Guide to Vidal Health Insurance TPA Claim Process

Vidal Health is a third party administrator (TPA) in Indian insurance industry. Vidal handles accounts of some of the leading corporate groups and provides its services to leading general and health insurance companies. We will explain reimbursement claim process of Vidal in this article, to help you understand how to fill Vidal claim form and which documents need to be attached with the claim for a successful claim experience.

Vidal Health TPA Cashless Claim Process

Planned hospitalization:

  • Fill the pre-authorization form after showing the Vidal Health Card
  • Submit the pre-authorization form, at least 4 days in advance at the branch office
  • Sign all the relevant documents along with the duly filled and signed claim form and submit them at the time of discharge
  • In case your claim is rejected, then you need to pay the bills upfront and later submit the claim form and the original documents at the branch office of Vidal Health Insurance TPA Pvt. Ltd. for reimbursement

Emergency hospitalization:

  • Get admitted at a network hospital
  • Intimate Vidal Health Insurance TPA within 24 hours
  • If the hospitalization is authorized, then you need to pay for non-medical expenses and sign all the relevant documents before getting discharged
  • If the hospitalization claim is rejected, the treatment can still be continued
  • At discharge, pay the medical bills and then submit the Vidal Health TPA claim form along with original documents for reimbursement

Get hospitalized at one of Vidal Health TPA’s network hospital. To check the list of network hospitals, please click here.

Vidal Health TPA Reimbursement Claim Process

  • Intimate Vidal Health TPA regarding hospitalization
  • Collect all the required documents
  • Fill the forms and sign them and submit the claim

Documents Required for Vidal Health Insurance Claim

KYC Documents

KYC or Know Your Customer documents are required to verify the identity of the policyholder and the patient. The KYC documents needed are as follows:

  • Aadhaar card copy of the patient
  • A PAN card copy of the main policyholder (or a valid government ID proof)
  • Vidal Health TPA card or the policy document/certificate
  • A cancelled cheque (original) of the primary policyholder’s bank account

Get your own Vidal Health TPA E-card using this link -

Hospitalization Documents

Your hospitalization documents such as hospital bills, breakup of the bill, breakup of the complete package, discharge summary, etc., have to be original and on the hospital’s letterhead. While collecting your documents from the hospital, consider these things:

  • Hospital bills are usually just a summary of expenses. So, don’t forget to ask for a breakup of bills.
  • If a package was included in the hospital bill, get the package breakup on the hospital’s letterhead or a paper that has the hospital seal on it.
  • Get all the payment receipts from the hospital. You’ll need them to add in the claim. Make sure that the total of all the payment receipts is equal to the total amount on the hospital bill.
  • If you are claiming pre-hospitalization and post-hospitalization expenses, a discharge summary is enough. You don’t need to ask the hospital for the bill breakup. Attach the original pharmacy, lab and consultation bills along with your Vidal Health TPA claim form.

Note: Make sure you check the duration eligibility for claiming pre and post hospitalization expenses specified in the policy. Ensure that you attach the doctor’s original prescriptions. These prescriptions serve as proof of the pre and post hospitalization charges. If you don’t attach them in the claim form, Vidal Health TPA may not pay you for those expenses.

Investigation Reports

It is necessary to reconcile your lab investigations that the hospital has billed with your reports. The reports have to original and on the hospital’s letterhead; otherwise, they may not be accepted by Vidal Health TPA. If you don’t have the reports while claiming, ensure that you write a cover note with a date-wise list of reports missing in your claim. This can have two outcomes ¬– Vidal Health TPA may:

  • Deduct the amount billed for those investigations from your claim amount
  • Vidal Health TPA may raise a query asking you to submit the missing reports

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

Accident Details, if Applicable

For accident-related claims, a Medico-legal Certificate from the hospital has to be submitted along with an FIR copy if the accident was reported to the police.

In case of self-injury, a letter explaining the accident in detail, signed by the patient has to be submitted to the TPA.

Vidal Health Insurance TPA Claim Form

The above mentioned documents need to accompany with a Vidal Health TPA claim form.

Download Vidal Health TPA Claim Form

How to Fill Vidal Health Insurance TPA Claim Form

Once you have got the Claim Form Part A, next step is to fill it up based on the information available with you. There are eight sections in the claim form.

Section A

In this section, details of primary or the main policyholder need to be added. Primary policyholder is the one in whose name the policy has been registered (the person who pays the annual premium). In case of corporate policies, employee is the primary policyholder. The contact information entered in this section is used by Vidal to contact the claimant, so make sure you entered valid information here.

Section B

When the patient has got more than one policy, then mention the details of any other one policy held by patient. Mark ‘No’ if there are no other policies covering the patient.

Section C

Patient’s details have to be entered in this section. Provide their name, gender, age, occupation and relationship with primary policyholder.

Section D

This is the section where hospitalization details are captured. Hospital name, bed category, reason for hospitalization, admission and discharge dates etc. are to be filled here. If the patient had an accident, then there are further fields that need to be filled.

Section E

Summary total of bills have to be filled in this section. All expenses between date and time of admission till discharge are counted as Hospitalization expenses. Any expense before date and time of admission is considered as pre hospitalization expense. Same way, all expenses after discharge are considered as post hospitalization expenses.

If there were ambulance charges, those have to be mentioned in a separate field. Total up all the expenses and mention against ‘Total’.

Section F

Give a list of all your claimable bills in section F. If the number of such bills is more than 10, please use a different page to make the whole list and attach with claim form. Give a summary of hospitalization and pre & post hospitalization expenses on the right-hand side table. Do not add any pharmacy bills in any of the 3 fields, rather enter that total in the fourth field ‘Pharmacy Bills’. Below these, add a total of all expenses you are claiming from Vidal.

Section G

Bank details of primary policyholder needs to be mentioned in section G. PAN has to be mentioned where claim amount is more than one lakh. The field ‘Cheque / DD Payable details’ is nothing but exact name of the account holder in bank records. This ensures the NEFT payment to account goes through seamlessly.

Remember to attach original cancelled cheque of primary policyholder’s bank account. The cheque should carry the name of account holder. If the cheque leaf doesn’t carry their name, then get a copy of bank account statement or passbook and have it sealed and signed by your bank. Use this as proof for account information.

Section H

The claimant needs to sign this form in Section H.

Avoid making mistakes while filling Vidal Health TPA claim form

Vidal Health TPA Claim Submission Timeline

Different insurance TPAs have different submission timelines, but they typically fall between 15 to 30 days after you get discharged from the hospital. If you claim reaches late, it may get rejected. However, if you have a valid reason for the delay, your claim can get settled.

If you are close to the submission deadline and don’t have all the documents as yet, submit the claim with whatever documents you have. When your claim is processed, Vidal Health TPA will raise a query regarding the missing documents and this will give you more time to procure the missing documents.

Claim Submission Address

If you have a corporate insurance plan, you can directly submit the claim form in your office to a Vidal Health TPA’s representative. For others, check this link for addresses where you can submit the claim form.

Once you sent the claim form, keep the courier acknowledgement or post office slip until your claims get settled. If possible, choose a courier service as it allows you to track the package in real-time. Once Vidal Health TPA receives your claim form, you will get a message with a link that allows you to track the claim status.

Most claimants make mistakes while filling the claim form. These mistakes can lead to reduced and delayed payments or even claim rejection.

Frequently Asked Questions

Vidal Health TPA can be intimated using this link.

The claim is usually approved within 21 working days if all the necessary supporting documents are submitted on time. Once the claim is approved, the insurance company takes 7-10 working days to process the payment.

For planned hospitalisation, a pre-authorisation request must be sent 48 hours before the hospitalisation.

For emergency hospitalisation, the pre-authorisation request must be sent within 6 hours of the admission.

Documents required for pre-authorisation:

  • A copy of Vidal health TPA card
  • A copy of policy certificate
  • Doctor’s prescription supporting the need for hospitalisation
  • Investigation reports

Visit the website and log into your account to check Vidal Health TPA claim status.
Call Vidal Health’s call center to check the claim status.

Login to Vidal Health Insurance TPA account and download a copy of your e-card from there. You can also call the customer service and place your e-card request.

You can lodge a grievance at Vidal Health TPA by clicking here. You will need to select your policy type and fill the form.

You can submit the Vidal Health TPA claim form within 7 days once the patient is discharged. The documents can, however, be submitted within 15 days of the discharge date.

No. You just need to fill the Vidal Health TPA claim form which is the same as part A of IRDA claim form.

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