CHOLA MS HELP

Presentation
on
Health Claim Process

1
Health Claim Process
 Enrolment- Process

• In house card printing monitored by

Enrolment Dept

What the ID card would contain;

• Name ,Unique alpha-numeric ID no, DOB,
• Age, Gender, Policy No., Valid from date
• Help Line & Toll Free No. and Address of the claims office.

• It is not a Credit Card, but an Identity Card which will identify you as
the beneficiary of Chola MS Help and will give you access to our
Network Hospitals
 Chola website access

The E-Cards are available on our website www.cholainsurance.com.

The member can login by using the Policy Number.

To access the E-cards follow the below mentioned Steps.

Please take the Family code as employee Id

Step 1 - Go To “Do More” Link

Step 2 - Click on “Individual Login” Icon
Step 3 - Enter Policy Number-
Step 4 - Enter Emp. ID as “Login ID”
Step 5 - Enter Emp. ID as “Password”
Step 6 - Print the E - card & set the new Password
 Availing Cashless facility from Chola MS Help
Cashless Claims – Planned Hospitalization
Identify the network hospital from the list provided by Chola
HELP.
Approach the hospital at least 48 hrs prior admission and flash
the ID card in the billing dept.
Hospital will capture the information of the patient in a Pre-
auth request, provided by us, and will fax the same to our toll
free fax
On receipt of the request our panel of doctors will scrutinize
the same as per policy terms and conditions and fax the
approval back to the hospital.
 Cashless response time (TAT) 4 hours
On receipt of the approval the hospital will extend cashless
hospitalization
Certain non medical expenses like registration fee, admission
fee, diet etc has to be born by the claimant.
After discharge, the hospital send the bills to Chola HELP and
gets it reimbursed.
Contd….
Emergency Hospitalization
 Patient get admitted as per the hospital procedure
 Attendant flashes ID card in the billing dept
 Hospital will capture the information of the patient in a Pre-
auth request, provided by us, and will fax the same to our toll
free fax
 On receipt of the request our panel of doctors will scrutinize
the same as per policy terms and conditions and fax the reply
back to the hospital.
 On receipt of the approval the hospital will extend cashless
hospitalization
 Certain non medical expenses like registration fee, admission
fee, diet etc has to be born by the claimant.
 After discharge, the hospital send the bills to Chola HELP and
gets it reimbursed.
 Please note that unless the ID flashed, the hospital will not
know that the patient is covered under mediclaim and may
ask for a advance.
 Claim Processing & Settlement Service
(Reimbursement claims)

 Reimbursement claim documents can be

submitted to any of our regional/branch offices

 Supported by experienced domain knowledge

and medical team

 Settlement of reimbursement claims would be

made within 30 working days from the receipt of
complete set of document.
 REIMBURSEMENT CLAIM PROCESS….
What documents are required to be submitted under a claim under
REIMBURSEMENT
You must submit following documents in Original within 30 days of
discharge from the hospital to CHOLA MS HELP.
 Signed Claim Form (mentioning Total Claimed Amount)
 Original Final Hospital Bill alongwith Payment Receipt
 Original Discharge Summary / Card
 All Original Investigation Reports (x-ray, MRI etc.)
 Original Bills & Receipts for investigations done outside hospital.
 Doctors Prescription, Pre – Post Hospitalisation bills (in original)
 Original Bills of medicines and surgical appliances if purchased.
 EACH & EVERY PAYMENT RECIPT / BILL SHOULD BE SUPPORTED BY
RELATED DOCUMENT.
 CRM Cell

Chola MS HELP LINE will operate

24/7 basis. CRM team will be
available between 7AM to 9PM. After
9 PM, calls will be forwarded to a pre-
designated mobile

The customer care number is All

India

Toll Free no -(1800-200-5544)

Mail ID for inquiry
help@cholams.murugappa.com

and is also supported by

Toll free fax -(1800-425-2200)

Mail ID for cashless
faxhealth@cholams.murugappa.com
 Customer Relations

 Chola MS Help Customer Relationship Managers will be

available across India at our regional/branch offices, to assist
the client in Health related issues

Chola MS Help Team at Delhi are-

1- Mr. Sandeep Srivastava
ID – sandeepsrivastav@cholamsispl.com
2- Dr. Mantosh Kumar
ID - kamalk@cholams.murugappa.com
Thank You