Status Check, Procedures, Facilities

Organization : Health India TPA
Service Name : Online Claim Intimation/Claim Status Track /ID Card Request/E-Card

Claim Status Track : https://healthindiatpa.com/ClaimCardStatus.aspx
Online Claim Intimation : https://healthindiatpa.com/ClaimIntimation/Web_Claim_Intimation.aspx
Online ID Card Request :https://healthindiatpa.com/Additional/IDRequest.aspx

Mediclaim

Mediclaim is a Health Insurance Product. Mediclaim Insurance is a cover, which takes care of the hospitalization expenses subject to maximum sum insured of the Insured in respect of the following situations

Related / Similar Facility : NDHM NHA Health ID Application

Situations:
** In case of a sudden illness.
** In case of an accident.
** In case of any surgery, which is required in respect of any disease, which has arisen during the policy period.

How different is a TPA from Insurance Company?:
Third Party Administrator (TPA) is service provider to all insurance companies servicing health Insurance policies. TPA adds value and facilitates smooth operation of health insurance policies through its value-addition like network of healthcare service providers, medical care standardization, Claims management, Client servicing, expert opinion etc.

When I call Health India TPA’s Call Center / Office, how will you identify me ?
Please mention your Policy Number or your Health India ID to the Call Center Executive. On establishing your identity, we shall be answering your queries related to Claims/Card status.

Will location of dependent family matter in availing services under TPA?
No, Location does not affect the operational activities, main member or the dependant member can avail same and equal benefits irrespective of their location. TPA Network of Healthcare Service Providers is across the country.

Will the change in names in between policy period matters?
Yes, According to the Insurance Company the claim will not be settled (unless prior intimation to Insurance company) if there is any alterations in the name, it has to be intimated to your respective Insurance Co. & requisite Endorsement for the change in name needs to be passed by Insurance co. This has to be done first hand and not when any claim arises.

Should the claim be submitted with the insurance company or with the TPA?
Preferably to the TPA only.

If I have not utilized my permissible eligibility amount in a particular policy period will I get any benefits like carry forward for the next period if I renew the policy?
The amount will not be carry forwarded to subsequent periods.

What are the documents required to be submitted to TPA to claim under reimbursement procedure?
Documents that you need to submit, for a hospitalization reimbursement claim in original, are:
** Hospital Discharge Card.
** In-patient hospital bills signed by Insured to authenticate the amount.
** Investigation Reports along with their bills.
** Prescription of doctor along with their chemist bills.
** Claim Form signed by the insured.
** Details of consumables & disposables used for medical & surgical procedures. (With their detailed break up)
** Doctor’s consultation bills with consultation notes.
** Photocopy of indoor case papers / operative notes.
** Copy of the TPA ID card or current policy copy and previous year’s policy copies (if any).
** Any other document as asked by TPA based on the detailed analysis of the claim.

How to send reimbursement claims to TPA?:
Reimbursement claims can be submitted to us through registered post / courier or can be handed over at any of our Branch offices.

Will medical costs be reimbursed from day one of the cover?:
Such condition will be applicable only if your policy states the feature, “30 days waiting period waived.” However these conditions depends on the nature of the claim and other terms and conditions of the policy.

What are “NON-MEDICAL EXPENSES”?:
Your health insurance policy pays for reasonable and necessary medical expenditure. There are several items that do not classify as medical expenses which varies for every insurers.. These items will not be payable and expenditure towards such items will have to be borne by you. The list of such expenses are periodically revised by the insurers and we are guided by them in this regard.

Can I claim medical expenses incurred before and after a surgery?:
You can claim medical expenses incurred 30 days before and 60 days after hospitalization (if specified in your policy), provided they are related to the ailment/accident for which you were hospitalized. Such expenses are termed as pre and post hospitalization.

Can I claim my dentist’s bills?:
No, you cannot. Dental treatments are only payable if they are as a result of some accidental injury. However for further clarifications, please refer to the terms and conditions of your policy.

Toll free no: 1800 2201 02
Customer Care No. 02266131199