Online Portal
You can use your mobile browser to log into the Medi Assist portal and track your claim. Visit track.mediassist.in and enter your claim number, employee code, or other relevant details to check the current status of your claim. The portal provides real-time updates, and you can also update any missing or invalid documents through the portal or app. All personal information is masked to ensure your privacy.
SMS
To receive claim status updates via SMS, simply send an SMS with the text 'CLAIMS (Claim Number)' to +91 96631 49992. You will instantly receive an SMS with the current status of your claim.
You can also track your claim by providing your email address. Medi Assist will send updates on your claim status to the registered email address. Additionally, you can reach out to the Medi Assist call center at 040-68178555 for any queries or further assistance regarding your claim.
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E-card: Generate and print your e-card through the Medi Assist online portal
The Medi Assist e-card is a mandatory online identity card that proves you and your dependents are insured under a health insurance policy. It is a more convenient alternative to a physical card, as it can be stored on your smartphone and contains the details of all your policy beneficiaries.
To generate and print your e-card through the Medi Assist online portal, follow these steps:
- Log in to your Medi Assist online portal using your username and password.
- Once you are logged in, look for the "Generate E-Card" option.
- Click on "Generate E-Card" to access the e-card generation page.
- On this page, you will be required to enter your Medi Assist ID/Employee ID/policy number or your claim ID.
- After entering the necessary information, follow the prompts to complete the e-card generation process.
- Once your e-card is generated, you will have the option to save it on your smartphone and/or print it out.
It is important to note that you can also download the e-card after logging in to the Medi Assist portal. Additionally, the network hospital search feature on the portal allows you to filter hospitals by location, radius, and specialty, making it easier for you to plan your hospitalization.
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