Raheja QBE Health Insurance Claim Settlement

The Raheja QBE health insurance policy offers a very well-established claim settlement system. It is one of the major features that reflect upon the quality of service of a health insurance policy and the Raheja QBE health insurance is decorous and organised in that aspect. The Raheja QBE health insurance settlement ratio is also decent, which roughly indicates the chances of your claims being settled under the insurer. Let us have a look at the Raheja QBE health insurance claim settlement procedure, its required documents, and some other details regarding this topic, further on this page.

The Claim Process for Cashless Treatment for Raheja QBE Health Insurance Claim Settlement

One of the most useful and crucial benefits of the Raheja QBE health insurance policy is its wide hospital network with more than 5000 cashless hospitals, across the country. The policyholders can avail of the cashless treatment feature through these network hospitals and have a better experience during a health-related complication or a medical emergency, where hospitalisation is required. This benefit can be availed very easily by following the straightforward procedures required for its initiation. The best part about the cashless treatment benefit, under the Raheja QBE health insurance policy, is that you can get admitted to a network hospital and avail of professional treatment without worrying about paying the entire medical cost of the procedure from your end. The majority of the expenses will be directly covered with the hospital by your insurer, upon the approval of the cashless treatment facility. It is one of the things that makes the policy a great choice, along with the decent figures in terms of Raheja QBE health claim ratio.

Guide to the Cashless Claim Treatment

There are some important details about the cashless claim treatment process that you should know beforehand for a smooth experience. The Raheja QBE health claim ratio is great and here is how you can submit for the procedure.

This is how you can submit a cashless Raheja QBE health insurance claim settlement:

There are two types of cashless Raheja QBE health insurance claim settlement procedures, known as planned and emergency and the submission method for them are different.

Planned Cashless Raheja QBE Health Insurance Claim Settlement Process

In the event that you have a medical procedure lined up in the near future, you can easily make use of the planned cashless claim under the Raheja QBE health insurance policy through their network hospital. For a planned hospitalisation, you have to submit the intimation to the provider prior to the proposed hospitalisation, which is at least 48 hours in advance before the scheduled admission date. The insurer will verify the submitted cashless treatment claim request and issue an approval, after which you will be able to access the cashless treatment benefit.

Emergency Cashless Raheja QBE Health Insurance Claim Settlement Process

Unlike planned hospitalisation, an emergency-derived need for hospitalisation can arise at any time without any prior indication. Under these circumstances, the policy intimation in advance is not possible, however, you can still avail of cashless treatment for emergency hospitalisation by following the necessary steps for it. The first step towards getting emergency cashless treatment under the Raheja QBE health insurance policy is to get admitted to a network hospital under the provider. Then, the pre-authorization is required to be submitted within 24 hours of hospital admission. Upon authorization of the emergency cashless treatment claim by the provider, the benefit will be available for use.  

The Cashless Claim Procedure After Admission

1. Following the admission, the insured will have to request authorization for the treatment by contacting the insurer and submitting a duly filled pre-authorization form. In case of an emergency, the form is required to be submitted within 24 hours of the hospital admission.
2. The insurer will verify the submitted cashless treatment request and documents and will provide a written confirmation about its approval or rejection.
3. Upon the approval for the cashless treatment, the medical expenses covered under the policy will be settled by the insurer with respect to the authorised amount at the time of discharge.
4. All the original medical bills, treatment evidence and other documentation related to the treatment are required to be submitted to the network provider instantly or positively before patient discharge.
5. The insured may have to settle certain costs, (if any) that are not authorised under the cashless facility, directly with the hospital.

List of Documents Required for Raheja QBE Health Cashless Claim

The general details and documents required for submission at the time of making a cashless claim under the Raheja QBE health insurance policy are as follows: 

1. Copy of the health card
2. Proof of identity and age of the patient and the policyholder (if different)
3. Doctor’s consultation report for hospitalisation
4. Detailed patient discharge summary
5. All invoices from the hospital
6. Diagnostic reports and respective receipts
7. Certificate obtained from the attending medical practitioner
8. Invoices from chemists in reference to genuine prescription
9. Additional documents (if needed)

How to Check Claim Status of Raheja QBE Health Insurance Policy?

Apart from the impressive Raheja QBE health insurance claim ratio and simple claim settlement procedure, the company also offers the ability to check the status of your submitted insurance claim in real time. 

The steps to check online and offline Raheja QBE health insurance claim settlement status are mentioned below:

The Online Process for Raheja QBE Health Insurance Claim Settlement

1. Head over to the Raheja QBE health insurance official website, find the “Claims” tab and pick the “Health Claims” option.
2. Scroll down and locate the TPA for your Raheja QBE health insurance claim and click on the respective link for the “real-time claim status” check.
3. Provide the required details, like the name of the insurance company, policy number, policy type, claim ID, date of hospitalisation, etc. and then click on submit to get the status details of the ongoing claim.

The Offline Process for Raheja QBE Health Insurance Claim Settlement

The Raheja QBE health insurance claim settlement status can also be checked via the offline method. In order to get it done, you will have to visit the nearest branch office of the insurer and contact the officials there about your claim status query. You can also contact the respective TPA through their toll-free number, i.e. 1800-4259-449 (Medi Assist) and 9122-66620808 (Paramount) for claim status queries. You can also send an email to customercare@rahejaqbe.com for requests related to all services.

The Claim Process for Reimbursement under Raheja QBE Health Insurance Claim Settlement

Apart from the cashless claim procedure, you can also apply for reimbursement claims under your Raheja QBE health insurance policy. In this type of claim, you will have to settle all the hospitalisation and medical treatment-related expenses from your end and then submit for reimbursement with Raheja QBE health insurance by following the proper procedure. Reimbursement claim is applicable for both treatment received from a network and non-network hospital and upon its approval, the authorised amount will be transferred to your provided bank account

Here is the Procedure to Submit a Reimbursement Claim

1. The written intimation is required to be submitted to the insurer at least 48 hours prior to the planned hospitalisation. In case of an emergency, the intimation has to be made within 24 hours of the hospital admission or before the patient's release, whichever comes first.
2. Pay for all the required treatment-related bills and expenses at the time of discharge and then apply for a reimbursement claim.
3. Download the claim form, duly fill it and submit it to the insurer, alongside all the original copies of the hospital bills, invoices, reports, etc. either immediately or, in any event, within 15 days of the patient's official release from the hospital.
4. The insurer will verify the submitted claim, bills and documents and if approved, will reimburse the authorised amount to the provided bank account.

List of Documents Required for Raheja QBE Health Reimbursement Claim

These are a few examples of details that you will be required to provide during the Raheja QBE health insurance claim settlement procedure:

1. The Raheja QBE health insurance policy number
2. The policyholder’s name
3. The name of the insured for whom the claim is being filed
4. Valid address and contact number details of the insured
5. Identity proof of the insured
6. Details about the disease or injury
7. Name and address of the hospital and the attending medical practitioner
8. Date of hospital admission
9. Other necessary documentation (if required)

The documents needed for the Raheja QBE health insurance reimbursement claim submission are:

1. Duly filled claim form, signed by the treating doctor and the insured
2. Summary of patient discharge
3. Hospital’s final bill with a precise break-up
4. Consultation paperwork by the doctor
5. All original investigation reports like X-ray, MRI, etc.
6. Invoices from the pharmacy with respect to the doctor’s prescription
7. Medico-Legal Certificate (MLC) and/or police FIR in cases of accidents
8. Health card copy
9. Referral letter by the medical practitioner advising hospitalisation
10. KYC details such as Pan Card and Aadhaar Card
11. Details for NEFT
12. Insured’s proof of travel in a listed public carrier (in case of Double Indemnity Benefit)
13. Police report, post-mortem report, death certificate obtained from municipal authorities, death summary provided by the hospital authorities, inquest report, coroner’s report, and some other additional details (if applicable)

Raheja QBE Health Insurance Incurred Claim Ratio (ICR)

Raheja QBE health insurance has a remarkable ICR, which stands for Incurred Claim Ratio. The ICR is the ratio of the total value of claims paid and the total value of premiums collected within a certain period, by an insurance company. This is very vital data and is released by the IRDAI, according to whom the Raheja QBE health insurance ICR for FY2020-21 was 97.22%.

Raheja QBE Health Insurance Claim Settlement Ratio (CSR)

The Raheja QBE health claim settlement ratio or CSR helps to establish the idea of how viable the company is in terms of settling your insurance claims. The CSR is the ratio value of the total number of resolved claims and the total number of received claims by the insurance company, within a specific period. The claim settlement ratio of Raheja QBE health insurance is good and in terms of efficiency, the company is reported to have settled 30.29% of its claims within a duration of fewer than 3 months, and about 7.21% of the claims were resolved within a duration of 3 to 6 months.