Raheja QBE Health Insurance Claim Settlement

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 claim settlement by following the steps given below:   

• The insured person will take treatment at the 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 the required medical details

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 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 Raheja QBE Health Insurance Claim Settlemen Ratio for FY 2018-19 is 33%, but it is expected to change.