EDO STATE HEALTH INSURANCE Claims Department – Terms of Service
These Terms of Service govern the submission, processing, and resolution of health insurance claims through EDOHIS Claims Department . By submitting a claim, you agree to comply with these Terms.
To submit a claim, you must:
- Be a registered health service provider under EDOHIC
- Ensure the claim falls within the active coverage period and meets the requirements outlined in your health insurance policy.
All authorizations must be sent for approval before treatment EXCEPT in cases of emergencies.
Requests must be accompanied by required documentation, including:
- Medical reports (if applicable)
All claims must be submitted by the 2nd day of the following month.
Submission Channels:
Email: [edhicclaims@gmail.com]
Claims will be reviewed and processed within [30 business days] from the date of complete submission.
Delays may occur if documentation is incomplete or requires verification.
Claim status updates will be provided via email.
Approved claims will be settled based on policy terms, limits, and exclusions.
Payments may be made to:
- The healthcare provider
All payments are final unless otherwise agreed under appeal or dispute resolution.
Claims may be denied due to:
-Declined authorization.
- Incomplete documentation
- Non-covered services
- Policy exclusions
- Late submission
A written explanation will be provided for all denied claims.
You have the right to appeal within [14] days by submitting a written request and any additional supporting documents.
Any fraudulent or intentionally misleading claim submission will result in:
- Immediate denial of the claim
- Possible termination of the policy
- Legal action under applicable laws
All personal and medical information submitted is treated in accordance with the [Nigeria Data Protection Act].
Information will only be shared with relevant parties involved in claim processing.
[EDOHIC] reserves the right to amend these Terms at any time. Continued use of the claims service constitutes acceptance of the updated Terms.
For questions, complaints, or assistance, contact:
- Phone: [07031652849]
- Email: [edhicclaims@gmail.com]