Ultimate Guide to FHPL TPA Health Insurance Claim Process

FHPL was established in 1995 and received its license from IRDA in 2002. The company caters to the needs of policyholders from the private and public sectors.

FHPL has a qualified workforce of hundred doctors and experienced management professionals spread across 40 branch offices. Today, FHPL is a leading company in the insurance sector with 33 million members.

A health insurance claim can be a tricky process. In this article, we have tried to simplify the FHPL reimbursement claim process for you.

FHPL TPA Cashless Claim Process

  • Produce the FHPL ID and a valid photo ID card at the billing department of the network hospital
  • The hospital will initiate the cashless request with the FHPL TPA
  • The FHPL TPA will issue the authorization letter according to the policy terms
  • Authorization for cashless benefits is issued after the verification of the documents and the conditions of the policy
  • The insured needs to sign on the final bill at the time of discharge

To get the benefit of cashless treatment, click here to check the list of FHPL network hospital list prior to hospitalization.

FHPL TPA Reimbursement Claim Process

  • It is mandatory to send claim intimation within 24 hours of hospitalization in case of reimbursement claims. For intimation, the insured can call their toll free number or send an e-mail at intimation@fhpl.net.
  • Submit the original medical documents and itemized bills to the insurance company

Documents Required for FHPL Insurance Claim

KYC Documents

KYC simply stands for Know Your Customer. The KYC documents are essential to establish the identity of the policyholder and the patient. You need to submit these KYC documents:

  • Aadhaar card copy of the patient
  • PAN card copy of the primary policyholder or a valid government ID proof
  • FHPL card or the policy certificate
  • Original cancelled cheque of primary policyholder’s bank account

To generate your FHPL TPA E-card, click on this link https://www.fhpl.net/FhplLogins/Ecard/Login.aspx?Type=ecard.

Hospitalization & Treatment Documents

Collect the following documents from the hospital:

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

Consider the following things:

  • If the hospital bill is the summary of the expenses, ask the hospital to give the breakup of the bill. If a surgery package reflects in your hospital bill, ask the hospital for the breakup of that too. Ensure that all the bills are on the hospital letterhead or have the hospital’s seal on it.
  • The total payment receipt amount has to tally with the total hospital bill. You’ll need to submit these bills in original.
  • In case of pre and/or post-hospitalization expenses claim, a discharge summary is enough. The hospital bill or the bill breakup is not needed.
  • Consider the eligible duration specified in the policy document for claiming pre and post-hospitalization charges.
  • The pre and post-hospitalization expenses such as consultation, pharmacy, and lab bills are to be submitted in original supported by the doctor’s prescriptions. If not, FHPL may reject your claim for those expenses.

Investigation Reports

The investigation reports in original have to be submitted to FHPL insurance TPA. The report on plain paper with hospital/lab seal on it may get rejected.

If some of the reports are missing, go ahead and submit the claim with whatever documents you have. However, ensure that you write a cover note mentioning a date-wise list of the missing reports. When FHPL processes your claim, they may raise a query asking you to submit the missing report or else they may deduct the amount of those expenses from the total claim amount.

In case of pre and post-hospitalization expenses, your investigation reports and bills need to be supported by the doctor’s prescriptions on the official letterhead.

Accident Details, if Applicable

For accident-related claims, you’ll have to submit:

  • A medico-legal certificate (MLC) from the hospital
  • FIR copy (if FIR was lodged)

If the accident is a case of self-injury, you must submit a letter signed by the patient explaining the incident in detail.

Family Health Plan Insurance TPA Claim Form

You need to download the FHPL claim form and submit it along with the documents mentioned above.

Download the FHPL TPA Claim Form

How to Fill FHPL TPA Claim Form

FHPL reimbursement claim form requires various sets of information which are categorized under eight sections in the form. Read on to understand what type of information needs to be filled in each of these sections.

Section A

This is the first section in the form. Insurance and contact details of the main/primary policyholder need to be entered here. The primary policyholder is the proposer in the policy or the person who pays the premium and in the case of a corporate mediclaim policy, the employee is a primary policyholder. Remember that FHPL will use the contact information filled in this section to contact the claimant, so fill the contact details accordingly.

Section B

While you are applying for a claim to FHPL, if the patient is covered under any other insurance policy, it needs to be mentioned in section B of the form.

Section C

Patient’s demographic details such as gender, age, occupation and their relationship with primary policyholder have to be mentioned in this section.

Section D

Hospitalization details of the patient are captured in this section. This includes hospital where the patient was admitted, which room category was chosen, the reason for hospitalization (pick one from illness, injury or maternity), admission and discharge dates and in case of injuries or accidents, a few more details pertaining to police FIR or medico-legal certificate from the hospital.

Section E

Summary total of bills needs to be filled in this section. All bills related to the hospital stay, including hospital main bill, any pharmacy bills when medicines purchased from the outside pharmacy, diagnostic bills, blood bank charges, etc. have to be added and mentioned as Hospitalization expenses. Total of all the bills prior to admission will come under Pre-Hospitalization expenses and a total of all bills after discharge from hospital is considered as Post-Hospitalization expenses. Any separate ambulance charges need to be filled in the field provided. Mention the total of all these categories in the field provided.

Section F

The complete list of all bills needs to be mentioned in this section. If the number of bills exceeds 10, then use a separate page to list down the bill details. As in section E, do a total of bills and mention on the right-hand side field, but take out pharmacy bills out of these 3 categories and mention the total separately in the 4th row.

Section G

FHPL will settle the payment in the bank account of the primary policyholder, i.e. the proposer in the policy or the employee in corporate policy. For claims above one lakh rupee, mention PAN number of a primary policyholder. But we advise that it is a good practice to mention PAN whatever be the claim amount because the insurance company can raise a query for PAN number even when the claim amount is less than one lakh.

‘Cheque / DD payable details’ is nothing but the name of account-holder as per bank records. This ensures smooth NEFT transfer into the bank account.

Section H

The last section in the FHPL claim form requires the signature of claimant and date and place.

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FHPL Insurance TPA Claim Submission Timeline

For most insurance TPAs, the submission timelines are 15-30 days after the patient is discharged. If you don’t submit the claim within the specified timeline, FHPL may reject your claim. However, if you have a valid reason for the delay, the TPA may proceed with the settlement of your claim.

If you are close to the timeline but don’t have all the documents needed, submit the claim without those documents. But, do write a cover-note listing the documents that are missing in the claim. By doing so, you’ll be filing the claim on time and when the TPA raises a query for the missing documents, you’ll get more time to procure them.

Claim Submission Address

Send your claim form along with the required documents at the address mentioned here. Corporate health insurance policyholders can submit their claim form at their office to the visiting FHPL insurance TPA representative. Keep your courier, post office acknowledgement slip safe until your claim is settled. You can track FHPL Insurance TPA claim status frequently to keep yourself updated.

Frequently Asked Questions

You can intimate FHPL TPA using this link https://fhpl.net/Main/ClaimIntimation Or, you can send FHPL TPA a claim intimation email at intimation@fhpl.net

You can submit the FHPL grievance form and report a grievance by following this link.

The claim should be filed with FHPL TPA. The TPA checks all your documents, verifies the claim, sets FHPL claim status, and approves the claim. Once the claim is approved, it shares the claim information and the settlement amount with the insurance company which then transfers this amount to the policyholder’s bank account.

Usually, FHPL takes 3 to 4 weeks to approve the claim. But this TAT is only applicable if you have submitted all the required medical documents on time. If the TPA raises a query, the approval takes longer than usual.

Once the claim is approved, the insurance company takes another 3 to 6 weeks to settle the claim amount.

No. You just need to fill part A of the IRDA claim form which is the same as the FHPL claim form.

Here are the documents that you must submit for pre-authorisation:

  • A copy of FHPL TPA card
  • A copy of policy certificate
  • Doctor’s prescription or advice on hospitalisation
  • Investigation reports

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