Documents Checklist For Reimbursement

• Original hospital final bill
• Original numbered receipts for payments made to the hospital
• Complete breakup of the hospital bill
• Original discharge summary (For post-hospitalization)
• All original investigation reports along with prescriptions
• All original medicine bills with relevant prescriptions
• Original signed Reimbursement claim form (Part ‘A’ should be filled and signed by the claimant, and Part ‘B’ should be filled and signed by Hospital Authority with Seal.)
• Copy of Govt. ID proof of the Patient and PAN card of the Proposer.
• Cancelled cheque or Passbook copy or Bank statement (containing IFSC, Account No, and Account holder name) of Proposer
• Copy of the Insurance ID card/ current policy copy and previous years’ policy copies (if any)
• Covering letter stating your complete address, contact numbers, and email address (if available).