Insurance & Claims Policy

1. Insurance Coverage

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SKNH proudly supports a comprehensive network of healthcare financing options, including:

• Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PM-JAY)

• Employees' State Insurance Corporation (ESIC)

• Swasthya Sathi (Government of West Bengal)

• Central Government Health Scheme (CGHS)

• Corporate Health Insurance Plans

• Individual & Family Health Insurance Policies

• Leading Public & Private Insurance Companies

• Major Third-Party Administrators (TPAs)

Our Insurance Desk continuously coordinates with insurance providers to offer patients a seamless healthcare experience.

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2. Cashless Hospitalization

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Eligible patients can avail Cashless Hospitalization under applicable Government Schemes and approved Insurance Policies.

 

The Cashless Facility may include:

 

Hospital Admission

Medical Treatment

Surgical Procedures

Day Care Procedures

Emergency Hospitalization (where applicable)

Approved Diagnostic Services

Inpatient Care

 

Cashless services are available only after successful authorization by the respective Insurance Company, Government Scheme, Employer, or TPA.

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3. Pre-Authorization Process

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Cashless treatment requires prior approval from the concerned insurer or TPA.

Our Insurance Team assists patients with:

• Insurance Eligibility Verification

• Policy Validation

• Cashless Authorization Request

• Required Medical Documentation

• Continuous Coordination with Insurance Providers

• Real-Time Status Updates

Patients are requested to provide valid insurance documents at the earliest to minimize approval delays.

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4. Insurance Eligibility

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Insurance benefits are available only when:

• The Insurance Policy is active.

• The patient is eligible under the respective scheme.

• The proposed treatment is covered.

• Hospitalization fulfills the insurer's medical guidelines.

• Required approvals have been granted.

Coverage varies according to the individual policy, employer plan, or Government Scheme.

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5. Government Health Schemes

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Eligible beneficiaries may receive cashless treatment under Government-sponsored healthcare programs accepted by SKNH.

These include:

• Ayushman Bharat (PM-JAY)

• ESIC

• Swasthya Sathi

• CGHS

• Other approved Government Healthcare Programs

Benefits are provided strictly according to the applicable Government guidelines and package rates.

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6. Insurance Documentation

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To facilitate claim processing, patients may be required to submit:

• Health Insurance Card / E-Card

• Government Scheme Card (if applicable)

• Valid Photo Identification

• Admission Documents

• Medical History (if required)

• Investigation Reports

• Doctor's Prescription

• Authorization Forms

• Any additional documents requested by the insurer or TPA

Providing complete documentation helps reduce claim processing time.

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7. Claim Assistance

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Our dedicated Insurance & Billing Team provides complete assistance throughout the claim process, including:

• Cashless Claim Processing

• Insurance Verification

• Medical Documentation

• TPA Coordination

• Claim Submission Support

• Discharge Documentation

• Reimbursement Document Preparation

We strive to make every insurance claim process simple, transparent, and efficient.

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8. Reimbursement Claims

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If Cashless Hospitalization is unavailable or declined:

• Patients may choose reimbursement mode.

• Hospital bills are payable at discharge.

• SKNH will provide all required medical and billing documents.

• Patients may submit these documents to their insurer for reimbursement.

Reimbursement decisions remain solely under the authority of the respective Insurance Company.

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9. Patient Responsibility

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Patients are requested to:

• Declare insurance details before admission.

• Carry valid insurance documents.

• Provide accurate personal information.

• Complete required consent forms.

• Respond promptly to additional documentation requests.

• Pay all non-covered expenses before discharge.

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10. Non-Payable Expenses

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Certain expenses may not be covered under insurance policies, including but not limited to:

• Administrative Charges

• Registration Fees

• Consumables

• Personal Comfort Items

• Cosmetic Procedures

• Non-Medical Items

• Policy Exclusions

• Co-payments

• Deductibles

These expenses shall be payable directly by the patient unless specifically covered under the policy.

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11. Coverage Limitations

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Insurance approval depends upon several factors, including:

• Policy Terms & Conditions

• Waiting Periods

• Sum Insured

• Package Limits

• Disease-specific Limits

• Room Rent Eligibility

• Co-payment Clauses

• Exclusions

• Medical Necessity

• Final Approval by the Insurer

Acceptance of an insurance policy at SKNH does not guarantee approval of every claim.

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12. Claim Rejection & Appeals

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In the event of:

• Claim Rejection

• Partial Approval

• Query Raised by Insurer

• Additional Documentation Request

SKNH will provide reasonable assistance by supplying medical records and clarifications wherever applicable.

However, the final decision always rests with the Insurance Company, Government Authority, Employer, or TPA.

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13. Insurance & Billing Support

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Our dedicated Insurance & Billing Department is available to assist patients with:

• Insurance Verification

• Cashless Authorization

• Government Scheme Assistance

• Billing Queries

• Claim Documentation

• TPA Coordination

• Reimbursement Support

• General Insurance Assistance

Patients are encouraged to contact the Insurance Desk before admission whenever possible for faster processing.

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Terms & Conditions

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• Insurance approval is subject to the respective insurer's authorization.

• Cashless treatment is available only for eligible patients and approved treatments.

• Coverage varies according to each insurance policy and Government Scheme.

• The hospital cannot influence or guarantee insurance approvals.

• Any amount not approved by the insurer shall be payable by the patient.

• Hospital treatment follows established medical protocols irrespective of insurance status.

• SKNH reserves the right to update this policy at any time in accordance with changes in regulatory guidelines, insurance requirements, or hospital procedures.

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Our Commitment

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At Sree Krishna Nursing Home (SKNH), we are committed to delivering ethical, transparent, patient-centric, and financially accessible healthcare. Our experienced Insurance & Claims Team works diligently to simplify insurance procedures, minimize paperwork, and ensure that every eligible patient receives the maximum benefits available under their health insurance policy or government healthcare scheme.

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Your Health is Our Priority - Your Trust is Our Responsibility.