Check List of Documents: Please put a “X” mark against the box Total No.

of Enclosures:

1. Claim Form duly filled and signed by claimant.

(Fill the claim amount in Signed Claim Form)

2. Original Main Hospital Bill with break up

(Detailed Breakup of various heads like OT Charges, Nursing Charges and Room Rent, Medicine, etc)

3. Original Hospital Payment Receipt with serial number.

(With seal and signature of the hospital if the main hospital bill does not carry bill number)

4. Original Detailed Discharge Summary from the hospital.

(Gives the summary of diagnosis, period of admission and treatment in the Hospital)

5. Original hospital payment Receipt with serial number

(For Consultation/Surgeon charges if charged outside the main hospital bill)

6. Original Investigation reports with supporting bills& IOL stickers and Invoice in cataract claims. (Along
with prescriptions & reports for all tests done along with images)

7. Police FIR/ Medico Legal Certificate/self declaration

(Mandatory for all road traffic accident duly attested by Police)

8. Original Pharmacy bills with original Doctors Prescriptions

(On doctors letterhead mentioning duration and dosage for medicines)
9. Registration No. of the Hospital ……………

10. Original Death Summary in case of a death claims, Legal Heir Certificate, No Objection letter from other
Family members.

11. Indoor case papers.

12. First consultation and all previous consultation/investigation reports if any.

(In case of the death of patient during hospital stay, mention the same in the claim form or on checklist)

Imp Points to remember:

A. Please retain a copy of all documents submitted to us for further reference
B. Please retain POD copy of the courier for tracking your consignment in case of any delay etc.
C. For implants used in Cataract, Heart Valve Surgeries, CABG, Abdominal Surgeries, Knee
replacement surgeries. Please submit the bill (in case purchased outside) from the vendors for the
prosthetic devices used along with Sticker
D. Please arrange the enclosures as per checklist and note the claim No. on the query compliance
documents.
Courier the documents following Address:

Star Health And Allied Insurance Co. Ltd

Claimcell Dept. | Kotak Towers | 8th Flr. | Zone 3 | Bldg. No. 21 |

Infinity IT Park

Goregaon Mulund Link Road, Malad (E) | Mum-400097.