Quick and hassle free claims process

Claims procedure

Who to contact for your claim

Other policies

Saral Suraksha Bima, Pravasi Bhartiya Bima Yojana, Group Hospital Cash, Group Premier Personal Accident, Group Loan Insurance, Health Bharosa, RQBE Disability Income Protect-Group, RQBE Surrogacy and Oocyte Donor Insurance Policy-Group, Wage Compensation Policy-Group — kindly contact our QBE call centre team.

Contact number: 18001027723 (Monday to Saturday, 9 am to 8 pm)
Email address: [email protected]

Process of claims

As easy as 1-2-3

  1. Hospitalization

    Hospitalization with submission of health card and valid photo id proof.

  2. Preauthorization

    The TPA and hospital co-ordinate for verification and approval of the insurance documents.

  3. Authorization and claim approval

    Approval from RQBE is given to the hospital.

Service standards

Health Claims Turnaround Time

Health Claims Service Indicators
Health claims turnaround time
Claims Turnaround time
Acceptance of cashless claims by TPA/company to Hospital and communicate to them 1 Hour
TPA’s offer of settlement to the Insurer / Hospital after submission of document 3 Hours
Settlement of claims (other than cashless) 15 Days

Claims Service Standards

  • Registration of a claim - Within 48 to 72 hrs of receipt of notification.
  • TAT for approval of Pre-auth request within 1 hour.
  • TAT for granting final authorisation within 3 hours
  • Payment of additional amount to policyholder charged by the hospitals for delay beyond 3 hours
  • Reimbursement settlement/Rejection within 15 working days of receipt of complete documents.

Documents

What you need to submit

Please take care to submit all the below documents while submitting your claim:

  • Duly filled claim form duly signed by the insured and the treating doctor.
  • Discharge summary with the details of complaints and the treatment availed.
  • Final Hospital Bill with detailed break-up along with interim bills payment receipts.
  • Doctor’s consultation papers.
  • All investigation reports (e.g. original blood report, X-ray, sonography, CT scan, MRI, etc.)
  • All pharmacy bills supported by doctor prescriptions.
  • Implant sticker or invoice, if used (e.g. lens details in cataract case, stent details in angioplasty).
  • Medico legal certificate (MLC) and / or FIR for all accident cases.
  • For all miscellaneous charges, detailed bills supporting prescription of the treating doctor.
  • Photocopy of the health card.
  • Any other related documents. Please note all documents that are sent to the TPA should be in original.
  • Medical Practitioner’s referral letter advising Hospitalization
  • Indoor case paper
  • First Information Report, final police report, if applicable;
  • Post-mortem report, if conducted;
  • Death Certificate from the municipal authorities;
  • Death Summary from the Hospital authorities, if death is confirmed by the Hospital;
  • Inquest/Panchnama Report;
  • Coroner’s Report
  • Copy of Schedule/Certificate of Insurance
  • Disability certificate from a Medical Practitioner or Hospital confirming the extent and nature of disability.
  • Bills and receipt towards expenses relevant to funeral ceremony / repatriation of mortal remains;
  • Loan Certificate/Amortization Schedule prepared by the Bank/ Financial Institution at the time of disbursement of Loan showing details of the Loan/EMIs, Principal Outstanding, etc.,
  • KYC Details (Pan card, Aadhaar Card)
  • Proof of travel by the Insured Person in a listed public carrier in case the Double Indemnity Benefit is applicable. Additional documents will be called for when the above listed documents do not adequately corroborate admissibility of the claim under respective benefits as per the Policy terms.
  • NEFT Details
  • Submit documents at nearest QBE branch.

Kindly note that this is not an exhaustive list and any other documents could be required post assessment of your case.

Points to remember

Before you claim

For Cashless Facility

  • Avail the benefits of cashless service at QBE network hospitals.
  • Kindly ensure that the pre-authorisation form is completely filled and signed by the Insured and the attending doctor.
  • Kindly ensure to mention the mobile number on the pre-authorisation form.
  • In case of planned hospitalization, please send the pre-authorisation form in advance (not before 15 days of admission date).
  • In case of emergency hospitalization, please send the pre-authorisation form within 24 hours from the time of hospitalization.
  • In case of cashless denial, insured to pay hospitalization expenses. Quote your cashless (pre-authorisation) number as reference in all the future correspondence with RQBE.
  • Do not refer to the network list of any other service provider.
  • Do not wait until the discharge time to raise the enhancement request.
  • Insured to bear any inadmissible expenses, co-payments and or deductions.

For Availing Reimbursements

  • Mention correct and complete communication address with the pin code on the claim form.
  • Always keep a photocopy of the claim documents submitted to RQBE.
  • Kindly ensure that the claim form is completely filled and signed by the insured and the attending doctor.
  • Kindly ensure to mention the mobile number on the claim form.
  • All claim documents are to be submitted in original within 30 days from the date of discharge.
  • Quote your claim number as reference in all future correspondence with RQBE.
  • Insured to bear any inadmissible expenses, co-payments and or deductions.

Claim forms

TPA Details

Third party administrators

Kindly get in touch on the below mentioned toll free number or email for any claim related queries or assistances.

Medi Assist

Medi Assist Insurance TPA Pvt. Ltd.

Toll Free Number
1800-4259-449
Address & disclosures

4th Floor, Aarpee Chambers, Shagbaug, Off Andheri-Kurla Road, Next To Times Square, Marol, Andheri East, Mumbai, Maharashtra 400059

IBC Knowledge Park, Tower D, 4th Floor, Bannerghatta Main Rd, 4/1, Bengaluru, Karnataka 560029

Paramount

Paramount TPA

Toll Free Number
9122-66620808
Address & disclosures

Plot No. A-442, Road No. 28, Ram Nagar, M.I.D.C. Industrial Area, Wagle Estate, Thane West Pin Code – 400604

Volo Health

Volo Health Insurance TPA Pvt. Ltd

Toll Free Number
1800202022
Address & disclosures

38, Golf Links, New Delhi-110003

Need more help?

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