Ultimate Guide to Ericson Health Insurance TPA Claim Process

Ericson Insurance TPA is in the process of building the largest direct billing cashless network hospitals across India.

They have developed their own state-of-the-art IT system and provide a full-range comprehensive health insurance services. This includes enrolment, claims processing, pre-authorization, case management, emergency assistance, network maintenance and other customer services all across the country.

Ericson Insurance TPA Cashless Claim Process

  • Check the network hospitals of Ericson Health TPA and choose the one closest to where you live.
  • Provide your Ericson Insurance TPA card to get cashless treatment.
  • Intimate your TPA within 24 hours of your hospitalisation in case of emergency admission and at least 48 hours before admission in case of planned hospitalization.
  • Take photocopies of all the hospitalization documents before the discharge as the originals remain with the hospital.

Please click here to find your nearest Ericson Insurance TPA network hospital:

Ericson Insurance TPA Reimbursement Claim Process

  • Intimate the TPA about the hospitalisation within 24 hours of admission.
  • Submit the claim documents within the stipulated time frame mentioned in the policy.
  • Prepare the documents as per the TPA’s checklist.
  • Submit the original hospitalization documents to the TPA but keep a copy with you for future reference.
  • Get the acknowledgement for all the submitted documents.
  • Collect the paid receipts for all the bills you paid from the hospital or consultants & submit the same in original to your TPA for processing.
  • Respond to the queries raised by the TPA or insurer within the stipulated timeline to avoid further delay in claim settlement.
  • If there are any claim-related queries, get it cleared with the TPA’s help.

Documents Required for Ericson Insurance TPA Insurance Claim

You’ll need to submit 4 different types of documents:

KYC documents

Know Your Customer (KYC) documents include the following:

  • Policyholder’s PAN card or any government ID proof
  • Patient’s Aadhaar card
  • Ericson Insurance TPA card or the policy document
  • An insurance or e-card copy

Generate your Ericson Insurance TPA E-card here.

Hospitalization Documents

Collect the following documents from the hospital:

  • Payment receipts
  • Discharge summary
  • Package breakup
  • Hospital bill breakup

Submit these documents with your claim form. However, ensure that you consider the following things:

  • The hospital bills and package breakup have to be on the hospital letterhead or with the hospital deal on it.
  • The payment receipts have to match up with the total hospital bill. Include the original bills in your claim.
  • In case of pre and/or post-hospitalization expenses claim, submit a copy of the discharge summary. No need to include the hospital bill or the bill breakup.
  • Consider the eligible duration for pre and post-hospitalization charges claim.
  • All the pre and post-hospitalization expenses such as pharmacy, consultation, lab bills have to be submitted in original backed by the doctor’s prescriptions. Otherwise, Ericson Insurance TPA may reject the claim for those expenses.

Investigation Reports

Original investigation reports need to be submitted to Ericson Insurance TPA. Reports on plain paper with the lab/hospital stamp may not be accepted.

If you do not have all the reports, you can still go ahead and submit your claim with the documents you have. But ensure that you write a cover note with a date-wise list of reports that are missing in the claim. By doing so, you’ll have time to get hold of the documents and by the time Ericson Insurance TPA raises a query and asks you the submit the remaining reports, you’ll have them ready.

If you could not get the missing documents in time, the amount of those expenses will be deducted from the total claim amount.

If you are claiming for pre and post-hospitalization expenses, ensure that your investigation reports and bills are supported by the doctor’s prescriptions on the official letterhead.

Accident Details, if Applicable

For accident-related claims the following documents are required:

  • Medico-legal Certificate (MLC) from the hospital
  • FIR copy if the incident was reported to the police.

If the accident is self-injury, write a letter giving details of the accident ruling out the case of self-harm.

Ericson Insurance TPA Claim Form

Submit the claim form along with the documents mentioned above.

Download Ericson Insurance TPA Claim Form

How to Fill Ericson Insurance TPA Claim Form

The claim form comprises 8 sections. Let’s understand what information needs to go in which section:

Section A

Fill the first section with insurance and the contact details of the primary policyholder. Ensure that the information is correct. The information will be used to contact the policyholder.

Section B

Fill this section with information whether the patient has any other insurance policy.

Section C

Fill the patient’s details such as gender, age, occupation, and the relationship with the primary policyholder.

Section D

Fill the hospitalization details such as the reason for hospitalization, room type, admission and discharge dates, etc.

Section E

Fill the billing details in 3 segments: Pre-hospitalization, hospitalization and post-hospitalization. Enter the amount of total charges such as ambulance charges in the separate field provided. Lastly, add up all the expenses of each segment and enter the final total in the field provided.

Section F

Fill the list of all the bills. The form provides space for listing only 10 bills. You can write the rest of them (if more than 10 bills) on a plain paper and attach it to the form.

Enter the total bill amount after deducting the pharmacy expenses. There is a separate field provided to enter the pharmacy costs.

Section G

Fill the policyholder’s account details. Ensure that it is correct and exactly how it appears on the bank account. Correct information will ensure successful NEFT transaction.

Section H

Sign the declaration with the date and place in this section.

A Zero Error Claim Needs an Expert Touch.

Ericson Insurance TPA Claim Submission Timeline

Mostly, the submission timelines are 15-30 days after the patient’s discharge. Make sure you file your claim before the deadline.

If you have a valid reason for submitting late, include a letter explaining the reason in your claim. If Ericson Insurance TPA is convinced, they’ll process the claim; otherwise, it will be rejected.

In case you don’t have all the documents to file a claim, file it anyways with whatever documents you have. But make sure you include a cover note with a list of documents that are missing in the claim. You’ll have 2 benefits by doing this – you’ll file your claim on time and you’ll also get more time to procure the remaining documents.

Claim Submission Address

Send your claim form along with the required documents at your city address mentioned here.

Corporate insurance policyholders can submit their claim form to the visiting Ericson Insurance TPA representative.

Keep your courier, post office slip or acknowledgement safe until your claim is approved. In the meantime, track Ericson Insurance TPA claim status frequently to keep yourself updated.

Most claimants make mistakes while filling their claim form. And that can cause reduced or delayed payouts. Worst can be the claim rejection.

Frequently Asked Questions

To intimate Ericson TPA regarding the claim, visit this link and fill the form.

Ericson TPA usually approves the claim within 3 to 4 weeks. However, on failing to submit all the documents, the process may get delayed. So, ensure that you submit the originals on time. Right after the TPA approves your claim, it sends the insurance company your profile. The insurance company then transfers the settlement amount in your bank account within 2 to 3 weeks.

The claim should be submitted with Ericson TPA. However, the policyholder can submit the claim with the insurance company too.

  • A copy of Ericson TPA card
  • A copy of your policy certificate
  • Doctor’s prescription or a letter advising hospitalisation
  • Investigation reports

To check your Ericson TPA claim status, please click here.

No. You must only fill the Ericson TPA claim form which is the equivalent of IRDA claim form part A.

You must submit a claim within 7 days of the discharge date. However, you can submit the supporting medical documents within 15 days of the discharge date.

You can file a claim to recover your pre and post-hospitalisation expenses through reimbursement. Charges related to the treatment incurred 30 days before the treatment and 60 days after the treatment are covered.

When you’ve opted for cashless treatment at a network hospital, you must leave the original bills, discharge summary, investigation report, and correctly filled claim form with the hospital. However, make sure that you collect the signed copies of these documents and keep them with you for future reference.

The copy of the medical records and bills are required in case you file a post-hospitalisation reimbursement claim.

Yes, you can. 30 days pre-hospitalisation and 60 days post-hospitalisation expenses are covered. So, you can claim your pre-hospitalisation expenses with the claim for hositalisation expenses, and claim your post-hospitalisation expenses separately.

The member can lodge a grievance at the TPA cell. The insurance company appoints these cells at their regional offices.

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