Health Claims
Quick and hassle
free claims process
Get your claims as easy as 1-2-3
Claims Procedure
For claim registration of Retail/GMC Policies ( Health QuBE, Health QuBE Super Top Up, Arogya Sanjeevani, Group Health Insurance, Group Health Super Top Up) kindly contact our TPA.
Contact number- 1800-4259-449, 9122-66620808, 1800202022, 1800220102, 080-28004114/18004257878
Email address- info@mediassistindia.com, contact.phs@paramounttpa.com, support@volohealthtpa.com, customersupport@healthindiatpa.com, help@vidalhealthtpa.com,
For claim registration of other policies ( Saral Suraksha Bima, Pravasi Bhartiya Bima Yojana, Group Hospital Cash, Group Premier Personal Accident, Group Loan Insurance, Health Bharosa, RQBE Disability Income Protect-Group, RQBE Surrogacy and Oocyte Donar Insurance Policy-Group, Wage Compensation Policy-Group) kindly contact our Raheja QBE call centre team.
Contact number- 18001027723 (Monday to Saturday, 9 am to 8 pm)
Email address- customercare@rahejaqbe.com
Health Claims Service Indicators
| Health Claims Turnaround Time | ||
|---|---|---|
| Claims | Acceptance of cashless claims by TPA/company to Hospital and communicate to them | 1 Hour |
| TPA's offer of settlement to the Insurer / Hospital after submission of document | 3 Hours | |
| Settlement of claims (other than cashless) | 15 Days | |
Process of claims:
Hospitalization with submission of health card and valid photo id proof.
The TPA and hospital co-ordinate for verification and approval of the insurance documents.
Approval from RQBE is given to the hospital.
Document Required* (In Originals)
Please take care to submit all the below documents while submitting your claim:
- Duly filled claim form duly signed by the insured and the treating doctor.
- Discharge summary with the details of complaints and the treatment availed.
- Final Hospital Bill with detailed break-up along with interim bills payment receipts.
- Doctor’s consultation papers.
- All investigation reports (e.g. original blood report, X-ray, sonography, CT scan, MRI, etc.)
- All pharmacy bills supported by doctor prescriptions.
- Implant sticker or invoice, if used (e.g. lens details in cataract case, stent details in angioplasty).
- Medico legal certificate (MLC) and / or FIR for all accident cases.
- For all miscellaneous charges, detailed bills supporting prescription of the treating doctor.
- Photocopy of the health card.
- Any other related documents,
- Please note all documents that are sent to the TPA should be in original.
- Medical Practitioner’s referral letter advising Hospitalization
- Indoor case paper
- First Information Report, final police report, if applicable;
- Post-mortem report, if conducted;
- Death Certificate from the municipal authorities;
- Death Summary from the Hospital authorities, if death is confirmed by the Hospital;
- Inquest/Panchnama Report;
- Coroner’s Report
- Copy of Schedule/Certificate of Insurance
- Disability certificate from a Medical Practitioner or Hospital confirming the extent and nature of disability.
- Bills and receipt towards expenses relevant to funeral ceremony / repatriation of mortal remains;
- Loan Certificate/Amortization Schedule prepared by the Bank/ Financial Institution at the time of disbursement of Loan showing details of the Loan/EMIs, Principal Outstanding, etc.,
- KYC Details ( Pan card , Aadhaar Card )
- Proof of travel by the Insured Person in a listed public carrier in case the Double Indemnity Benefit is applicable. Additional documents will be called for when the above listed documents do not adequately corroborate admissibility of the claim under respective benefits as per the Policy terms.
- NEFT Details
- Submit documents at nearest Raheja QBE branch .
TATs and service level parameters
Claims Service Standards:
- Registration of a claim - Within 48 to 72 hrs of receipt of notification.
- TAT for approval of Pre –auth request within 1 hour.
- TAT for granting final authorisation within 3 hours
- Payment of additional amount to policyholder charged by the hospitals for delay beyond 3 hours
- Reimbursement settlement/Rejection within 15 working days of receipt of complete documents.
Kindly note that this is not an exhaustive list and any other documents could be required post assessment of your case.
Standard Payments
The following are the standard payments under a standard health insurance policy:
- Accommodation charges - room rent (as per eligibility)
- ICU charges wherever applicable.
- Treating doctor fees (e.g. surgeon charges, visit fees, consultation fees, etc.)
- Nursing Charges.
- Anaesthesia & and anaesthetist charges.
- Investigation charges.
- Pharmacy bills.
- Consumables.
- Operation theatre charges wherever applicable.
- Implant (s) charges wherever applicable for e.g. stents, lens etc.
* This is just an exemplary list; such payments/deduction could vary on Policy Terms & Conditions.
Standard Deductions
Points to Remember
- Avail the benefits of cashless service at Raheja QBE network hospitals.
- Kindly ensure that the pre-authorisation form is completely filled and signed by the Insured and the attending doctor.
- Kindly ensure to mention the mobile number on the pre-authorisation form.
- In case of planned hospitalization, please send the pre-authorisation form in advance (not before 15 days of admission date).
- In case of emergency hospitalization, please send the pre-authorisation form within 24 hours from the time of hospitalization.
- In case of cashless denial, insured to pay hospitalization expenses. Quote your cashless (pre-authorisation) number as reference in all the future correspondence with RQBE.
- Do not refer to the network list of any other service provider.
- Do not wait until the discharge time to raise the enhancement request.
- Insured to bear any inadmissible expenses, co-payments and or deductions.
- Mention correct and complete communication address with the pin code on the claim form.
- Always keep a photocopy of the claim documents submitted to RQBE.
- Kindly ensure that the claim form is completely filled and signed by the insured and the attending doctor.
- Kindly ensure to mention the mobile number on the claim form.
- All claim documents are to be submitted in original within 30 days from the date of discharge.
- Quote your claim number as reference in all future correspondence with RQBE.
- Insured to bear any inadmissible expenses, co-payments and or deductions.
TPA Details
Medi AssistKindly get in touch on the below mentioned toll free number or email for any claim related queries or assistances. For real-time claims status, kindly visit https://www.medibuddy.in/claim
Toll Free Number : 1800-4259-449
Email Address :info@mediassistindia.com
Medi Assist Insurance TPA Pvt. Ltd. 4th Floor, Aarpee Chambers, Shagbaug, Off Andheri-Kurla Road, Next To Times Square, Marol, Andheri East, Mumbai, Maharashtra 400059
Medi Assist Insurance TPA Pvt. Ltd. IBC Knowledge Park, Tower D, 4th Floor, Bannerghatta Main Rd, 4/1, Bengaluru, Karnataka 560029
TPA Details
ParamountKindly get in touch on the below mentioned toll free number or email for any claim related queries or assistances. For real-time claims status, kindly visit https://www.paramounttpa.com/PolicyClaim/PolyClaimStatus.aspx
Toll Free Number : 9122-66620808
Email Address :contact.phs@paramounttpa.com
nonetwork.phs@paramounttpa.com
Paramount TPA Office Address Plot No. A-442, Road No. 28, Ram Nagar, M.I.D.C. Industrial Area, Wagle Estate, Thane West Pin Code – 400604
Paramount TPA Head Office Address Plot No. A-442, Road No. 28, Ram Nagar, M.I.D.C. Industrial Area, Wagle Estate, Thane West Pin Code – 400604
TPA Details
Volo HealthVolo Health Insurance TPA Pvt. Ltd 38, Golf Links, New Delhi-110003
TPA Details
HealthIndia Insurance TPA Services Pvt. Ltd.Kindly get in touch on the below mentioned toll free number or email for any claim related queries or assistances. For real-time claims status, kindly visit https://www.healthindiatpa.com/CustomerCorner/ClaimStatus.aspx
Toll Free Number : 1800220102
Email Address :customersupport@healthindiatpa.com
HealthIndia Insurance TPA Services Pvt. ltd 4th Floor, Neelkanth Corporate IT Park, 406 to 412, Kirol Road, Vidyavihar West, Mumbai Maharashtra - 400086
TPA Details
Vidal Health Insurance TPA Pvt. Ltd.Kindly get in touch on the below mentioned toll free number or email for any claim related queries or assistances. For real-time claims status, kindly visit https://www.vidalhealthtpa.com/vidalhealthtpa
Toll Free Number : 080-28004114/18004257878
Email Address :help@vidalhealthtpa.com
Vidal Health Insurance TPA Pvt. Ltd. 1st floor, Tower 2, SJR i Park, EPIP Zone, Whitefield, Bangalore, Karnataka 560066