( ALL THE DOCUMENTS SHOULD BE SUBMITTED IN ORIGINAL)

Hospitalization should be intimated to Insurance Company & TPA OR H R DEPTwith in 24 Hrs after admission date
1
PHS Contact No. 022-66620808
2 Claim should be submitted within 15 days from date of discharge
3 Claim Form of Insurance Company - Filled Patient & Employee details - Hospital details with stamp and signatur is mandatory.

In case of No intimation / Delay Submission of the files letter from the insured required stating reason for the same - Should be Compulsare
4
carry at the time of Claim submission
5 Duly filled claim form ( Contact No & Email ID with Employee No / Card No.)

6 Patient & Employee Photo ID Proof - AADHAR Card and PAN Card - Should be Compulsare carry at the time of Claim submission

Cancelled Cheque with IFSC Code and Printed Name or E-Statement of your account mentioning Acc holder name, Acc no. MICR CODE,
7
IFSC CODE - Should be Compulsare carry at the time of Claim submission
8 PHS ID No. OR Name of the Company and Employee no .
Xerox copy of the hospital Registration Certificate
9 OR
Hospital Registration No. Printed on Discharge Card & Main Paid Bill & Telephone no,Mobile no of hospital / Doctor
If Registration is not there then declaration from hospital stating no's of beds in the hospital,24hrs Nursing staff,Fully Equipped Operation Theater & Qualified
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Doctors in the hospital.

Main Hospital FINAL Bill with Detail Break up - Item & Cost wise break up duly stamped and signed by Hospital authority
11
( Example - laboratary charges, IV Fluids, Medicine, injections, Drugs & Consumables, etc )
12 Original Hospital Discharge card / discharge summary duly stamped and signed by Hospital authority.
13 Original Medical bills/ Cash Memo with doctor's prescriptions, Name of Patient & date
14 Original Pathological and Medical investigation, Xray / MRI / CT film with Printed reports with bills
15 Revenue Stamp or PAID stamp on receipts where payment is above Rs.5000/-
16 Obstrectic history from treating doctor ( Gravida, Para, Living Children, Abortions) - Maternity Claim
17 One Latest Sonography Report in case of Maternity Claim
18 Indoor Case Sheets required in case of Hospitalisation - TPR Chart, Drugs Chart, Line of treatment chart, Blood sugar chart, Nursing Notes etc.
19 OT Notes & Anasthetist Notes require for Surgery or Procedure.
20 Statement of Total expenses incurred
21 FIR copy & Medico Legal certificate by Hospital Authority ( in Accident case)
22 Alcoholic History & Incident Hisory report by Hospital Authority ( In Accident case)

23 Implant Invoice along with Payment receipts and & Implant Lables / Stickers for Stents / Mesh / IOL - Lence etc.

24 "A Scan" Report and IOL- Lence sticker along with Tax Paid Invoice in case of Cataract Claim

Email : synechron.mediclaim@paramounttpa.com Mob:+91 7498408576/7498466413/7498888531