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.
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 – http://18.104.22.168/HeritageWeb/Home/ECard_Request
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.
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.
- 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.