Ultimate Guide to Heritage Health Insurance TPA Claim Process

Established in the year 1998, Heritage Health Insurance TPA Pvt. Ltd is a third-party administrator (TPA) which has business tie-ups with many Indian Insurance Companies. It also has a strategic alliance with American Assist Travel Services to help with settling Overseas Mediclaim Policies, issued by Indian Insurance Companies.

Read on for a simple and detailed explanation of Heritage Health Insurance’s reimbursement claim process which includes advice on complete documentation, assistance with filling the form and intricacies of claim submission.

Heritage TPA Cashless Claim Process

  • Show the Heritage card at the Network hospital.
  • Use the Pre-Authorisation Form to request for Cashless Claim through the network hospital.
  • After due verification of the request and subject to Policy terms, conditions & exceptions, Heritage issues an Authorisation Letter to the Network Hospital, thereby guaranteeing payment.
  • After discharge, the hospital has to submit all the required documents in original. The payment is released to the hospital directly by Heritage Health Insurance.
Before getting hospitalized, ensure that your hospital is one of the network hospitals. To check the list of network hospitals, please click here.

Heritage TPA Reimbursement Claim Process

  • Intimate Heritage Health immediately regarding the hospitalisation.
  • Submit the relevant treatment papers & bills as specified by Heritage.
  • Claim the treatment expenses incurred, within 7 days from discharge from the Hospital.

Documents Required for Heritage Health Insurance Claim

There are 4 categories that claim documents are divided into. Some categories may not apply depending on the type of your claim.

KYC Documents

KYC stands for Know Your Customer and KYC documents are required to verify and establish the identity of the policyholder and the patient. KYC documents include:

  • A copy of Aadhaar card of the patient
  • A copy of PAN card of the main policyholder (In case of unavailability of the PAN card, any other valid government ID proof may work)
  • Heritage Health card or the policy certificate
  • An original cancelled cheque of the bank account of the primary policyholder

Get your own Heritage Health TPA E-card using this link –

Hospitalization Documents

You must have all the original hospitalization documents on the hospital’s letterhead including hospital bills, discharge summary, breakup of bill, payment receipts, breakup of the complete package, etc. Here are a few things you must ensure while collecting all the documents from the hospital:

  • Hospital bills usually consist of the summary of expenses. So, get a bill breakup from the hospital.
  • Ask for the package breakup on the hospital’s letterhead if it was added to the bill. If the letterhead isn’t available, just the hospital’s seal would do.
  • Get payment receipts from the hospital to add in the claim. Ensure that the total receipt amount is equal to the amount in the bill.

In case of only pre-hospitalization and post-hospitalization claims, just the discharge summary would serve the purpose. So, you need not ask the hospital for bill breakups. Just attach the originals of your pharmacy, consultation, or lab bills with your Heritage Health claim form.

Note: Check if you are eligible as per the pre and post hospitalization duration specified in the policy. Also, add the doctor’s original prescriptions as a proof of pre and post hospitalization. Heritage Health Insurance will not pay in case they aren’t present.

Investigation Reports

Examine the lab investigations that the hospital has billed and reconcile them with your reports. Ensure that the reports are original, i.e., on the letterhead of the hospital. Reports on plain paper with the seal of the hospital will not be accepted by the Heritage Health Insurance. If you don’t have the reports, add a cover-note and a date-wise list of reports you will not be submitting.

If the reports are missing:
  • Amount billed for investigations will be deducted.
  • Heritage Health will raise a query asking you to add the reports.

In case of pre and post hospitalization, add the reports backed with the doctor’s prescription on the letterhead or on the lab requisition slip.

Accident Details, if Applicable

In case of accidents, you must submit the MLC, Medico-legal Certificate, from the hospital. Also, submit the FIR copy if the accident was reported.

In case of self -injury such as self-fall or injury while playing, submit a letter explaining the accident in detail, signed by the patient.

Heritage Health TPA Claim Form

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

Download Heritage Health TPA Claim Form

How to Fill Heritage Health Claim Form

There are 8 sections in Heritage Health claim form, which is also known as Part A form.

Section A-C

Fill the details of the primary policyholder as well as the patient in sections A, B, and C. In case of corporate insurance, the employee is the policy holder.

Section D

Section D would contain the details related to treatment including admission date, discharge date, date when the illness was diagnosed, the nature of the treatment, etc.

Section E-F

Sections E and F contain the billing details. You can put the expenses in 3 segments.

  • Pre-hospitalization – Expenses before the hospitalization
  • Hospitalization – Expenses during the stay at the hospital
  • Post-hospitalization – Expenses after the discharge

Based on the sequence of these segments above, list your bills. Calculate the expenses individually for these segments and fill them in the form. To claim the expenses of ambulance, daily hospital cash, health-check, etc. if specified in your policy terms, fill the amounts in the separate field given in the form.

In section F, the same information will be filled a little differently. Remove the pharmacy bills from the total amount and fill them separately in this section. The form has space for 10 bill details. Use these to fill the expenses during hospitalization as well as pre-hospitalization and post-hospitalization expenses.

Section G-H

Section G contains the bank details of the primary policyholder. Ensure that you fill the exact name of the account holder as on the cheque or DD payable details.

In section H, sign the declaration.

Avoid the most common mistakes while filling Heritage TPA claim form – Let a Claim Expert Prepare Your Claim

Heritage Health Claim Submission Timeline

Although the submission timeline is different for different insurance TPAs, there is normally a 15-30 day time period that you get to submit your claim to Heritage Health Insurance. Any delay will lead to the rejection of the claim. However, if you can justify the reason of the delay, your claim can get settled.

If you do not have all the necessary documents and think that there will be a delay waiting for the documents, submit the claim form with all the documents you have within 30 days of the discharge. Afterward, Heritage Health Insurance TPA will then raise a query which will give you some time to submit the additional documents.

Claim Submission Address

Corporate employees can submit the claim form in their office to the Heritage Health representative. Otherwise, here’s the link to the addresses of Heritage Health’s TPA centres in various cities.

Do not lose the receipt of post office or courier slip until your claim gets approved. Also, choose the courier service that allows you to track delivery online. Once the form reaches the Heritage Health Insurance office, you will receive a message with the tracking link where you can check the status of your claim.

Claimants often make mistakes while filling the claim forms. And this can lead to delays in payment, deductions, and even the rejection of the claim.

Frequently Asked Questions

Heritage TPA must be intimated 3 to 4 days before the hospitalization if it is planned. However, in case of emergency hospitalization, the TPA must be intimated within 24 hours of hospitalization. To get the Heritage TPA claim intimation form, click here.

You can also call the customer care to intimate the TPA.

Usually, the reimbursement claim process is 2-3 weeks long after the claim submission. Once all your documents are verified and your claim is verified, the Heritage TPA intimates the insurance company about the approval and shares the settlement figure. Afterward, it takes another 2-4 weeks for the insurance company to credit the settlement amount in your bank account.

But the process can get longer if Heritage TPA raises a query and asks for some additional information or documents. If you resolve queries within time, the process may take 4-8 weeks to complete.

Policyholders usually claim pre and post hospitalization charges separately when they have opted for cashless treatment during hospitalization. To recover the pre and post hospitalization expenses, the insured must submit all the necessary documents as specified by Heritage TPA along with the duly filled claim form. Once all the documents and the form is verified, the TPA credits the settlement amount in the policyholder’s bank account.

The documents that should be attached with Heritage TPA pre-authorization form are:

  • Heritage card photocopy
  • A copy of policy certificate
  • Admission advice/first prescription
  • Investigation reports or any other document required by Heritage TPA

A grievance is usually lodged when the insured has submitted incomplete documents, has failed to intimate the insurance company, or in case of delays.

However, the claim denial can be reversed if you lodge a grievance and justify your reasons. If the Heritage TPA finds your reasons valid, it may settle your claim amount. To lodge a grievance, you can send an email at tpa-grievance@bajoria.in or fill the grievance form using this link.

As per Heritage TPA, there usually is a period of 7 days after the discharge that the policyholders need to submit the claim within. But the most time-consuming process is getting hold of every document related to the treatment. And due to various personal and professional responsibilities, policyholders often fail to submit the claim on time.

In that case, you must submit all the documents that you have handy and add a cover note on top of the claim application with a list of documents that aren’t attached with the form. By the time Heritage TPA raises a query for missing documents, you will get some buffer time to go to the hospital and collect all the documents.

But if you completely fail to submit the claim before the deadline, you must still submit the claim with a letter explaining the delay. If Heritage TPA finds that your reason for the delay is valid, it may accept your application.

Visit this link and fill in the policy details accurately to check your Heritage TPA claim status.

You can get the Heritage Health E-card by clicking here.

Heritage TPA has only a single page reimbursement claim form which is exactly the same as the IRDA claim form part A.

Make the claim process completely hassle-free.

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