Raheja QBE Health Insurance

The features of Raheja QBE Health Insurance are mentioned below:

• No. of members- The plan covers maximum 4 members of your family that may include up to 2 children and 2 adults.
• Lifelong Renewal – The plans offered are lifelong renewable, hence it saves you from the financial burden and stress caused by a medical emergency and keeps you well prepared to handle any situation.
• Pre & Post hospitalization cover- The plan covers medical expenses for 30 days & 60 days prior to hospitalization and 60 days and 90 days post hospitalization in the basic plan, super saver and a la carte plans. It covers 60 days pre hospitalization & 90 days post hospitalization in comprehensive plan and 90 only for related medical expenses.
• Pre-existing diseases- Pre-existing diseases are covered after 4 years of waiting period.
• Co-payment- The plan has in-built Health Insurance benefits and contains add-on covers for co-payment policy .

The benefits of buying Raheja QBE Health Insurance are mentioned below:

• Discounts: Raheja Health Insurance provides a premium discount in case you opt for a 20% co-pay policy
• Cashless facility: Offers cashless facility with a very strong network of hospitals
• Flexibility: Offers flexibility to make the premium payments via UPI, Paytm, Net banking, Debit/Credit card etc. as per your convenience
• Organ donor benefit: Offers organ donor benefit charges of 20% on the sum insured of Rs.3 to 50 lakh in the basic, comprehensive, super saver and a la carte plans
• Inpatient benefit: Offers coverage for hospitalization & medical expenses or day care procedures including Medical Practitioner's charges, drugs and consumables, diagnostic procedures, anesthesia, blood, oxygen, operation theatre charges, Hospital Room Rent or boarding expenses, nursing charges, Intensive Care Unit (ICU) charges, surgical appliances, medicines, cost of prosthetics if implanted during Surgical Procedures subject to the sublimit on the, room category, ICU, room-rent etc.
• Mediclaim settlement: Offers quick and hassle-free claim settlement services
• Ambulance cover: Offers ambulance charges of Rs.500 for sum insured of Rs.1 to 2 lakh, Rs.1,500 for sum insured of Rs.3 to 9 lakh & Rs.2,500 for sum insured of Rs.10 to 50 lakh
• Tax benefits: Section 80C and 10(10D) under the Income Tax Act, provides tax benefits for premiums paid regularly

There are two ways to make claim under a Health Insurance Policy:

• Cashless basis
• Reimbursement basis In simple terms, for making a claim on cashless basis, the treatment must be done only at a network hospital of the insurance company servicing your policy. For availing the treatment, you would have to first seek an authorization as per the procedures laid down and in the prescribed form. In case of claims on reimbursement basis, the insurance company has to be informed as per their prescribed procedures. The policyholder has to ensure that documents such as claim form, discharge summary, prescriptions and bills to be submitted for the claim on reimbursement are obtained after hospitalization. Raheja QBE Health Insurance has a well-defined claim processing system.

  Documentation for smooth Claim Settlement

  The below documentation is required within 15 days from the discharge of the insured from the hospital. The below documentation is required as per the type of claims registered:
• Duly filled and signed form in original;
• Original bills, receipts and discharge card from the Hospital / Medical Practitioner;
• Original bills from the chemists;
• Medical Practitioner’s prescription advising drugs, diagnostic tests/consultation;
• Original pathological/Diagnostic Test reports/radiology reports and payment receipts;
• Indoor case papers;
• Death Certificate from the municipal authorities;
• Post mortem report, if conducted;
• Panchnama Report;
• Coroner‟s Report;
• Medical Practitioner’s referral letter advising Hospitalization
• First Information Report, final police report, if applicable;
• Post mortem report, if conducted;
• Death Summary from the Hospital authorities, if death is confirmed by the Hospital;
• Any additional document to access the claim as required by Raheja QBE Health Insurance Company

  Claim Process - Cashless Service

• Once the doctor advises hospitalization or a treatment, intimate your claim. This pre-authorization should be done by calling the call center by requesting an authorization within 48 hours before the planned hospitalization or within 48 hours of admission to the hospital or before discharge from the hospital whichever is earlier
• Intimation can be done by calling on the toll-free number of the Raheja QBE Health Insurance Company 1800 102 7723 or email on claims@rahejaqbe.com
• Get hospitalized in any of the network hospitals
• Show your Raheja QBE Health Card to the representative at the TPA desk
• Complete the ‘Cashless Request Form’ available at the hospital’s insurance/TPA Desk.
• Submit your authorization form along with your health card copy and your photo identity copy
• You will have to wait for an approval from the hospital.
• Send the completed form via email TPA along with any important medical details
• Verify and sign the details along with all the bills
• You may leave the investigation and original discharge letter with the hospital and retain a photocopy of these for your reference
• If the authorization of the cashless claim is denied by Raheja QBE either due to insufficient sum insured or any incorrect or insufficient information, you will be liable to make payment of the hospital bill and then apply for a reimbursement. The reimbursement would be done by Raheja QBE considering the terms and conditions of the policy

  Claim process - Reimbursement facility

• Get hospitalized
• This pre-authorization should be done by calling the call center 1800 102 7723 or email on claims@rahejaqbe.com by requesting an authorization within 48 hours before the planned hospitalization or within 48 hours of admission to the hospital or before discharge from the hospital whichever is earlier
• Immediately intimate or register the claim at the call center/E-mail as soon as possible
• Make the hospital bill payments in full as required
• Collect all the original bills, documents and reports at the time of discharge
• Register a claim with TPA for processing and reimbursement, by filling in the claim form and attaching required documents as mentioned in the claim form The claim intimation can be done via Raheja QBE Health Insurance toll free number 1800 102 7723 the same could also be emailed to claims@rahejaqbe.com Note: If you are a Coverfox customer, you can directly reach out to us for all your claim-related issues and queries.

Raheja QBE Health Insurance offers an array of reasonably priced health insurance policies. Their plans are made-to-measure to shield you against your mounting financial responsibilities towards your family during and after hospitalization and medical treatments. They boast of a very good claim settlement ratio amongst other private insurers. Their continuous efforts to offer excellent customer service is their ultimate performance. Hence, if you are scouting for an insurer who will deliver dependability, competence and brilliant post sales services in consort with the product