How to avail of the facility

The Golden Four Steps

Step One : Obtain the medical details of your ailment from treating doctor in the prescribed format

For all hospitalization insured has to give prior intimation (before admission) in the prescribed format to PHS 24-hours helpdesk. In case of any elective hospitalization preferably 48-72 hours before hospitalization.

Step Two : Fax the Request Note

A request form for cashless admission in the network hospital is required to be submitted to PHS by insured/hospital along with necessary medical details like investigation reports etc which can confirm the diagnosis and enable PHS to verify your coverage as per the policy terms & conditions.

Step Three : Get the Pre-Authorization

After verification, PHS will issue an Authorization Letter (AL). Authorization Letter is guarantee of payment issued by PHS to the network hospital so that the insured can obtain medical treatment. For all hospitalization (Elective or Emergency), it is mandatory for the issued to obtain prior approval from PHS in the form of Authorization Letter to enjoy cashless facility.

Step Four: Avail of the Cashless Hospitalization

Insured are requested to approach the Admission / Reception Counter of the hospital on the day of admission with the Authorization letter and your ID Card. (PHS will also arrange to send Authorization letter to the Hospital.)

When Cashless Hospital can be denied

• In case of admission to network hospital without prior intimation to PHS helpdesk
• In case sufficient information in the prescribed format is not given.
• In case of vague symptoms when medical team of PHS is not sure of eligibility under the coverage due to inadequate medical information, pre-authorization for cashless can be denied.

The denial of cashless facility does not mean denial of treatment and does not in any way prevent you from seeking necessary medical attention or hospitalization.