ManipalCigna Health Insurance Claim Form

ManipalCigna Health Insurance Claim Form

ManipalCigna health insurance claim form is provided by ManipalCigna Health Insurance Company Limited. It is a mandatory form that must be submitted to initiate a successful health insurance claim. The insured can request reimbursement of medical expenses incurred on hospitalization/treatment through this form.

What is the ManipalCigna Health Insurance Claim Form?

The ManipalCigna health insurance claim form has details about the insured, their health insurance, claim history, hospitalization, treatment and medical bills. The insured must submit a completely filled claim form along with the other mandatory documents to avoid a delay in the claim settlement process.

Types of ManipalCigna Health Insurance Claim Forms

There are two types of claims the insured can raise under a ManipalCigna health insurance plan – reimbursement and cashless.

• A reimbursement health insurance claim is raised when the insured has to pay the medical bill themselves initially and then fills out the claim form to receive the amount from the insurer.
• The insurer settles the medical bill directly with the hospital under a cashless claim. This means that the insurer does not have to pay the bill out of their pocket. The insured must submit a pre-authorization form to avail a cashless health insurance benefit.

How to Download the ManipalCigna Health Insurance Claim Form?

Check out the different ways through which you can download the ManipalCigna health insurance claim form:

Website - Downloads Page

• Visit the 'Downloads' page on the insurer's website
• Click 'Claims'
• Select your ManipalCigna health insurance plan from the left margin
• Three forms will be displayed – Claim Form Part A & Claim Form Part B for reimbursement and Request for Cashless Hospitalization Form if you want to obtain pre-authorization for a cashless treatment
• Click 'Download' mentioned in front of the claim form
• It will open in a new tab from where the user can download or print it

Website - Claims Page

• Visit the website's homepage
• Select 'Claims' on the horizontal menu bar
• Now, click 'Claim Process' mentioned on the banner. Scroll down to the Reimbursement Claim Process
• You will see the option to download Claim Form Part A and Claim Form Part B
• Click the button and the ManipalCigna health insurance claim form will be downloaded

Other ways to get the ManipalCigna health insurance claim form

The policyholder can also obtain a physical copy of the claim form for ManipalCigna health insurance plans by visiting the nearest branch office.

How to Fill the ManipalCigna Health Insurance Claim Form?

There are two parts of the ManipalCigna health insurance claim form, Part A and Part B. Both are mandatory documents without which the claim process can get delayed. Part A is to be filled out by the insured, while Part B is to be filled out by the hospital.

1. Part A of the ManipalCigna Health Insurance Claim Form

   Here are the particulars mentioned in the ManipalCigna health insurance claim form Part A:

   Details of Primary Insured: Policy no., Sl. no./certificate no., company/ TPA ID no., name, address, contact details

   Details of Insurance History: Currently covered by any other mediclaim/ health insurance; date of its commencement, company name, policy no., sum insured; if hospitalized in the last four years, its date, diagnosis; if previously covered by any other claim and its company name

   Details of Insured Person Hospitalized: Name, gender, date of birth, relationship to primary insured, occupation, address, contact details

   Details of Hospitalization: Name of hospital where admitted, room category occupied, hospitalization reason, date and time of admission, date and time of discharge, cause of injury, system of medicine

   Details of Claim: Details of the treatment expenses claimed, claim for domiciliary hospitalization, details of lump sum/cash benefit claimed, checklist for claim documents submitted

   Details of Bills Enclosed: Sl. no., bill no., date, issued by, towards, no.s, amount

   Details of Primary Insured's Bank Account: PAN, account number, bank name and branch, cheque/DD payable details, IFSC code

   Declaration by the Insured: Date, place, signature

   Disclaimer: The above-mentioned claim form details are indicative only. The policyholder must fill out all required details in the claim form provided by ManipalCigna Health Insurance Company Limited.

2. Part B of the ManipalCigna Health Insurance Claim Form

   The ManipalCigna health insurance claim form Part B must be filled out by the hospital. It contains details about the patient and their admission, diagnosis and treatment, non-network hospital (if applicable), etc.

Common Mistakes to Avoid when Submitting ManipalCigna Health Insurance Claim Form

Here are a few common mistakes that the insured must avoid when submitting the ManipalCigna health insurance claim form:

• Misrepresentation of information or factual inaccuracy in any form field
• Incorrect or mismatched signature
• Mentioning details of a wrong or inactive bank account
• Raising a claim when the waiting period is not over
• Claiming for a policy exclusion
• Raising a claim for an amount above the specified limit
• Submitting the claim documents after the specified time period is over

Documents Required with the ManipalCigna Health Insurance Claim Form

Check out some of the important documents that the insured should submit with the ManipalCigna health insurance claim form:

• Original discharge summary
• Original hospital bills
• Original payment receipts
• Doctor consultation and prescription receipts
• Lab and diagnostic reports
• Identity proof
• Cancelled cheque or bank statement

FAQs on ManipalCigna Health Insurance Claim Form