Who is empanelled
- Government and corporate: ECHS, CGHS, FCI, Medisep, BSNL, Airport Authority of India, Air India (retired employees)
- A large panel of insurers including Star Health, Care Health, Niva Bupa, HDFC Ergo, ICICI Lombard, Bajaj Allianz, Aditya Birla, Tata AIG, SBI General, New India Assurance, United India, Oriental and National Insurance
- TPAs including Medi Assist, FHPL, Paramount, Vidal Health, MD India, Health India and Raksha
Empanelments can change — confirm with the TPA / Insurance Help Desk on the ground floor at the main entrance.
Planned admission
- Get your doctor's advice for admission and estimate
- Visit the TPA desk with your documents
- Take cashless approval before admission — up to 7 days in advance
- A security deposit of ₹10,000 or 10% of the estimate is collected at admission and refunded after final authorisation, less any short payment
Emergency admission
- ICU or accident: show the TPA ID card and pay a ₹10,000 deposit; complete the cashless process within 24 hours
- Ward: pay the prescribed deposit and complete cashless finalisation within 24 hours
- If you did not have TPA details at admission: provide them within 48 working hours, before discharge, or before any surgery — whichever is earliest
- Deposits are refunded within 48 working hours from discharge
Documents checklist
- Insurance / TPA ID card or policy copy
- PAN card and Aadhaar of the patient and proposer
- Positive investigation reports
- Treating doctor's consultation paper
- Discharge card of previous hospitalisation (e.g. chemotherapy, PTCA, CABG, DJ stent removal, transfer)
- MLC / FIR copy for medico-legal cases
- Surgery grade and estimate of OT materials and pharmacy (from admitting doctor)
- Consent form to avail cashless facility
- NEFT details
Avoiding claim problems
Give a true and complete medical history to the doctor when the pre-authorisation form is filled. If a claim is denied due to inconsistent information between the pre-authorisation and treatment records, the patient has to settle the hospital bill.
Common reasons claims get delayed
- Missing documents such as PAN, Aadhaar or previous discharge summaries
- Mismatch between the declared medical history and treatment records
- Policy waiting periods or exclusions not checked in advance
- Late submission of TPA details after an emergency admission
- Room category or package limits under the policy
Reading your policy beforehand and speaking to the TPA desk early avoids many of these problems.
Reimbursement if cashless is not possible
If cashless approval is not granted or your insurer is not empanelled, you may pay the hospital and claim reimbursement from your insurer. Collect the discharge summary, final itemised bills, payment receipts, investigation reports and prescriptions, and submit them to your insurer within the time limit in your policy.
Questions to ask the TPA desk
- Is my insurer or scheme currently empanelled?
- What documents do I need for my specific treatment?
- What is the estimated cost and what might not be covered?
- How long will approval take?
- What deposit is needed, and when will it be refunded?
Specialists you can consult
Frequently asked questions
Is Medisep accepted at Smita Hospital?
Yes. Medisep is among the government empanelments, along with ECHS, CGHS, FCI, BSNL and others.
How early should I apply for cashless?
For planned admission, take approval before admission — up to 7 days in advance.
What is the emergency deposit?
For an ICU or accident admission, ₹10,000 with the TPA ID card, completing the cashless process within 24 hours.
Where is the TPA desk?
On the ground floor at the main entrance.
Sources
- Insurance Services & Empanelled Insurance Co / TPAs, smitahospital.com
