The Complete Guide to Good Health TPA
Health Insurance Claim Process

One of the largest TPAs in India licensed by Insurance Regulatory and Development Authority, Good Health Insurance TPA Limited covers over 4.5 Lakh lives. The company offers its services to individuals as well as to corporate clients in sectors including Pharmaceuticals, Software, Research, Shipping, Education, Agri Chem., Housing, and other industrial groups.

This Good Health TPA claim guide explains the claim process with detailed information on filling the claim form, submitting necessary documents, and other claim intricacies.

Good Health TPA Claim Process - Cashless

Here’s how you can opt for a cashless claim at a Good Health TPA network hospital:

  • Go through the Good Health TPA network hospital list and opt for a treatment at one of the hospitals in the list.
  • Present your ID proof and Good Health TPA e-card for preauthorization at the hospital. On authorization from the insurance company, the hospital receives a pre-authorization letter.
  • Pay for the deductibles, if any, as per the policy.

Once you complete the formalities on your end, the hospital will send the treatment documents after the discharge as a proof to the TPA. After verification, Good Health Insurance TPA will pay the treatment expenses directly to the hospital.

Good Health TPA Claim Process – Reimbursement

Follow these steps to submit a claim through the reimbursement claim process:

  • Intimate Good Health Insurance TPA that you’re going to file a claim. The intimation must be sent to the TPA at least 3-4 days before admission of the patient in the hospital. If its an emergency hospitalization, then you must inform the TPA within 24 of admission.
  • Fill Good Health TPA reimbursement claim form and attach all the original medical documents listed in the sections below with the form.
  • Send Good Health TPA claim form to the TPA centre within 7 days after the discharge.
  • Check claim status everyday till the claim gets settled to know if the TPA has raised a query.
  • Resolve the query by submitting the necessary documents, and on verification of every detail, the insurance company will reimburse your medical expenses covered in the policy.

Documents Required for Good Health TPA Claim

KYC Documents

  • Patient’s Aadhar card cop
  • Policyholder’s government ID proof copy or PAN card copy
  • Policyholder’s cancelled cheques (only original)
  • A copy of insurance of e-card

Hospitalization Documents

  • Discharge summary
  • Summary of total expenses/bill
  • Breakup of all expenses
  • Receipt of payment
  • Pharmacy bills
  • OT (Operation Theatre) notes
  • Doctor’s prescriptions
  • Bill break up of additional packages, if any, etc.

The originals of these documents must be submitted with the form. Only the bill breakup and additional package documents can be accepted on a plain paper with the hospital’s seal. For pre and post-hospitalization claim, enclose doctor’s prescription with the bills.

Investigation Reports

  • ECG Doctor’s request for an investigation
  • Investigation Reports (Including CT/ MRI / USG / HPE)

Note: Submitting original reports, i.e. on the hospital’s letterhead, is mandatory.

Accident Details, if Applicable

  • Medico Legal Certificate
  • FIR, if the accident was reported

Insurance companies do not pay for injuries caused in cases of self-harm. Hence, the patient needs to submit a self-attested letter explaining the incident in detail.

Good Health TPA Claim Form

The Good Health TPA claim form for reimbursement must be downloaded in addition to the documents mentioned above.

Download Good Health TPA Claim Form

How to Fill Good Health TPA Claim Form

Section A

The section A of the form is for the personal details of the policyholder, i.e., the person who pays the premium. In case of corporate policies, the employee is the policyholder.

The personal information that needs to be filled in this section includes the name, address and contact details of the policyholder.

Section B

Fill this section of the form only if the patient is covered under some other policy too. If not, you can leave out the section.

Section C

Patient’s demographic information including age, gender, occupation, and how they are related to the policyholder must be mentioned in this section of the form.

Section D

All the hospitalization details of the patient must go in this section. The information should include name of the hospital, room category, admission and discharge date, nature of injury or illness, and FIR and Medico-Legal certificate details depending on the reason of the injury.

Section E

Enter the summary total of the bills in section E. The total must consist of all the expenses during patient’s stay at the hospital including diagnosis, pharmacy, blood bank, etc. Fill the total expense incurred prior to admission in the ‘pre-hospitalization expenses’ section and the total expense after discharge in the ‘post-hospitalization expenses’ section. Additional expenses such as health check-up, ambulance, blood bank, etc. must be filled in the separate fields given in this section.

Section F

Mention the complete list of all the expenses in this section. There are fields for 10 bills in this section. However, if the number of expenses exceed 10, then you can use a separate page altogether to list extra expenses. Under the column ‘Towards’ list the total hospitalization expense in the first row, total pre-hospitalization expenses in the second row, total post-hospitalization expense in third, and pharmacy bill total in the 4th row.

Section G

Section G is for the bank details of the policyholder. Since the claim amount is sent to the account mentioned in this section, make sure you enter the information correctly as it is on the cheque or DD payable details. It is advised to enter PAN card details if the claim amount exceeds 1 Lakh.

Section H

The claimant needs to sign the declaration with the date and time in section H.

Avoid Deductions Because of Silly Mistakes While Filling the Form

Good Health TPA Submissions Timeline

There usually is a time period of 15 to 30 days after discharge that the policyholder gets to submit a claim. However, if any number of missing documents may cause a delay in submission, you must fill the form and attach the documents that you have. You can then wait for Good Health TPA to raise a query which you can respond to with the documents required, i.e. the documents that were missing earlier.

Note: If you’re submitting the form with incomplete documents, then do not forget to add a cover-note on top of the form with the list of all the missing documents.

To be sure that you didn’t miss any query raised by Good Health TPA, you must check the status of your claim every day. You can check the claim status by sending a text message at 56363. The body of the text should be – GOODHEALTH CLAIM Your Claim Number

Example - GOODHEALTH CLAIM 543210

Address for Claim Submission

Click this link to view addresses of all the Good Health TPA centres.

For corporate policies or insurances, the policyholders can submit their claim form and the documents to a Good Health representative who visits the office premises frequently.

Frequently Asked Questions

You can intimate Good Health TPA by clicking this link –

Ensure that you send the intimation at least 48 hours in advance. However, if that’s not possible because of emergency admission, intimate Good Health TPA within 6 to 12 hours of the admission.

For Good Health TPA card download, please click here.

To check the status of your claim at Good Health TPA, just send an SMS to 56363 in this format: GOODHEALTH CLAIMYour Claim No.

Example: GOODHEALTH CLAIM 123456

If you wish to raise a grievance request, send an SMS to 56363 in this format: GOODHEALTH GRIEVANCE Your Grievance message

Or, you can report grievance online using this link -

Good Health TPA usually takes 2 to 3 weeks to process a claim. But that is only possible if all your documents are complete and valid so that the TPA doesn’t raise any query. Once the claim is approved, the TPA communicates the settlement amount to the insurance company. The insurer then transfers the settlement amount to your bank account within 3-6 weeks.

No, you need not fill Good Health TPA claim form part B. Just fill the single Good Health TPA claim form which is an equivalent of the IRDA claim form part A.

Documents required for pre-authorisation:

  • A copy of Good health TPA card
  • A policy certificate copy
  • Doctor’s prescription or advice in writing on why hospitalisation is necessary
  • Investigation reports

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