Medi Assist Claim Form - Pazcare

Medi Assist Claim Form

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Medi Assist claim form for group medical insurance

The Medi Assist claim form for a group health insurance plan contains two parts. Medi Assist reimbursement Claim form part A, which is filled by the insured or the policyholder. Then the claim form part B, which is filled by the hospital where the treatment was taken.

Download the Medi Assist claim form

How to fill Medi Assist claim form for your group medical policy?

  1. Firstly, intimate the TPA about the hospitalisation. The Medi Assist claim form can be downloaded from the Pazcare dashboard or from https://blog.mediassist.in/download-claim-forms/ 
  2. Start by filling in the health insurance policy number followed by the claim number and the Medi Assist TPA Id number. These details will be present on your TPA Id card or your health insurance Id card.
  3. Enter your personal details like name, address, phone number, state, city and all the necessary details asked in your Medi Assist claim form.
  4. If you are covered by any other health insurance policy, please mention those details under the section “Details of insurance history” in your Medi Assist reimbursement claim form.
  5. Then fill in the details of the insured person hospitalised and the details of the hospitalisation like the type of room, date of admission, the reason for hospitalisation and other details mentioned in the Medi Assist claim form part A.
  6. Fill in the details of the claim in your Medi Assist claim form. This includes pre-hospitalisation and post-hospitalisation expenses, ambulance charges, and other details that are applicable to your group health insurance policy.
  7. Please enclose the other required documents mentioned in your Medi Assist reimbursement claim form.
  8. Also, fill in the bank account details of the insured along with a cancelled cheque leaf for the health insurance reimbursement claim for your group medical cover.
  9. The Medi Assist claim form part B will be filled by the hospital where the treatment was taken.

Medi Assist reimbursement claim form filled sample 

Medi Assist reimbursement claim form filled sample-Pazcare

Medi Assist reimbursement claim process

After you fill out the Medi Assist claim form, here is how you will file for the reimbursement claim.

  1. A reimbursement claim can be filed when the insured is admitted to a non-network hospital of a health insurance company.
  2. Make sure you collect all the necessary documents to file a reimbursement claim. This also includes all the original copies of hospital bills and a duly filled Medi Assist claim form.
  3. Also, make sure you have xerox copies of all the attached documents for your reference.
  4. You can submit these documents online/offline based on your convenience. If offline make sure you send the original copies of the necessary documents to the Medi Assist TPA office.
  5. The Medi Assist TPA verifies the claim raised and if it finds the claim valid then the claim is forwarded to the health insurance company for claim approval. 
  6. The Medi Assist claim status can be reviewed on the Medi Assist insurance website.

Download the Medi Assist claim form

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