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.
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 - https://www.vizagsteel.com/code/r_port/docs/2_generation_of_e_card.pdf.
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.
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.