Ultimate Guide to Raksha TPA Reimbursement Claim Process

Raksha TPA  is one of the leading Health Insurance third party administrators (TPA) in the Indian insurance industry. It has a wide network of hospitals as part of its cashless network. However, when a policyholder does not get a cashless facility, they have an option to claim their treatment expenses through reimbursement claim.

At SureClaim, we have provided a solution to many policyholders and resolved their claim related issues. In this article, we will discuss in detail various aspects of Rakha TPA reimbursement claim process. You first need to download the Raksha TPA reimbursement claim form. Then you need to fill it up with relevant details and attach supporting documents. The claim documents need to be submitted to Raksha TPA within certain time limit. We’ll take these topics one by one in this guide.

Download Raksha TPA Claim form

Raksha TPA uses IRDA Claim forms for processing claims. There is a part A and part B in the claim form. Part A has to be filled by the claimant and part B has to be filled by the hospital where treatment took place.

In case you are only claiming for pre and post hospitalization expenses, you can skip part b form. Please get in touch with us for getting Raksha TPA claim form.

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How to fill Raksha TPA reimbursement claim form

Part A of the reimbursement claim form has eight sections. The information you fill will be useful for Raksha TPA to process your claim and you must attach all the supporting documents along with claim form.

Let’s look at all the information you require to fill the Raksha TPA claim form part A.

Patient and treatment information

Patient’s age, gender, occupation, and relationship with primary policyholder is required. Their treatment information will include hospital name where treatment took place, room category was chosen for the hospital stay, admission and discharge dates and the date of delivery or accident or the estimated date when the disease was first diagnosed as per applicability in the claim.

Insurance policy details

Policy number or customer ID mentioned in the insurance card is required to identify the policy in which the claim is being raised. Name of the primary policyholder is required as well. Primary is the one in whose name the policy has been issued by the insurance company. So in an individual retail policy, the proposer is the primary whereas, in corporate policy, an employee is the primary member.

Any other insurance policy

If the patient is covered in any other health insurance policy as well (and you may or may not have claimed in that policy), please mention those details in the appropriate section.

Contact details

Contact address, email ID and a mobile number have to be mentioned in section A of the claim form part A. Raksha TPA will use this information to share claim-related updates with the claimant.

Bill details

The claim form has space for 10 bills, so if you have more than 10 bills, use a separate sheet to mention details of all of them. Bill date, value and issuing hospital/shop is what you need for the bills. Make sure the bills are pre-numbered otherwise Raksha TPA will accept them.

Do a total of bill values for expenses from the date and time of admission till date and time of discharge. This is called hospitalization expenses. All other bills before date and time of admission are considered pre-hospitalization expenses. Similarly, all bills after the date and time of discharge are considered post hospitalization expenses. Fill this total in requisite fields.

In section F of the form, total of these bills has to be mentioned in a slightly different way. You carry out a total of all pharmacy bills separately and mention that in the required field. Reduce the pharmacy bills from hospitalization, pre and post hospitalization totals when you fill this information in section F.

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Bank details

Bank account details of the primary policyholder need to be mentioned in the claim form as the settlement amount will only come to their account. If you give account details of the patient, who is not the primary himself or herself, then Raksha TPA will hold the payment till you give the account details of the primary. Thus, you will get your claim money faster if you mention account details correctly. Please note that the exact name of the bank account holder needs to be filled against the field ‘Cheque / DD payable details’.

Hope this article will help you in filing reimbursement claim. If you have any query or you need expert assistance in claim preparation, feel free to contact us.