Medical Claim ProcessPlease select an Insurer to get the contact details

Takaful Oman

Customer Care No

+968 800 800 001

Mail ID

[email protected]

Claims Online

15,742

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Medical Insurance Claims Process

Medical claims are categorized into two types: cashless claims and reimbursement claims.

Cashless Claims
These are processed directly at the hospital by presenting your resident card and medical card. The hospital staff coordinates with the TPA/insurer to obtain claim approval.

Reimbursement Claims
In this process, you receive treatment at the hospital, settle the payment yourself, and then submit the required documents (listed below) to the insurer for claim settlement.

Checklist for Reimbursement Claims -

Sr. No	Document Type
1	INSURANCE CARD / MEDICAL CARD ( photocopy)
2	CIVIL ID CARD/ RESIDENT CARD ( photocopy)
3	DULY FILLED CLAIM FORM ( ASOAP FORM )
	3.1 Name / Age / Gender
	3.2 Card/Policy Number
	3.3 Disease Diagnosis*
	3.4 Investigation Advice
	3.5 Stamp & Seal of Treating doctor/ Hospital with Date*
4	DOCTOR PRESCRIPTION for Outpatient Treatment
5	DOCTOR PRESCRIPTION for Inpatient Treatment
6	INTIMATION / PREAPPROVAL COPY of Mail- Intimated / Received.
7	HOSPITAL DISCHARGE SUMMARY
7(a)	Inpatient (admitted ) Case papers
7(b)	Admission Date & Discharge Date
7(c)	Nursing Charts
7(d)	Treatment given or Surgery (if any)
7(e)	Pharmacy ( Doctor's Prescription Mentioning Medicine Names, bill break up of each medicine with quantity and Total Charges)
7(f)	Investigation reports if any investigation bills are submitted.
7(g)	Payments Receipts ( Cash/ Debit or Credit Card Payments)
7(h)	All 'Original' Bills/Invoices.
7(h)	Break up towards the submitted bills/Invoice if any.
8	REFERRAL LETTER: If Referred to Physician, Consultant or for Diagnosis, Physiotherapy etc
9	Doctors letter mentioning signs, symptoms and Disease Diagnosis for Optical, Skin or Dermatological claims / Cases.

NOTE:The specific steps and requirements may vary depending on the insurance company and policy terms. It is essential to carefully review your policy documents and follow the instructions provided by your insurer.