Policyholder’s Guide to MDIndia TPA Health Insurance Claim Process

MDIndia Healthcare Service (TPA) Pvt. Ltd. was formed in November 2000 as a licensed Third Party Administrator with the aim to provide the best administration services to insured clients. The company soon achieved success with its quality health and welfare administration services. Eventually, under the directives from the regulatory authorities, the company changed its name to MDIndia Health Insurance TPA private limited.

MDIndia TPA Cashless Claim Process

  • The policyholder needs to carry a photocopy of the current year’s policy, MD ID card, and a valid photo ID proof of the patient to the network hospital
  • The insured needs to approach the TPA counter at the network hospital and provide the MD ID
  • There will also be a request for Authorization Form which is to be duly filled and signed by the insured

To view the MDIndia hospital list, click here.

To check out the list of hospitals in your TPA network, please click here.

MDIndia TPA Reimbursement Claim Process

  • The insured intimates the TPA via E-mail, website or toll free number within 24 hours of hospitalisation.
  • All the original documents of the treatment are collected from the network hospital.
  • The insured submits all the original hospital documents along with the form to the TPA within 7 days after the discharge.
  • MDIndia Health Insurance TPA raises a query if they find any discrepancy in the documents.
  • Once the query is resolved by the insured, the insurance company credits the claim amount in the policyholder’s bank account.

Documents Required for MDIndia TPA

KYC Documents

To help MDIndia TPA establish your identity, here is the list of KYC documents you will need to submit:

  • An Aadhar card copy of patient
  • The policyholder’s valid government ID proof copy, PAN card preferred
  • MDIndia e-card copy
  • An original cheque from policyholder’s bank account
To get your MD India TPA e-card, visit this link.

Hospitalization Documents

Attach the hospitalization documents, printed on hospital’s official letterhead with the MDIndia online claim form. Documents the policyholder must submit include:

  • Original discharge summary
  • Original hospital bill with the hospital’s seal and signature
  • Detailed hospital bill with the entire break-up of the expenses
  • All original prescriptions
  • Medical bills
  • Cash receipts
  • Itemized receipts

Investigation Reports

Original investigation reports, on hospital’s letterhead, must be submitted to the MDIndia TPA. The reports include:

  • Test reports
  • Doctor’s request for an investigation

Accident Details, if Applicable

In an accident case, get Medico-legal certificate from the hospital and submit it to the TPA. If you have reported the accident, submit the copy of FIR as well.

If you opted for treatment in case of self-injury or self-harm, write a letter to the TPA explaining the accident. Sign it and submit it to the TPA.

MD India TPA Claim Form

Attach all the documents mentioned above with the MD India TPA claim form you can download here.

Download MD India TPA Claim Form

How to Fill MDIndia Claim Form

Section A

Fill personal information including name, age, address, etc. of the insured in section A.

Section B

If the patient has additional coverage, fill the details of that policy in this section.

Section C

In section C, fill the demographic details of the patient including age, occupation, gender, their relationship with the policyholder, etc.

Section D

Fill all the hospitalization details in section D. The information must include the name of the hospital, the category of the room chosen, type of the injury, date of hospital admission and discharge, FIR and Medico Legal certificate.

Section E

Enter the total amount of treatment expenses in this section. Fill the total pre and post hospitalization costs against the fields given in this section. Use separate fields as in the form to mention the additional charges including health checkups, ambulance charges, blood bank, etc.

Section F

List all the expenses in the correct order in the 10 spaces given in this section. If the number of your bills exceeds 10, then use extra space to list the bill amounts. Fill the total pre-hospitalization charges in first row, hospitalization charges in the second, post-hospital charges in the third row and the pharmacy charges in the fourth row.

Section G

Enter the policyholder’s bank account details in section G correctly as on the cheque. Mention the PAN card number as well if the claim amount is 1 Lakh or above.

Section H

The claimant must sign the declaration in section H.

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Submission Timelines

Usually the policyholder gets 15 to 30 days of time to file a claim. But many people end up with a rejected claim because of the delay in submission. So, if you do not have all the required documents, you can add a cover note on top of your claim form and a list of the documents missing. The insurance company will raise a query and by the time it does, you will have enough time at hand to get hold of the documents.

To ensure that you do not miss out on solving the query raised against your application, keep checking the status of your claim. To check the claim status, please click here.

Address for Claim Submission

The corporate policy holders can submit their claim forms in their office premises to an MDIndia representative.

Frequently Asked Questions

Visit this link to send MD India claim intimation.

The medical documents requested by the MD India TPA should be submitted within 7 days of the date of discharge.

The reimbursement claim process is completed by MD India TPA within 3 to 4 weeks. But that is only possible when you have submitted all the relevant documents on time. Once the documents are verified and the claim settled, the claim settlement amount is shared with the insurance company. The insurance company then transfers the settlement amount in your bank account in a period of 2 to 4 weeks.

You must submit the documents below to MD India TPA:

  • A copy of MD India TPA e-card
  • Policy certificate copy
  • Doctor’s prescription or a document with hospitalisation advice
  • Investigation reports

You can check your MD India claim status here.

You can get your MD India e-card by following this link.

MD India claim form is the equivalent of part A of the IRDA claim form. And, part B of the IRDA claim form needs not be filled when filing a claim with MD India TPA.

Usually there is a waiting period of 30 days before you can start claiming. However, this clause may vary depending on the type of the policy.

You can visit any registered hospital to get your treatment expenses reimbursed.

Yes. The Turn Around Time (TAT) for claiming pre-hospitalisation and post-hospitalisation charges is 30 days and 60 days.

A single mistake in the claim process can lead to deductions and even rejections.

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