Health Insurance TPA of India Ltd. is a joint venture of public sector Non-life insurance companies – National Insurance Co. Ltd, The Oriental Insurance Co. Ltd, The New India Assurance Co. Ltd, United India Insurance Co. Ltd and GIC of India.
It was incorporated on August 14, 2013 with two key objectives - to enhance customer experience and to bring in greater efficiency in health insurance claims processing. The company’s headquarters is in New Delhi and is planning to develop its branches in different cities in due course.
The TPA needs these documents to establish the identity of the patient and the policyholder.
- Patient’s Aadhar card copy
- A PAN card copy or some other govt. ID proof of the policyholder
- Policyholder’s original cancelled cheque
- Health Insurance TPA e-card copy or the insurance certificate copy
To generate your Health Insurance TPA E-card online, click here
- Hospital Main Bill
- Hospital Break-up Bill
- Hospital Discharge Summary
- Pharmacy Bill
- Hospital Bill Payment Receipt
- Doctor’s Prescriptions
- Operation Theater Notes
Additional Package breakup, if added in the bill, should be on network hospital’s letterhead. Just a plain paper and official seal can do too. For pre and post hospitalisation health Insurance claim, just the discharge papers with the doctor’s original prescription is required.
Submit the original lab investigation reports on the letterhead. A plain paper document with hospital’s seal will not be accepted by Health Insurance TPA. If the reports are missing from the claim, then:
- It will lead to deduction in the claim amount.
- A query in response to the claim will be raised.
In case the reports are actually missing, add a cover-note on top of the form with the list of reports not available. Also, in case of pre-hospitalization and post-hospitalization claim, add the doctor’s prescription to support the reports on a letterhead or a lab requisition slip.
Accident Details, if Applicable
- Medico Legal Certificate
- FIR (if you report the injury or accident)
The patient must also sign a detailed letter explaining the accident or injury to ensure that it isn’t the case of self-harm.