Raheja QBE Health Insurance Claim Settlement

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Highlights
Claim SettlementDedicated Team
COVID-19 CoverYes
Network Hospitals5,000+
Policies Sold135
Renewability Lifelong Renewability

Claim Settlement of Raheja QBE Health Insurance

Raheja QBE is committed to providing excellent claims settlement service to make it the First Choice Insurer for its customers. The claim settlement process for Raheja QBE is as smooth as you would want it to be. It is hassle-free and does not demand much effort from the policyholders. The company has a dedicated team for settling claims thus ensuring a fair, friendly, and timely settlement of all the valid claims.  

  • Claim Process for Cashless Treatment

    Cashless treatment is available at all the network hospitals of Raheja QBE. The insured individual can avail this facility by visiting any network hospital and presenting the health membership number provided by the company. Follow the steps given below to avail this benefit from the company:

    • Visit any network provider of the company for the required treatment 
    • Get a form from the network provider to make a request for cashless treatment
    • Send the completed form to the TPA for authorization
    • Once the TPA get a cashless request form and related medical information from the insured individual or the hospital, the TPA will issue a pre-authorization letter to the hospital
    • If your offer is accepted, then the due payment will be made as per the timeline of the company, starting from the date the company accepted it
    • Verify the discharge papers on discharge from the hospital and make payment for the non-medical and inadmissible expenses
    •  Remember that the TPA can even deny pre-authorisation in case the insured person fails to provide the required medical details
    • Do not worry even if your claim gets rejected as you can later claim for reimbursement
  • Reimbursement Treatment

    In case if your request for cashless treatment has been rejected, then you can pay for the treatment from your own pocket at that time and later try for reimbursement by following the steps given below:   

    • The insured person will take treatment at network or non-network hospital
    • Submit the required documents to the TPA/company within the specified period 
    • Inform the company or the TPA at least 48 hours before hospitalisation 
    • The company will offer claim settlement in a specific number of days after receiving final documents
    • The TPA has the right to deny the claim in case the insured person is not able to provide required medical details
  • Documents Needed

    You will require the following documents to make a reimbursement claim with Raheja QBE-

    • Duly filled claim form
    • Recorded medical history of the patient, a summary report from the hospital or the discharge certificate; all of which should be original 
    • Cash memos from the Hospital(s) or Chemist(s) supported with proper prescriptions 
    • Original payment receipt along with the prescription from attending medical practitioner 
    • Receipts and certificate of diagnosis of the practioner attending the insured individual
    • An original certificate from the surgeon that has the diagnosis and nature of operation performed mentioned in it along with bills or receipts, etc.
    • Any other document required by the company or TPA

     

  • Incurred Claim Ratio (ICR) of Raheja QBE Health Insurance

    Incurred Claim Ratio can be defined as the net claims paid by an insurer against the net premiums earned. Every year, IRDAI, i.e. Insurance Regulatory and Development Authority of India releases the data for ICR. As per the IRDAI, the Incurred Claims Ratio of Raheja QBE for FY 2018-19 is 33%, but it is expected to change.

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Claim Process at Raheja QBE Health Insurance

  • Network Hospital
  • Non-Network Hospital
  • 1

    Claim Assistance

    For any assistance or query, call InsuranceDekho at the toll-free number 755 1196 989.
  • 2

    Claim Intimation

    Emergency hospitalisation needs intimation as soon as it occurs and for planned hospitalisation intimate within 48 hours prior to admission.
  • 3

    Claim Processing

    Fill in the pre-authorisation form and hand it over to hospital's insurance/TPA desk to initiate claim request.
  • 4

    Claim Settlement

    Once your request is approved, claim is settled. If not approved, claim for reimbursement after discharge.
  • 1

    Claim Assistance

    For any assistance or query, call InsuranceDekho at the toll-free number 755 1196 989.
  • 2

    Claim Intimation

    Emergency hospitalisation needs intimation as soon as it occurs and for planned hospitalisation intimate within 48 hours prior to admission.
  • 3

    Claim Processing

    Submit claim form with original documents such as doctor’s reports, hospital bills, diagnostic tests, etc.
  • 4

    Claim Settlement

    Once your request for reimbursement of expenses is approved, the claim will be settled.

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