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, max liability 3rd year onwards 50%, 4th Year onwards 100%.
• 30-day waiting period - fresh proposals excluding accidental hospitalisation
• 2-year waiting period for listed conditions
• 4-year waiting period - joint replacement and organ transplant
• 4-year Waiting Period - Mental illness and psychiatric illness
• 4-year Waiting Period - HIV/ AIDS
• 4-year Waiting Period - Behavioural and Neuro developmental disorders
• Cost of an annual health check-up
• Injury or illness directly or indirectly caused by or arising from or attributable to war, invasion, act of foreign enemy, war like operations
• Cosmetic treatments, plastic surgery other than as may be necessitated due to an accident or as a part of any illness, refractive error corrective procedures, experimental, investigational or unproven/experimental treatment, devices and pharmacological regimens of any description
• Expenses incurred towards treatment of illness or injury arising out of alcohol use/ misuse or abuse of alcohol, narcotic substance or drugs
• Charges incurred in connection with cost of spectacles and contact lenses, hearing aids, durable medical equipment, namely that equipment used externally for the human body which can withstand repeated use; is not designed to be disposable; is used to serve a medical purpose, such cost of all appliances/devices whether for diagnosis or treatment after discharge from the hospital.

Eligibility

Entry Age – Minimum – 1 Day

Entry Age – Maximum – None

Cover type – Individual and Family Floater

Co-payment - Compulsory Co-payment applicable on every admissible claim