Procedure for Claims
- Member/Relative / Friends can intimate about the claim within 48 hours from the date of accident
- Death claim should be intimated to ARC within 20 Days from the date of death.
- To Register the claim: Contact or SMS to 9606666564, 8296161666, 080 – 40993666 / 777 / 888 / or you can write us to firstname.lastname@example.org along with Membership No./ARC card No.
- Cashless facility will be given only for INPATIENT (Hospitalization) claims minimum hospitalization of 24 Hours & claim has to be registered / inform within 24 Hours to avail the cashless Benefit.
- The age of the member to be covered under this policy is between 5 to 65 years, and for renewal the upper age limit for acceptance will be 75 years of age.*
- After intimation our PRO will visit the patient for verification within 48 hours*
- Outpatient treatment is payable up to 30 days only, from the date of accident, and 31st day of treatment will not be payable. And the sum assured for Outpatient is 10,000/- per year
- Inpatient Treatment will be payable from the Date of admission to date of Discharge post follow ups, Implant removal will not be covered under this policy and the sum assured for Inpatient is 1,00,000/- per year *
- Outpatient claims will be settled within 7 working days from the date of documents submitted to ARC (subjected to submission of all required documents).*
- In-Patient claims will be settled within 35 days from the date of documents submitted to ARC (subjected to submission of all required documents).*
- Any treatment pertaining to Dental, Medical condition and treatment pertaining to Ligament tear partial /Whole, Meniscal Tear partial /whole pertaining to knee not associated with fracture will not be covered.*
- Treatment Rendered by a Registered Medical practitioner with minimum qualification of MBBS will only be entertained
- Expenses pertaining to the treatment of trauma / Injury / Accidents will only be considered other supporting drugs like Vitamins, Calcium, and Proton Pump Inhibitors, Proteins supplement etc. will not be considered.
- Hospitalization Less than 24 hours for in-patient Treatment is not payable In-Patient Bills to be submitted with the discharge summary to ARC within 15 Days from the date of Discharge, otherwise claim will not be considered and treated as No claim.
- Out Patient Bills to be submitted to ARC within 45 days from the date of Accident otherwise claim is Treated as No claim
- Any Adventures games, Intentional Self Injuries, Suicide or attempt to suicide, Assault, insanity or whilst under the influence of Intoxicating Drink or Drugs and alcohol, Racing, Body building Injuries, Mixed Marshal Art injuries, Boxing, Karate, injuries while Lifting the impossible weights is not covered under this Policy
- The submitted documents will not be returned to patient or any other Individuals related to the patient once the claim is settled
- All the death related documents should be submitted within 90 days.
- Snake bite, Dog bite, Insects bite treatment will be considered as only out patient. *
- In case of Reimbursement/Outstation claim patient has to submit the required documents.
- All the documents should be submitted in Original only Second admission for Implant removal, Post hospitalization, follow ups are not covered under this policy.
OUT PATIENT DOCUMENTS CHECKLIST
1. Claim form and intimation to be filled and signed by the member, In case of injury to Right hand LTM and in illiterate Parents or the guardian can fill & sign the documents on behalf of the member.
2. Copy of any Government ID proof like Pan card / Aadhar card/Voter ID/Pass port/DL copy should be enclosed.
3. Bank details of the Patient, Pass book front page copy/Cancelled Cheque leaf copy should be enclosed.
4. ARC Membership card (Copy).
5. Medical Certificate from the treating doctor stating the history and line of treatment.
6. Vaccination card with seal and signature of the doctor with qualification and Registration Number (In case of Dog bite) to be enclosed .No bulk purchase of vaccine permitted . Vaccine should be purchased against prescription from the treating doctor and from a chemist.
7. X Ray Plates and reports should be enclosed.
8. Pharmacy bills with prescription from the treating doctor to be enclosed.
9. Lab reports, C.T.,MRI.
10. Statement by the patient, History of injury took place to be enclosed.
11. Letter for refund from company (In case policy is in the name of company and the Approval amount to be released in favor of patient) to be enclosed.
12. All Claim related documents should be submitted original only.
IN PATIENT (Hospitalization)
1. If it’s RTA (Road Traffic Accident) MLC/FIR/Police intimation is mandatory (Copy).
2. If in case of work place accident Required Letter from Company (Details of accident).
3. Blood Alcohol estimation Letter from the treating Doctor (Original).
4. Detailed Discharge Summary (Original).
5. Final In Patient Bill with break up (Original).
6. Cash paid receipt with hospital seal signature (Original).
7. Medicine bills with prescription (Original).
8. X-Ray Reports Along with Films/Plates (Original), Lab Reports, ECG, MRI, CT Scan Reports to be enclosed.
9. Pre & Post-Operative X-Ray films/Plates are mandatory.
10. Implant Invoice (If any Implants used).
11. Indoor case papers (Admission Notes, Daily Doctor Notes, Nursing Chart & OT Notes with attestation from hospital if any (Copy).
12. Ifits RTA (DL) Copy is required.
13. Any Govt ID Proof Like Aadhar card/Voter ID/Pan card/Passport Copy to be enclosed.
14. Letter from hospital with reason in case of Non-MLC.
DEATH CLAIM CHECK LIST
- Claim Form duly filled with details of Accident
- Hospital records – Original i.e. Case Sheet – Death Summary / Discharge summary (if died in Hospital attested by Treating Doctor with seal & Signature (Original)
- Complaint Letter – attested by police with seal
- First Information Report (FIR), Panchnama/Inquest Report – attested by police with seal (Originals)
- Post-Mortem Report-attested by Doctor/police with seal and sign (Originals)
- Paper cutting-Xerox, Color photo, spot photo of the accident (if available)
- Death Certificate by Panchayat/Municipality / Corporation/Hospital if died in Hospital (Originals)
- Final Investigation Report/Charge Sheet – Attested by SI (Originals)
- Driving License/RC (if the deceased is driving)
- Details of the Employee – Employee No, Designation, Service Details etc. along with copy of ID Card of employee (if employed) attested by the company officials with seal and Signature on Company Letter Head
- Attendance just before the death (in case employee) attested by company officials with seal
- Salary Slips for 3 Months prior to Accident -if employed attested by company officials and with seal.
- Family Members Certificates – Original/No Objection from other family members other than the Nominee
- Aadhar card and PAN Card /Voter ID/Ration Card of Deceased person and Nominee with self-attestation
*All documents must be attested by the Company with Seal in case the Insured is employed. Above policy Terms & Conditions as per the associate Insurer The New India Assurance Company Limited (NIACL). Any correction or updating will be done accordingly as per the Insurer Guideline *