Health Claims

Quick and hassle
free claims process

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Claims Procedure

Claims servicing and processing as per the policy terms and conditions will be done by Raheja QBE’s appointed TPA. The TPA will essentially recommend it for approval.

Process of claims:

Hospitalization

Hospitalization with submission of health card and valid photo id proof.

Preauthorization

The TPA and hospital co-ordinate for verification and approval of the insurance documents.

Authorization and claim approval

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
  • Submit documents at nearest Raheja QBE branch.
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.

Points to Remember

For Cashless Facility:
  • 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.
For Availing Reimbursements:
  • 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

Kindly get in touch on the below mentioned toll free number or email for any claim related queries or assistances.

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

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