The Ultimate Guide to Genins India TPA Health
Insurance Claim Process

Founded in 1996, Genins India Insurance TPA’s main objective was to increase health insurance along with effective health care management.

It is one of the pioneers in the field since 2002 when they started TPA operations much before the norms were promulgated by the IRDA. Genins India TPA also provides pre-insurance health check-up and implementation of end-to-end RSBY project on behalf of various insurance companies.

Genins India Cashless Claim Process

  • Visit any of the network hospital and produce Genins India TPAcard.
  • The network hospital will send the request toGenins India TPA for authorization.
  • Your treatment will commence after authorization from Genins, in case of planned hospitalization.
  • You should get the authorization 7 days prior to hospitalization in case of planned admission. But, in case of emergency, you can obtain the authorization within 24 hours of hospitalization.
  • The hospital will not charge you for any expenses except the non-payable items, standard deductible, co-payment and any other expense specified in the approval letter as per the terms & conditions of your policy.
  • Before discharge, you should check the final bill and discharge summary. Correctly fill up the insurance form and sign all the documents.
Make sure you check the network hospital list before hospitalisation. Please click here to find your nearest network hospital.

Genins India Reimbursement Claim Process

  • Intimate Genins India within 24 hours of hospitalization through letter, fax or mail.
  • Visit its website and download the claim form.
  • Pay the total expenses directly to the hospital.
  • Submit the claim for the reimbursement after discharge.
  • Submit a complete set of claim documents to Genins India Insurance TPA Ltd. within 15 days of discharge.

Documents Required for Genins India Insurance Claim

There are typically 4 different types of documents required while submitting your claim. The types of documents may differ and may depend on the type of claim.

KYC Documents

Know Your Customer (KYC) is essential to verify policyholder’s identity. These documents may include:

  • Patient’s Aadhaar card copy
  • Policyholder’s PAN cardcopy (in absence of PAN card, any government-issued ID proof can work instead)
  • Genins India or the insurance policy certificate
  • Acancelled chequewith plan holder’s banking account details

Generate your Genins India TPA E-card here.

Hospitalization and Treatment Documents

Documents such as payment receipts,discharge summary, package breakup, hospital bill, hospital bill breakup, etc. given by the hospital have to be submitted along with the claim form. Only original documents printed on the hospital’s letterhead are accepted for claims. Consider these checkpoints while collecting the documents from the hospital:

You’ll be given a hospital bill which is a summary of all expenses. Ensure that you have the breakup of the bill.

  • If a surgery package has been added to your hospital bill, ask for the package breakup printed on the hospital’s letterhead. The breakup printed on plain paper with the hospital’s seal may work too.
  • Collect the receipts of all the payments you made to the hospital. Tally the receipt amounts with the final bill amount. Include them all in your claim.
  • For pre and post-hospitalization, the break of the bills or the bill itself is not needed. You just need to submit a photocopy of the discharge summary.
  • Remember to check the eligibility for the duration in case of pre and post-hospitalization. Also, include pharmacy, consultation, lab and consultation bills (all in original) in your claim.
  • Provide the doctor prescriptions (original) to support all your pre and post-hospitalization bills you are including in your claim. Otherwise, Genins India may not pay you for those expenses.

Investigation Reports

Reconcile your reports with the lab investigation reports and scans billed by the hospital. have all these reports have to be in original printed on the hospital’s and/or the lab’s letterhead. Genins India may not accept a print on a plain paper with hospital/lab seal.

Avoid missing out on any reports in your claim. Otherwise, Genins India may deduct the expenses incurred for those investigations during the processing of the claim. Or it may raise a query and ask you to submit the missing reports.

The best thing you could do if you don’t have some reports is to write a cover note enclosed with your claim. In the cover note, you may just list the reports you are not going to submit because you don’t have them.

For pre and post-hospitalization claims, all investigation/lab bills need to be supported with the investigation reports. And each of these reports needs to be supported by the doctor’s prescription that’s written/printed on their letterhead or on a lab requisition slip.

Accident Details, if Applicable

For accident-related claims, medico-legal Certificate (MLC) from the hospital and an FIR copy are needed.

In case of self-injury, a signed letter explaining the details of the injury needs to go along with the claim.

Genins India TPA Claim Form

Submit all the documents mentioned above along with the claim form. Download the Genins India TPA Claim Form for reimbursement here.

Download Genins India TPA Claim Form

How to Fill Genins India Claim Form

Genins India reimbursement claim form (Part A) is divided into eight sections. Let’s understand how to fill these sections:

Section A-C

Fill policyholder’s and patient’s insurance details in section A, B, and C. If your policy is a corporate health insurance, the corporate employee is the primary policyholder.

Section D

Fill this section with details of the treatment. The details include the type of treatment (injury or illness), hospital admission date, the date when the disease/illness was diagnosed, etc.

Section E-F

Fill the billing details in section E and F. The expenses are first categorized into 3 segments - Pre Hospitalization, Hospitalization, and Post Hospitalization.

Categorize all your bills in a sequence based on these segments. Calculate the bill amounts for each of these categories and then fill up these amounts in the form.

Other expenses like ambulance, daily lumpsum hospital cash, health check, etc. are entered in separate fields in the section.

Fill section F with the same billing information, minus the pharmacy expenses. There is a separate field for pharmacy costs in the section. A space to list down 10 bills is given. If there are more than 10 bills, list them down on a separate sheet and then attach it to the Genins India TPA claim form.

Section G-H

Fill the policyholder’s bank details in section G. Ensure the name and other banking details are exactly the same as they appear on the cheque book. Also, don’t forget to sign the declaration in section H.

Avoid common mistakes most claimants make while filling Genins India Claim, get expert help now!

Genins India Claim Submission Timeline

Most submission timelines fall between 15-30 days after the discharge of the patient. You need to submit your claimwithin the specified timeline. If you don’t, Genins India can reject your claim. Having said that, if you can justify your late submission, Genins India may process your claim.

If you have not received some of the documents and you have almost reached the timeline, submit the claim with whatever documents you have. There are two benefits of doing this –

  • You submit your claim on time
  • When Genins India processes your claim request and raises a query for the missing documents, you get more time to procure the documents.

Claim Submission Address

Send your claim documents at the address mentioned here.

Corporate employees can submit the claim form to the Genins India representative visiting their office.

Track your Genins India TPA claim status here.

Most claimants find the claim form confusing or they do not have enough information to fill up the form. So, they end up making mistakes in the form which can put them at risk of their claim getting rejected, reduced payouts or delayed payments.

Frequently Asked Questions

Visit this link to intimate Genins India about the claim. If the admission of the patient is pre-planned, Genins TPA must be intimated at least 3 to 4 days in advance. But if the hospitalisation isn’t planned, the TPA can be intimated within 24 hours of hospitalisation.

Genins India TPA takes at least 3 to 4 weeks to approve the claim. But this is only possible when you have submitted all the required original documents to the TPA on time. Any delay in submitting the documents results in delay of claim settlement. As soon as Genins TPA approves the claim, it shares the settlement amount with the insurance company. You will receive the claim settlement amount in your bank account within 2 to 3 weeks after that.

The claim should always be filed with Genins TPA. The TPA verifies your document and analyzes the case before approving the claim. The insurance company only settles the claim amount with you.

Submit the pre-authorisation form to Genins TPA with these documents:

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

Check your Genins India TPA Ltd. claim status here.

Get your Genins TPA e-card here.

No; you need to fill only part A. Genins TPA claim form is the equivalent of part A of IRDA claim form.

You must submit Genins India TPA claim form within 7 days after the discharge. You can, however, submit the documents later. In any case, the documents must be submitted within 15 days of the discharge date. If you do not have all the documents, submit the ones you have. And by the time TPA raises a query, you can collect all your documents from the hospital and resolve the query with the supporting documents.

Prepare a correct claim for maximum claim benefits.

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