Raksha TPA is one of the leading Health Insurance third party administrators (TPA) in the Indian insurance industry. It has a wide network of hospitals as part of its cashless network.
However, when a policyholder does not get a cashless facility, they have an option to claim their treatment expenses through reimbursement claim.
At SureClaim, we have provided a solution to many policyholders and resolved their claim related issues. In this article, we will discuss in detail various aspects of Raksha TPA reimbursement claim process. We’ll take these topics one by one in this guide.
Know Your Customer (KYC) verifies and establishes the identity of the policyholder. Submit these KYC documents:
- Patient’s Aadhaar card copy
- Policyholder’s PAN card copy (or government ID proof)
- Raksha TPA card or policy certificate
- An original cancelled cheque of the policyholder’s bank account
Generate your Raksha TPA E-card using this link - https://www.Rakshatpa.com/WebPortal/Login/Anonymous/ECard.
Hospitalization & Treatment Documents
The original documents (printed on the hospital’s letterhead) such as discharge summary, payment receipts, hospital bill, package breakup, bill breakup, etc. issued by the hospital have to be submitted along with the claim form. Consider these checkpoints while gathering the documents from the hospital for the claim.
- The hospital bill is usually a summary of all expenses incurred during hospitalization. Ask the hospital to give you a breakup of the bill.
- If a surgery package reflects in your hospital bill, ask for the package break up on the hospital’s letterhead or with the hospital’s seal on it.
- Ask for receipts for the payments you made to the hospital. Tally the receipt amounts with the final hospital bill amount.
- For pre and post-hospitalization claims, all you need is a photocopy of the discharge summary. The hospital bill or its breakup is not needed.
- Check the policy document for duration eligibility in case of pre and post-hospitalization. Include original pharmacy, lab, and consultation bills in your claim.
- The doctor’s prescriptions have to be submitted in original to support all your pre and post-hospitalization bills. Otherwise, Raksha TPA may reject your pre and post-hospitalization claims.
Carefully examine the lab investigations that the hospital has billed you. Then reconcile them with your reports. All the reports have to be in original printed on the hospital’s letterhead or the lab’s letterhead. Raksha TPA may not accept the reports printed on a plain paper with the seal of hospital/lab on it. If you don’t have some reports, the best thing to do is write a cover note with a date-wise list of reports you are not going to submit. Raksha TPA may deduct the amount billed for the investigations from the claim amount. Or, it may raise a query to intimate you to submit the missing reports.
For pre and post-hospitalization claims:
- Submit investigation/lab bills with the investigation reports.
- Support the investigation reports with the doctor’s prescription that’s written/printed on their letterhead/lab requisition slip.
Accident Details, if Applicable
A medico-legal Certificate (MLC) from the hospital and an FIR copy (if reported to police) are needed. If the accident is self-injury, a letter needs to be drafted explaining the details of the injury. This letter has to be signed by the patient.