Cashless Mediclaim & TPA
In case of a planned admission, you would have first consulted a doctor who in turn would have advised you on the probable date of hospitalization. In such a case, you must apply for approval of the estimated hospital expenses directly by your TPA at least 4-5 days prior to the date of hospitalization.
In case you have not applied for pre-authorization sufficiently in advance or if the doctor treating you advises you to get hospitalized immediately after the consultation, our Help Desk (Phone: 022-24460649 / 24447543) will assist you through the preauthorization procedure. Normal working hours are from 10.00 am to 8.00 pm, Monday to Saturday .
However, the Corporate/TPA Help Desk is only a facilitator and can in no way influence the decision on the approval. Your TPA may not grant approval due to any of the following reasons:
If the ailment for which you are hospitalized is not covered in your policy.
If the information contained in pre-authorization form is insufficient to approve the request, though most of the time the TPA will request the hospital if additional information is needed.
If you have exhausted the sum assured for that year.
The pre-authorization procedure is detailed below:
Step 1: Establish contact with the Help Desk at the hospital or please refer here for all the information related to cashless processing or reimbursement.
Step 2: Collect the pre-authorization forms pertaining to your TPA + TPA Checklist + TPA undertaking form from OPD Customer care help desk/ Doctor's secretaries / West block help desk or download all these forms. Please present your Health Insurance card for the staff to assist you appropriately.
Step 3: Form Filling - your pre-authorization form will have two sections-
General details on the health insurance policy - to be filled in by you (the TPA Help Desk will assist you in case you have any difficulty).
The treatment recommended for you - to be filled in and duly signed by the doctor who is treating you (Do not attempt to fill this section, contact the TPA Help Desk in case of any difficulty). TPA Checklist + TPA undertaking forms are self-explanatory.
Step 4: Return the completed form (filled and signed), along with the copies of the document mentioned in TPA check list to the TPA Help Desk/ ELSE make a single pdf file of all your documents (as per TPA checklist) and email to nationalcashless@gmail.com, with subject as 'Patient's name, HH Number and mobile number'. The personnel at the desk will verify the form for its completeness and let you know in case of any discrepancy.
Step 5: Once the form is completely filled, the TPA Help Desk will upload the documents on the portal and transmit to the office of your TPA.
Step 6: The TPA Help Desk will revert to you with the approval/ denial status and also the status of approval .
A TPA deposit payment of Rs.7500/- has to be paid on admission, which shall be refunded post discharge, subject to completion of all formalities and payment received by the hospital, and may take 45-90 days.
In an emergency hospitalization, the important thing is to get the patient treatment at the earliest. The Corporate Help Desk will take up your case on a fast track basis with your TPA and is likely to receive approvals within 6 hours during any working day.
Step 1: Show your health insurance card and fill in the pre-authorization form.
Step 2: The TPA desk in the hospital will fast track the process for your cashless process but in case you cannot wait for the approval, you can pay the deposit if demanded by the hospital and start the treatment and reimburse the expense later on.
Step 3: Generally the time to taken to process an emergency case is 6 hours, but will depend upon the insurance co / TPA. You need to follow up with the TPA to know the status of the request.
Insurance Companies /TPAs empanelled with
NATIONAL HOSPITAL & I.C.C.U.
Private Insurance Companies
Aditya Birla Health Insurance Co.Ltd
Bajaj Allianz General InsuranceCo.Ltd.
ICICI Lombard General Ins.Co.Ltd
ICICI Prudential Life Insurance Co.Ltd
Star Health & Allied Ins.Co.Ltd.
Niva Bupa Health Insurance Co.Ltd.
Future Generali India Insurance Co.Ltd.
Care Health Insurance Ltd
HDFC ERGO General Insurance.Ltd.
Reliance General Insurance Co.Ltd
Iffco Tokio General Insurance Co.Ltd
Aditya Birla Health Insurance CoLtd
SBI General Insurance Co.Ltd.
Universal Sompo General Insurance Co.Ltd
TATA AIG General Insurance Co.Ltd
TPAs (Third Party Administrators)
Family Healthplan Ltd.
East West Assist Insurance TPA Pvt.Ltd.
Ericson Insurance TPA Pvt.Ltd.
Genins India Ltd
Good Health TPA Pvt Ltd
Health Insurance TPA of India Ltd.
Heritage Health Services Pvt.Ltd.
MD India Healthcare Services TPA Pvt.Ltd
Medi Assist (I) Pvt.Ltd.
Medsave Healthcare Ltd
Medvantage Insurance TPA Pvt. Ltd
Paramount Health Services Pvt.Ltd.
Park Mediclaim TPA Pvt Ltd.
Raksha TPA Pvt.Ltd.
Safeway TPA Services Pvt Ltd.
Vidal Health TPA Pvt. Ltd.