Ultimate Guide to HealthIndia TPA Claim Process

HealthIndia Insurance TPA Services Pvt. Ltd. was established in year 2002 and is licensed by IRDA. It offers administration programs and related outsourcing services to Insurance companies all across the country.

Their primary role is to coordinate with hospitals in terms of treatment being offered and pass the bills on your behalf to the insurance companies.

The content below is to advice you on how to fill the HealthIndia TPA claim form, the complete documentation, and other details required in the during the process.

HealthIndia TPA Cashless Claim Process

  • The insured shows their e-card at the network hospital for pre-authorization.
  • A pre-authorization request is sent to the TPA by the hospital to check your cashless eligibility.
  • TPA authorizes the cashless treatment of the insured/patient within 24 hours.
  • The member shows their government ID proof and avails cashless treatment at the network hospital.
For a cashless claim, the hospital you choose must be within TPA’s network. Click here to check if your chosen hospital is in the list of HealthIndia TPA network hospital list.

HealthIndia TPA Reimbursement Claim Process

  • The policyholder intimates the HealthIndia TPA about hospitalization 4 days prior to admission.
  • In case of emergency hospitalization, the policyholder intimates the TPA within 24 hours of admission.
  • They submit the medical documents and bills as per what’s specified in the policy certificate.
  • Then claim within 7-10 days after the discharge.

Documents Required for HealthIndia TPA Claim

Documents necessary to file a HealthIndia TPA claim are divided in 4 categories and their requirement varies from policy to policy.

KYC Documents

  • An Aadhar card copy of patient
  • A copy of PAN card of the main policyholder (Government ID proof can work too if PAN card isn’t available)
  • Policyholder’s original cancelled cheque
  • A copy of the HealthIndia TPA e-card or insurance certificate

Hospitalization Documents

  • Hospital Main Bill
  • Hospital Break-up Bill
  • Hospital Bill Payment Receipt
  • Hospital Discharge Summary
  • Pharmacy Bill
  • Operation Theater Notes
  • Doctor’s Prescriptions

Ensure that you add the breakup of surgery packages on the letterhead. A print on plain paper with hospital’s seal would work too.

Note: Check claim duration for pre and post hospitalization. Also, without a prescription, HealthIndia won’t pay you the claim amount.

Investigation Reports

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

In case the reports are missing, add a cover-note with the list of the ones missing. A query will be raised and by then, you will get enough time to ask for reports.

Note: Originals are mandatory. For pre and post hospitalization expenses, doctor’s prescription must back the reports.

Accident Details, if Applicable

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

HealthIndia TPA Claim Form

Attach the originals of the documents mentioned above with this form.

Download HealthIndia TPA Claim Form

How to Fill HealthIndia TPA Claim Form

Section A-C

Section A, B and C take the information of the primary policyholder and the patient. Employees are the policyholders in corporate insurances.

Section D

Details including admission date, discharge date, type or nature of treatment, the date of diagnosis, etc. go in section D.

Section E-F

Get the breakup of all the hospitalization documents and bills and fill the information in section E.

Separate fields are given for some expenses including health-check, daily hospital cash, ambulance, etc.

Pharmacy bill amount should be added separately in section F. There is a space for 10 bills in the form. Use them accordingly.

Section G-H

Section G would contain the bank details of the policyholder. Check if you’re filling the right name as per what is on the cheque.

Sign the declaration in section H.

Avoid the most common mistakes when filling HealthIndia
TPA claim form – Get Expert Help Now

Sign up

HealthIndia Submission Timeline

The submission timeline is different for various insurance TPAs. However, most TPA’s give you 15 to 30 days to submit the claim. If you think that you don’t have all the documents and you’re running out of time, then submit the claim with incomplete document. The TPA will raise a query and you can respond to it with the required documents. Ensure that you keep checking the HealthIndia Insurance claim status so that you can respond to the query within time.

Although delays result in claim rejection. But if you can justify the delay, your claim can get settled.

Claim Submission Address

Employees with corporate insurances must submit their claim in their office spaces to the HealthIndia Insurance’s representative. If not, submit the claim at the address mentioned here.

Keep the receipt of the claim submission with you until the claim is settled.

Frequently Asked Questions

You can send Health India TPA claim intimation using this link. If you have planned the hospitalisation, intimate the TPA at least 3 to 4 days prior to the hospitalisation. However, if the hospitalisation isn’t pre-planned, ensure that you intimate the TPA within 24 hours of the admission of the patient.

Usually, if all the documents are in place and completed properly, Health India TPA approves the claim within 3 to 4 weeks. And once the claim is approved, the insurance company receives the details. And in a period of 2 to 4 weeks after that, the settlement amount is transferred to your account.

The claim should be filed with Health India TPA. The TPA checks how valid your claim is. And once the documents are verified and the claim settlement amount calculated, the complete information is sent to the insurance company which then settles the amount.

Here are the documents that you must submit:

  • A copy of Health India TPA card
  • Policy certificate copy
  • Doctor’s prescription advising on hospitalisation
  • Investigation reports

You can check Health India TPA claim status by clicking here.

Health India TPA claim form is the same as the IRDA claim form part A. And part B need not be filled.

While the claim form must be submitted within 7 days after the discharge, you can submit the medical documents required by Health India TPA within 15 days of the discharge. However, if you still haven’t been able to collect all the original documents, submit the ones available. The TPA will then raise a query about the missing documents. This way you will get some buffer time that you can use to collect the documents. Once you have the remaining documents as well, resolve the queries by submitting them to the TPA.

Filling the claim form and submitting the claim can get complicated because of the technical jargons.

We're Here to Help

Get 360 degree claim assistance from our in-house claim experts.