Claims Process for Zolo Wellness Membership Program

Question

Accepted Answer

The claim intimation could be easily done for both reimbursement and cashless hospitalization on Onsurity app and Onsurity Good Doctor will assist the member Zoloite for availing the group health insurance claim from the partner insurance company in case of a valid claim.

The process to raise a claim on Onsurity is provided as below:

Please login into the Onsurity app and on the Home Page under the Insurance section, tap on the Claim Now button.
After tapping the Claim Now button, you can see the steps to raise the claim and claim type process (reimbursement / cashless). Further, you can see the list of documents required and claim form for reimbursement claims and can track the nearest network hospital incase of a cashless claim.
Tap on Raise a Request button.
Now select the Claim Type (Planned Cashless / Emergency Cashless / Reimbursement claim) and tap on Submit. Your claim request will be successfully registered with us and we will get back to you on your registered mobile number within 24 hours.

Please note the following important terms:

Onsurity will only provide assistance services during the claim as a group administrator.Final authority for claims approval, validation and payout rests with our Insurance partner.
In case of any emergency claim, please visit the hospital’s TPA desk for cashless facility.
Please carry your E-health card and valid government approved identity card to the hospitalTPA desk for the cashless claim.
Please keep all documents for claims handy every time.

The list of document required for a claim is provided as below:

A: Documents required for reimbursement claim (You are expected to SCAN all these documents and UPLOAD)

Duly filled and signed Claim Form
Photocopy of PAN and Aadhar card
Original detailed discharge summary / daycare summary from the hospital
Original consolidated hospital bill with the break-up of each Item, duly signed by the insured
Original payment receipt of the hospital bill
First consultation letter and subsequent prescriptions
Original bills, original payment receipts and reports for investigation
Original medicine bills and receipts with corresponding prescriptions
Original invoice/bills for implants (viz. Stent /PHS Mesh / IOL etc.) with the original payment receipts
Canceled cheque of the primary beneficiary with IFSC code for the account to which the claim amount has to be transferred
KYC details if the claimed amount is more than 1 lac (address proof)

Road Traffic Accident (In addition to the documents listed above under A)

Copy of the first information report from the police department / copy of the medico-legal certificate
Treating doctor’s certificate giving details of injuries (How, when and where the injury sustained) including whether the claimant was under the influence of any intoxicating material

In Non-Medico legal cases (In addition to the documents listed above under A)

Treating doctor’s certificate giving details of injuries (How, when and where the injury sustained) including whether the claimant was under the influence of any intoxicating material.

For Death Cases (In addition to the documents listed above under A)

Original death summary from the hospital
Copy of the death certificate from treating doctor or the hospital authority
Copy of the legal heir certificate, if the claim is for the death of the principle insured
Viscera Report for death due to poisoning OR snake bite

Pre- and Post-hospitalisation expenses

Original medicine bills, original payment receipt with prescriptions
Original investigations bills, original payment receipt with prescriptions and report
Original consultation bills, original payment receipt with prescription
Copy of the discharge summary of the main claim