Claims and Exclusion
 

Claims

Cashless Claim - Cashless treatment is only available at a Network hospital. In order to avail cashless treatment, the following procedure must be followed by You:

• Choose the network hospital.
• You can find the complete list of network hospitals on our website.
• Fill in the cashless request form which is available with the Hospital Insurance Help Desk and get it certified by your treating doctor.
• We will scrutinize the document and convey the decision to the hospital. We will sanction the cashless request or call for additional documents if required.
• On approval of a cashless claim, the hospital bills will be settled directly.

Reimbursement Claim -  If treatment is taken in a Hospital which is not on our Network or if You do not wish to avail cashless facility the following procedure must be followed by You for reporting a claim:

• Intimate Us through the toll free number - 1800 103 8889 immediately on admission not later than 15 days from the date of discharge from a Hospital.
• Avail treatment and settle all the bills with the hospital and then file a claim for reimbursement.
• Claim documents may be submitted at below address:

  Claims Department,
  Future Generali Health (FGH), Future Generali India Insurance Co. Ltd.
  Office No. 3, 3rd Floor, “A” Building , G - O – Square
  S. No. 249 & 250, Aundh Hinjewadi Link Road, Wakad, Pune - 411 057.
  Toll Free Number: 1800 103 8889
  Toll Free Fax : 1800 103 9998
  Email: fgh@futuregenerali.in

Claim Documents

• The indicative list of claim documents required is mentioned below
• The claim form specified by Us duly completed and signed by the claimant or a family member;
• first consultation letter;
• first prescription from the Medical Practitioner;
• original vouchers;
• original Hospital bills giving a detailed break up of all expense heads mentioned in the bill;
• Money receipt duly signed with a revenue stamp;
• birth/death certificate (as applicable);
• the original Hospital discharge card;
• all original laboratory and diagnostic test Reports such as X-Ray, E.C.G, USG, MRI Scan, Haemogram, etc;
• If medicines have been purchased in cash and if this has not been reflected in the Hospital bill, please enclose a prescription from the Medical Practitioner and the supporting medicine bill from the chemist;
• If diagnostic or radiology tests have been paid for in cash and it has not been reflected in the Hospital bill, please enclose a prescription from the Medical Practitioner advising the tests, the actual test reports and the bill from the diagnostic centre for the tests.

Exclusions¹⁰

• Pre-existing disease: Compulsory waiting period - 2 Years
• 30-day waiting period - fresh proposals excluding accidental hospitalisation
• 2-year waiting period for listed conditions
• 4-year Waiting Period - Mental illness and psychiatric illness
• 4-year Waiting Period - HIV/ AIDS
• 4-year Waiting Period - Behavioural and Neuro developmental disorders
• External Congenital Anomaly and related Illness/ defect.
• Dental Treatment or Surgery of any kind unless requiring Hospitalization as a result of Injury
• Joint replacement surgery shall be covered after a waiting period of 2 years, unless required due to an accident.
• Use of intoxicating drugs or alcohol.