Cashless

1. Insured patient visits a network hospital for treatment.

2. They approach the Insurance / TPA desk and present a copy of their policy along
with the medical documents requesting to send the details to the insurance
company for availing cashless coverage.

3. The hospital completes the preauthorisation form and submits it along with the
policy details to the insurance company via the portal.

4. Insurance company receives the details, creates the intimation and registers the
claim.

5. A notification regarding the claim is sent to the Insured’s registered mobile

number.

6. The Insurance company reviews the cashless documents received, verifies the
information and determines the admissibility of the claim based on the policy
terms and conditions.

7. The decision on the claim is communicated to both the hospital and the Insured
through a letter of approval or a query if additional documents are needed. If the
claim is not admissible, it will be repudiated based on policy terms and
conditions.

8. If a query is raised for additional documents, the hospital submits the required
information through the portal and the medical team at the Insurance company
with process the claim again.

9. The Insured is updated on the status of the claim at every step.

10. Once the claim is approved, the insured is responsible only for the difference
amount i.e., non-payable charges.

11. The hospital will not collect any payment from the Insured if the claim is fully
approved by the insurance company.
Reimbursement

1. The Insured patient receives treatment at a network or non-network hospital.

2. The Insured notifies Customer care about the hospitalisation details via call or
email.

3. The insured pays for the expenses incurred during the hospitalisation.

4. The original hospitalisation documents along with the duly signed claim form are
submitted to the nearest branch office or agent.

5. Upon receiving the claim documents the Insured is given acknowledgement for
the submitted documents.

6. The documents are uploaded into the system and processed by the medical
team.

7. The claim is evaluated based on the policy terms and conditions.

8. If the claim is admissible, the Insurance company processes the payment, and
the amount is credited to the Proposer's account.

9. If the claim is not admissible, it will be repudiated on the valid grounds and the
reason for rejection will be communicated to the insured.

10. If the additional information or records are needed, the insured must submit
these documents to the nearest branch office or agent again.

11. The insured is updated on the status of the claim at each step of the process.
Documents to be submitted for Reimbursement: The reimbursement claim is to be
supported with the following documents in original and submitted within the prescribed
time limit.

i. Duly filled in claim forms with treating doctor signature.

ii. Pre/Post Hospitalisation investigations and treatment papers.
iii. All investigations reports including Radiological films (Xray, CT scan, MRI and
USG) and Biopsy during hospitalisation.
iv. Discharge Summary from the hospital
v. Cash receipts from hospital, chemists
vi. Cash receipts and reports for tests done
vii. Receipts from doctors, surgeons, anaesthetist
viii. Certificate from the attending doctor regarding the diagnosis.
ix. KYC (Identity proof with Address) of the proposer, as per AML Guidelines
x. Copy of PAN Card
xi. NEFT documents viz., Customer name, Bank Account No., Name of the Bank,
IFSC code
xii. CKYC No. of the proposer (if available) xiii. Legal heir/succession certificate,
wherever applicable
 Cashless Claim Process

Insured Contacts Hospital submits the dully

Claim processing as per Final decision
Hospital Insurance / TPA filled Pre - authorization
policy terms and (Approve/Query/Reject)
Desk with Health Card / form to the Insurer with
conditions.
Policy details policy details
 Reimbursement Claim Process

Claim intimation via toll free Submission of the original

Insured taken treatment Scanning and uploading of the claim
no. or Email to be given within claim documents to the
and paid the 24hrs of hospitalization or documents.
hospitalization bill. office within 15 days of
before discharge. discharge.

Claim processing as per

policy terms and Final decision
conditions. (Approve/Query/Reject)
CASHLESS EVERYWHERE

Cashless Everywhere is an enhancement to the health insurance policy that allows you to access

cashless medical treatment not only at hospitals within the insurance company’s network but also at
hospitals outside the network. This means that you won’t have to pay upfront for medical expenses

at a wider range of hospitals, subject to certain conditions. Instead, the insurance company will

settle the bill directly with the hospital, making the process smoother and easier for you.

We are glad to announce that, in our continued commitment to enhancing access under our Health

Insurance Policy, we are providing “Cashless Everywhere”. Policyholders can now benefit from the
'Cashless Anywhere' facility, enabling them to seek medical care in any hospital without upfront
payment.

1)For planned admissions, notify GALAXY HEALTH INSURANCE at least 72 hours before the ad
mission date via letter, email, or fax. Include the patient's name, hospital name, policy number, and tr
eatment plan. For cashless requests, email anywherecashless@galaxyhealth.com or call our toll-
free number 18002030007.

2)For emergency admissions, submit a cashless request within 24 hours of admission. Inform

GALAXY HEALTH INSURANCE in writing (letter, email, or fax) with the patient’s name,

hospital name, policy number, and treatment plan. For cashless requests, email

anywherecashless@galaxyhealth.com or call our toll-free number 18002030007.

3)The hospital must adhere to the policy's terms and meet the definition of a "hospital." The
insurance company has the final decision on cashless benefits approval for any hospital. The
hospitals which are flagged as excluded provider or blacklisted in the IIB portal will not be
entertained for the cashless facility.

4) The cashless facility is available only for treatments covered by the policy. The Pre-
Authorization form must be completed and signed by both the insured person and the

hospital, and submitted with all necessary documents, including a copy of the insured

person's ID.
 5) Hospitals outside the company's network must provide a consent letter to extend the
cashless facility.

6) The company reserves the right to deny cashless requests. If a request is denied, the
customer may submit documents after treatment, but the claim will be subject to the
policy's terms and conditions.

Mandatory Documents

Please ensure the following documents are provided:

1. Patient identification documents (e.g., Aadhaar card, PAN card).

2. Doctor’s prescription advising admission on official letterhead, including all relevant treatment
records.

3. The Request for Cashless Facility (in the Prescribed format) should be completed and signed by the
Insured Person and the Hospital and submitted with all the requisite documents including a copy of
the Insured Person’s Identification.

4. Letter of consent from the non-network hospital to extend the cashless facility, click this link for
the format.

5. Request letter from the hospital for empanelment.

6. Memorandum of Understanding (MOU) signed with the hospital.

Note: The GALAXY Networking team will manage the MOU process after receiving the hospital's
consent for empanelment.