You must notify us either at the toll-free number 1800 425 9449 (Mediassist TPA) or writing at info@mediassist.com, in the event of hospitalization of covid-19.

You must notify us either at the toll-free number 9122-66620808 (Paramount TPA ) or writing at contact.phs@paramounttpa.com, in the event of hospitalization of covid-19.

You must notify us either at the toll-free number 011- 47222615,129,126,180 (East West TPA) or writing at cashless@eastwestassist.com, in the event of hospitalization of covid-19.

Claim documents need to be submitted at your TPA branch location. Please find below details.

MediAssist TPA-

Claim documents need to be submitted at any MediAssist branch location.

Click on below link to get the list of all MediAssist office addresses:

https://mediassisttpa.in/contact.html

Paramount TPA –

Thane Address: Plot No. A-442, Road No. 28, Ram Nagar, M.I.D.C. Industrial Area, Wagle Estate, Thane West Pin Code – 400604.

East West TPA -

East West Assist Insurance TPA Pvt. Ltd PLOT NO-172, JP HOUSE, LANE 2, Westend Marg, Saidulajab, Next to Saket Metro Station New Delhi-110030.

The following details are to be provided to the Company at the time of intimation of Claim:

1. Policy Number
2. Name of the Policyholder
3. Name of the Insured Person in whose relation the Claim is being lodged
4. Nature of Illness / Injury
5. Name and address of the attending Medical Practitioner and Hospital
6. Date of Admission
7. Any other information as requested by Us

You can download a copy of the ‘claim form’ from our website using below link

https://www.rahejaqbe.com/claims/health-claims

List of necessary claim documents to be submitted for reimbursement are as following

1. Claim form duly signed
2. Copy of photo ID of patient
3. Hospital Discharge summary
4. Hospital Main Bill with payment receipts
5. Hospital Break up bill
6. Payment receipts of all the bills submitted with prescriptions.
7. Original investigation reports
8. Doctors reference slip for investigation
9. Pharmacy Bills

You should submit your claim within 15 days from date of discharge from the hospital.

You will receive an update on status of your claim through SMS and emails on the registered contact details with us. Hence, it is important that your contact details are always updated with us.

In case of cashless claims, we will issue the authorization letter to the hospital through fax or email.

You should carry the Health card provided by the company with this Policy, along with a valid photo identification proof (Voter ID card / Driving License / Passport / PAN Card / Aadhar Card any other identity proof as approved by the Company).

We shall settle claims, including its rejection, within 7 (seven) working days from receipt of Final COVID-19 claim related document required but not later than 30 days.

You should submit the Post-hospitalization claim documents at Your own expense within 15 days of completion of Post-hospitalization treatment or period, whichever is earlier.

We shall receive Pre and Post- hospitalization claim documents either along with the inpatient Hospitalization papers or separately and process the same based on merit of the claim derived based on documents received.

The Sum Insured opted under the Plan shall be reduced by the amount payable / paid under the Benefit(s) and the balance shall be available as the Sum Insured for the unexpired Policy Period.

We are not obliged to make payment for any Claim or that part of any Claim that could have been avoided or reduced You/ Insured Person could reasonably have minimized the costs incurred, or that is brought about or contributed to by You/Insured Person failing to follow the directions, advice or guidance provided by a Medical Practitioner.

If You/ Insured Person suffers a relapse within 45 days of the date of discharge from the Hospital for which a Claim has been made, then such relapse shall be deemed to be part of the same Claim and all the limits for “Instance of same Illness” under this Policy shall be applied as if they were under a single Claim.

Where a rejection is communicated by Us, you may if so desired within 15 days represent to Us for reconsideration of the decision.

Completed claim forms and documents must be furnished to Us within the stipulated timelines. Failure to furnish such evidence within the time required shall not invalidate nor reduce any claim if You can satisfy Us that it was not reasonably possible for You to submit / give proof within such time.

The due intimation, submission of documents and compliance with requirements by You as mentioned above shall be essential failing which We shall not be bound to entertain a claim.

If the cost of Hospitalization exceeds the authorized limit as mentioned in the authorization letter, the Network Provider shall request Us for an enhancement of authorization limit including details of the specific circumstances which have led to the need for increase in the previously authorized limit.

We will verify the eligibility and in our sole discretion evaluate the request for enhancement on the availability of further limits

In the event of a change in the treatment during Hospitalization to the Insured Person, the Network Provider shall obtain a fresh authorization letter from Us in accordance with the process

At the time of discharge the Network Provider may forward a final request for authorization for any residual amount to us along with the discharge summary and the billing format. Upon receipt of the final authorization letter from us, you may be discharged by the Network Provider.

There can be instances where we may deny Cashless facility for Hospitalization due to insufficient Sum Insured or insufficient information to determine admissibility in which case You may be required to pay for the treatment and submit the Claim for reimbursement to Us which will be considered subject to the Policy Terms & Conditions.

Shortfall documents are raised if the documents already sent are insufficient for further validation of the existing claim. They have to be sent within 10 working days of the receipt of the e-mail notifying you of insufficient documentation.

If you are an individual policy holder, you can submit the shortfall documents to the nearest Medi Assist branch. If you are a corporate employee, just hand them over to the respective helpdesk person.