Insurance Process

In the case of a planned admission, you would have been advised on the probable date of hospitalisation. You must apply for an approval of the estimated hospital expenses with your Third Party Administrator (TPA) at least 4-5 days prior to the date of hospitalisation. Our TPA counter will assist you with the pre-authorisation procedure. However, please bear in mind that the TPA counter is only a facilitator and cannot, in any way, influence the decision on the approval. The approval / denial of cashless facility is the decision of the TPA, depending on your policy terms and conditions.

  • Establish contact with our TPA counter.
  • Provide the necessary documents to the TPA counter:
    • Original health insurance card issued by your TPA
    • Copy of your insurance policy
    • Copy of government issued photo ID (PAN card / Driving license / Voter ID card, etc)
    • Copy of employee ID card (if it is a TPA group insurance policy / corporate policy)
  • Collect the pre-authorisation form pertaining to your TPA. This will include 2 sections:
    • General details on your health insurance policy (to be filled by you)
    • Recommended treatment details (needs to be filled and signed by the doctor who is treating you; patient should not fill this section)
  • Return the completed form to the TPA counter.
  • Once the form is complete, the TPA counter staff will fax / email the form to your TPA office.
  • The TPA counter will revert to you on the approval status.
  • TPA usually approves a part of the total estimate called ‘Initial Sanction’. Please ensure admission within 2-3 days of receiving this sanction, otherwise the initial sanction will be invalid and the entire process will need to be repeated for approval.
  • If hospitalisation is cancelled, please inform the TPA counter immediately.
  • Cashless hospitalisation is linked to the approval of estimated expenditure on your proposed treatment. In case you do not get an approval, you will need to bear the entire expenditure incurred on the treatment.
  • In case of emergency hospitalisation, the TPA counter will take up your case on a fast-track basis with your TPA and is likely to receive approvals within 3-4 hours during the working day.
  • It is mandatory for the hospital to have an approval from your TPA. In case of delay in receiving the approval, or if you cannot wait for receiving the approval due to medical emergency, you can begin the necessary treatment by paying the required cash deposit.
  • In the case of receiving an approval from your TPA after paying the cash deposit, you are entitled for refund of the cash deposit by cheque, within 2-3 working days after discharge.
  • Any additional complication / treatment over the estimate will be sent to the TPA for approval. In case of denials, this amount should be paid at the time of discharge, and can be claimed for reimbursement from the TPA.
  • For complete details on the medical expenses that are covered / not covered, check your health insurance policy.
  • In general, the expenses listed below are not reimbursable under cashless hospitalisation, and are referred to as non-medical expenses. The list is not exclusive and is available on the IRDAI website: www.irdai.gov.in
  • Registration / admission fee
  • Telephone charges
  • Visitors / attenders charges
  • Ambulance charges
  • Charges for diet, which are not part of the administered treatment
  • Document charges
  • Toiletries
  • Service charges
  • Other non-medical expenses

Insurance Empanelment

Location: Nursing Home Building, Ground Floor, TPA Counter

Hours:Monday – Saturday, 10:00 AM – 5:00 PM

Email: tpacell@kemhospital.org

Phone: +91 20 6603 7565