Complete Guide to Anmol TPA Health Insurance Claim Process

Anmol Medicare Insurance Ltd. is closely affiliated to Anmol Finsec Ltd., a broking firm founded in December 1997, to provide a variety of financial services. The organization is licensed by IRDA (Insurance Regulatory Development Authority) and serves all strata of the society.

This guide is to assist you and make the process of claiming medical insurance extremely easy and error-free for you. It will help you understand the intricacies of medical claim around filling the claim form and completing documentation.

Anmol Medicare TPA Claim Process - Cashless

  • Visit a hospital that is within the network of Anmol Medicare TPA.
  • Show your insurance card at the hospital to the concerned personnel so that they can send Anmol TPA a pre-authorization request.
  • If your pre-authorization request is approved subject to the terms and conditions of the policy, Anmol TPA will issue an authorization letter to the hospital which guarantees direct payment to the network hospital.
  • After the patient is discharged, the hospital sends all the original documents related to the treatment to Anmol Medicare TPA so that the payment is made directly to the hospital.
To check if the hospital you’ve chosen for treatment comes within the network of Anmol Medicare TPA, view the complete list here.

Anmol Medicare TPA Claim Process – Reimbursement

  • If you opt for reimbursement claim, you must ensure that the TPA is intimated about the patient’s admission in the hospital at least 3-4 days prior. If it is an emergency case, you can inform Anmol Medicare TPA within 24 hours of admission. Below are the steps you must follow to file a reimbursement claim.
  • Intimate Anmol Medicare TPA about the claim beforehand. You can inform Anmol Medicare TPA by filling the intimation form online. Download Anmol Medicare TPA intimation form.
  • Attach the medical bills and other documents required by TPA to analyse the case within 7 days of the patient’s discharge.
  • Check the Anmol Medicare claim status consistently till your claim is settled because policyholders often miss out on checking the queries raised regarding a document or the case itself.
  • Resolve the query raised by the TPA, if any.

Documents Required for Anmol Medicare TPA Claim

The documents required by Anmol Medicare Insurance are divided in 4 categories.

KYC Documents

KYC stands for Know Your Customer and KYC documents are required to verify and establish the identity of the policyholder and the patient. KYC documents include:

  • Patient’s Aadhar card copy
  • Copies of the policyholder’s government ID proof or PAN card
  • Cancelled cheque that belongs to the policyholder
  • An insurance or e-card copy.

These documents help Anmol Medicare TPA establish your identity.

Hospitalization Documents

  • Patient’s discharge Summary
  • Breakup of Bills
  • Summary of Bills
  • Payment Receipt
  • Operation Theatre Notes, etc.
  • Doctor’s Prescriptions
  • Pharmacy Bills
  • Bill breakup against additional packages

You must submit the originals of all the documents above. You can only send the additional package breakup printed on a plain paper with the hospital’s seal. For claiming pre-hospitalization and post-hospitalization charges, enclose your doctor’s original prescription with the bills.

Investigation Reports

Investigation reports during and before the treatment must be sent to Anmol Medicare TPA in original. While bill breakup can be accepted on a paper with hospital’s seal, the reports must definitely be printed on hospital’s letterhead.

In case of missing lab reports, enclose a cover note with the claim form. The cover note must have the reports that are missing listed down. You can then take your time to source the reports and send them to Anmol TPA when the query is raised. For pre and post hospitalization claims, enclose a doctor's prescription which must be on the official letterhead or a lab requisition slip.

Accident Details, if Applicable

  • Medico Legal Certificate
  • FIR (If you have filed a report)

In accident cases, the patient is required to write a detailed explanation of the incident and sign it. The purpose is to prove that the injury is due to an accident and not a self-harm attempt.

Anmol Medicare TPA Claim Form

Download the claim form by clicking here. Fill Your Claim Form with Zero Scope of Error

How to Fill Anmol Medicare Claim Form

There are 8 sections in an Anmol Medicare claim form. Read on to find out how to correctly fill the form.

Section A

The TPA personnel contacts the policyholder based on the information filled in this section. Hence, you must be very careful while filling the personal details of the policyholder required in this section. The primary policyholder is the one who is responsible for paying the premium. And in case of corporate policies, the policyholder is the employee.

Section B

You need to fill in this section only if the patient is covered under one or more policies apart from the one that you’re filling the form for. So, mention the details of other policies you may have in this section. Ignore the field if you do not have additional coverage.

Section C

The section C would contain the demographic details of the patient including patient’s age, gender, occupation, etc. You will also need to fill how the patient is related to the policyholder in this section.

Section D

Fill patient’s hospitalization details in section D. The field will capture the category of the room the patient chose, where the patient was admitted, admission date, discharge date, FIR details, Medico-Legal details, the nature of injury or illness, etc.

Section E

Section E is dedicated to hospitalization expenses. So, fill the total bill amount in the section during the hospital stay. There are fields where you can specifically add amounts of pharmacy bills, blood bank charges, ambulance service, etc.

Section F

Section F contains the similar information in a different way. You will need to list down all the bills in this section. There is a space for 10 bills. Use this effectively to add the amounts of all the pre and post hospitalization charges. If the bills exceed 10, use a separate page to list more. The main hospital bill including the pre and post hospitalization charges should be summed together and mentioned on the right side of the form. However, the amount in the pharmacy bills must be separately written in the 4th row on the right-side columns.

Section G

Reimbursed amount is sent to the primary policyholder’s bank account. So, mention the name of the account holder as per what’s written on the cheque and DD payable details. If the total amount of charges exceeds 10 Lakh, mentioning the PAN card details is advised. s

Section H

The claimant must sign with the date and time in this section.

Avoid common mistakes done when filling Anmol Medicare TPA claim form – Get Expert Help Now

Anmol Medicare TPA Submissions Timeline

Policyholder can usually submit their claim forms within 15-30 days after the patient’s discharge. However, if missing documents may result in delay, send the documents that you have available attached with the form. Add a cover-note on top of the form and list the ones missing. This will give you sufficient time to source the remaining originals.

Anmol Medicare TPA will then raise a query which you can respond to with the rest of the documents. Ensure that you keep tracking the status of your claim so that you don’t miss out on replying to a query in time.

Claim Submission Address

Check out the address and other contact details of various centres of Anmol Medicare by clicking this link.

Corporate policyholders may submit their Anmol Medicare TPA claim forms in their office premises to an Anmol representative.

Many policyholders bear huge deductions in their claim amount or even face rejection of their claim because of silly but the most common mistakes. But we have to agree, the claim process is tricky and the claim form can leave you completely confused.

Frequently Asked Questions

You can intimate Anmol TPA about the impending claim using this link -

Claim intimation should be given immediately whether it is reimbursement or cashless claim.

Claim approval through Anmol TPA usually takes 3 to 4 weeks. But that’s only possible if you have submitted all the required original documents. Otherwise, the claim approval takes longer. Once the claim is approved, the claim settlement amount is shared with the insurance company. The insurer then takes 2 to 4 weeks to send you the claim amount.

Health insurance claim must be submitted with Anmol TPA. Anmol TPA will verify your claim including the need for hospitalisation as well as the supporting documents. The insurance company only transfers the settlement amount to your bank account.

To check your Anmol TPA claim status, call the toll free number 1800-233-1999.

  • An Anmol TPA e-card copy
  • A policy certificate copy
  • Doctor’s prescription or formal letter advising hospitalisation
  • Investigation reports

You must only fill the Anmol TPA claim form which is the equivalent of IRDA claim form part A. Part B of the form needs not be filled.

The Anmol TPA claim form must be submitted within 7 days of the discharge while the supporting documents must be submitted 15 days within the discharge. If you do not have all the documents, you can submit the remaining ones after the TPA raises a query. This will buy you enough time to collect all the originals and your claim will not be rejected.

Improve the chances of claim approval and minimize the deductions.

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