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 30 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.

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.