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Hospital Claims

Last Updated on: Friday, 03 Nov 2023

Hospital Claims

Emergency hospitalization at a network hospital:

In case of an emergency if an insured member goes to a network hospital and after giving initial treatment, the treating doctor decides to admit the insured member based on the severity of illness, he/ she will be required to present his / her original health card at the admission office.

The hospital will check the validity of the health card. The hospital will itself notify EFU Health Ltd of the hospitalization. Approval will be given as per policy terms and conditions.

Once the insured will be discharged it will be the hospital’s responsibility to send the original bills along with all supportive documents and a copy of the approved Pre authorization / Approval form to EFU Health Ltd and payment would be made directly to the hospital.

Planned hospitalization at a network hospital:

If an insured is advised admission and plans to get hospitalized at a network hospital then he /she will send a completely filled Pre Authorization form to EFU Health Ltd two working days prior to the admission for approval.

Completely filled Pre-authorization forms can be submitted at the corporate office of the network hospital and hospital can send the form to EFU Health for approval or the insured member can send the Pre-authorization form to EFU Health directly also. Approval will be given if the treatment is covered as per the policy terms and condition.

Once approval is given the insured will get hospitalized at the network hospital, take treatment and get discharged. The hospital itself will send the original bills along with all supportive documents and a copy of the approved Pre authorization form to EFU Health.

Payment would be made directly to the hospital.

Hospital Claims

In case of an emergency if an insured member goes to a network hospital and after giving initial ...


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Reimbursement Claims

To avail inpatient hospitalization services, an insured can go to any hospital of his/her choice, ...


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List Of Excluded Hospitals

Here is the list of excluded hospital, kindly click on download button to view complete list.


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How to File a Claim

A claim should be lodged with the following documents: ...


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Complaints / Grievance

In case you are not satisfied with the decision taken on your claim ...

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EFU Health Corporate Customer Portal

In case of any issue cutomer portal is there to help you ...

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Online Claim Submission

Our claim settlement procedure is prompt and hassle-free. It is advisable to consult our Customer Services team.

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