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Unitedhealthcare india (private)ltd.

3B,B wing third floor,


Gundecha onclave,
Kherani road,Saki naka,Andheri (east),
Mumbai 400072
India
CHECK LIST FOR SUBMISSION OF CLAIM
Employee Name:
__________

_______________________________________

Employee

No:

Claim No. _____________________


Name of the company: ________________________________________________________
Contact Number: ____________________________________________________________
E- Mail ID: _________________________________________________________________
The below listed documents must be provided in order to assess your claim for
eligibility:

Submit all the documents along with completely filled in check-list ONLY to United
Healthcare Parekh India Pvt. Ltd

Check list for Documents:

Signed Claim Form. [ fill the claim amt in SCF]

Original Main Hospital bill with Bill Number, paid/received stamp of hospital &
signature with complete break up.
Original Paid Receipt with receipt number with seal & signature
Original Paid Receipt with receipt number for consultation/surgeon charges if
charged separately.
Hospital registration number/Number of beds, on hospital letterhead with
signature.
Doctors registration number on doctor letterhead with signature.

Original Discharge summary is Must.

Original Death summary in case of death is Must.

Original bills of pharmacy, investigation & others.

Original prescriptions on doctors letterhead mentioning continuation period


with doses (for all tests & medicines).

Individual Printed/Written investigation reports in original/attested from hospital


is Must.

Investigation Report Confirming Diagnosis.

Break-up with details of any pharmacy item, medicines, materials, investigations,


etc. charged in the bill (name with individual amount)

All Road traffic accident would require attested copy of FIR/Medical Legal
Certificate is Must ALONGWITH ALCHOLIC HISTORY

In case of self fall, need a letter mentioning the cause of fall on the doctors letter
head with signature.

In cases like cataract, valve surgeries, CABG, any abdominal surgeries, knee
replacements if any surgical or prosthetic device used need to be submitted with
proper sticker & label.

In case of late submission need Delay letter addressing to the Insurer.

Kindly retain copies of all the documents submitted to us.

If there are any documents further required, our document recovery team (DR Team) will
contact you via phone call/e-mail at the above provided contact details.

If the claim is pending for documents like 'Discharge Summary, Hospital Registration
Number, 1st Consultation Letter, Signed Claim Form, Delay Letter' kindly write to our
customerservice@uhcindia.com or call at 1800 22 4646 requesting for the format.

PLEASE NOTE : DELAY IN SUBMISSION CLAIM WILL NOT BE ADMISSABLE

Please find below Ailment Specific Requirement:1. CABG-Angiography/Angioplasty (if previous claim available, mention Claim No/Details)
2. Valve Replacement

Echo Report
Sticker/Invoice

3. Accident

MLC/FIR Copy
Details of Accident
Alcohol History

4. Fall

Details of fall

5. Poisoning

Details
MLC/FIR

6. MTP (Medical Termination of Pregnancy)-

USG Report

7. Cataract

A-Scan
Lens Sticker/Invoice

8. TKR/THR

X-ray
MRI
Implant Details

9. Fracture

X-ray
Details of Fracture

10. Fibroid Uterus/hysterectomy

USG

Histopathology

11. Endometriosis

Infertility History

12. LSCS

Indication
Baby Details

13. Ectopic Pregnancy To check the categorization Insurer wise, whether considered as
Medical emergency or Maternity, and paid from the balance accordingly.
14. Antenatal/Postnatal

Check Limit

15. Health Checkup

Check Limit

16. Ayurvedic

Treatment details
Hospitalization Justification
Govt.Hospital

17. Fever

Details (Vital signs)


Treatment details

18. Respiratory Infections

Treatment Details

19. Gastroenteritis

Treatment Details

20. Anemia

Treatment Details
Supporting Document / Reports.

21. Cirrhosis of Liver/Pancreatitis

Alcohol History

22. Organ Transplant Surgery

Report

23. Part Payment Claim

Other Insurer Settlement Letter in original, along with the deduction


details.
Attested Claim Documents

NOTE:
The above documents are the most probable requirement for processing the Claim; we
may get back to you in case of need for any further documents.