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Health Claim Process

Reliance General Insurance

Four Easy Steps to File Your Health Insurance Claim

To know about Cashless Everywhere Process, click here​

We aim to make the claim process as smooth as possible for your convenience. Here's how to go about it:

Step 1: Doctor advises hospitalisation (or treatment).

Step 2: Intimate your health insurance claim (as soon as it occurs).

Step 3:CASHLESS CLAIM -  Visit Network Hospital for the treatment.
              REIMBURSEMENT CLAIM - Undergo your treatment at the Non-network Hospital and make the payment.

Step 4:CASHLESS CLAIM - Hospital's TPA Desk contacts us for arranging cashless treatment.
             REIMBURSEMENT CLAIM - Submit your documents within 15 days of discharge for reimbursement.

For the flowchart of ​​claim process, click here

Claim Intimation:

To make your claim process fast and smooth, we serve our health insurance customers through RCare Health (our in-house health claims unit). We also have appointed a Third Party Administrator (TPA) desk duly licensed by IRDA for the same.

To file health insurance claim request, Insured/Claimant can contact on numbers mentioned on the Health Card / Policy Schedule.

Information to be kept ​ready while intimating the claim:

  • Policy Number
  • Insured/Claimant contact details (phone no. , email id, address, landmark etc.)
  • Name of Insured/ claimant person, who is hospitalised
  • Relationship of insured with the person who is hospitalised.
  • Name of the hospital
  • Nature of ailment-(For health claims)
  • Nature of  accident- (For accident cases)
  • Date & time of accident (For accident cases)
  • Location of accident (For accident cases)
  • Commencement date of the symptom of ailment​

A walk through the claim process:

Claim process for Cashless facility:
  1. Get admitted in any one of Reliance General Insurance​ Network Hospitals
  2. Flash the Reliance Health Card at TPA helpdesk of hospital
  3. Fill "Cashless Request Form" (available in all the network hospitals at TPA desk)
  4. Submit the authorisation form, along with a copy of the health card to the hospital at the time of admission (ensure to have a photo ID at this time)
  5. Await authorisation from the hospital (the hospital co-ordinates with the RCare Health /TPA for this)
  6. Hospital Fax/Email  the pre-authorisation form to the RCare Health /TPA along with necessary medical details
  7. Insured/ Claimant verify and sign all the bills
  8. Leave the original discharge summary and other investigation reports with the hospital
  9. Retain a photocopy for your records

Claim process if ‘cashless hospitalisation’ is denied by RCare Health/TPA:
  1. Settle the hospital bills in full as required
  2. Collect all the original bill documents and reports at the time of discharge
  3. Lodge your claim with RCare Health /TPA for processing and reimbursement

Claim process for emergency hospitalisation with ‘cashless facility’:
  1. Get admitted into the hospital
  2. Obtain the pre-authorisation form from hospital
  3. Get the form filled in and signed by the attending doctor
  4. Hospital Fax/Email  the pre-authorisation form to the RCare Health /TPA along with necessary medical details
  5. Insured/ Claimant verify and sign all the bills
  6. Leave the original discharge summary and other investigation reports with the hospital
  7. Retain a photocopy for your records

Please note that at the time of discharge, you will be required to pay for expenses that are not payable as per the terms and condition of the policy.

Claim process for planned hospitalisation with ‘cashless facility’:

  1. Co-ordinate with your doctor and the hospital and send all the details about the planned hospitalisation to RCare Health /TPA, two days before your hospitalisation(including the plan of treatment, cost estimates etc)
  2. Present the authorisation letter and photo ID card to the hospital at the time of admission
  3. Hospital Fax/Email  the pre-authorisation form to the RCare Health /TPA along with necessary medical details
  4. Insured/ Claimant verify and sign all the bills
  5. Leave the original discharge summary and other investigation reports with the hospital
  6. Retain a photocopy for your records

Please note that, at the time of discharge, you will be required to pay for expenses that are not payable as per the terms of the policy.

Claim process for emergency hospitalisation with ‘reimbursement facility’:
  1. Get admitted into the hospital
  2. Intimate the claim at RCare Health call centre/E-mail  as soon as possible
  3. Settle the hospital bills in full as required
  4. Collect all the original bills, documents and reports at the time of discharge
  5. Lodge your claim with RCare Health /TPA for processing and reimbursement, by filling in the claim form and attaching required documents as mentioned in the claim form

Claim process for planned hospitalisation with ‘reimbursement facility’:
  1. Intimate RCare Health /TPA of the planned hospitalisation
  2. Get admitted into the hospital
  3. Settle the hospital bills in full as required
  4. Collect all the original bills, documents and reports at the time of discharge
  5. Lodge your claim with RCare Health /TPA for processing and reimbursement

List of TPAs engaged for servicing of Group Health Policy Claims:​

The following is the list of TPAs having tie-up for the servicing of some of the group Mediclaim policies of RGICL

We would request to refer to the email from your HR department regarding TPA associated. Also, please refer to the health card/E-Health card received at your end for the TPA details-

1. FAMILY HEALTH PLAN INSURANCE TPA LTD
No:8-2-269/A/2-1 To 6, 2nd Floor, Srinilaya Cyber Spazio, Road No.2, Banjara Hills, Hyderabad, Telangana – 500034
For information call: 1-800-425-4033
Email: info@fhpl.net​​
​Public Disclosure_FHPL 2022-23.pdf​
FHPL TPA - Public Disclosures - FY 20-21.pdf​​​​
Public Disclosure FHPL_RGI_21-22.pdf​​​​

2. Paramount Health Services & Insurance TPA Pvt. Ltd.
Plot No.A-442, Road no 28, M.I.D.C.Industrial Area, Wagle Estate, Thane, Maharashtra 400604
Helpline No.: 022 6834 2424,66620808
Email: phs@paramounttpa.com​
​Public Disclosure_PHS 2022-23.pdf​
Paramount TPA - Public Disclosure -FY 20-21.pdf​<>
Public Disclosure PHS_RGI_22-23.pdf​

​ 3. Medi Assist Insurance TPA Pvt Ltd
Tower D, 4th Floor, IBC Knowledge Park, 4/1 Bannerghatta Road, Bangalore – 560 029
Helpline No.: 08022069449
Email: info@mediassist.in
Public Disclosure_Mediassist 2022-23.pdf
MediAssist TPA - Public Disclosure -FY 20- 21.pdf​<>
Public Disclosure Mediassist_RGI_22-23.pdf​

​4. Raksha Health Insurance TPA Pvt. Ltd.
C/o.Escorts Corporate Centre 15/5,Mathura Road, Faridabad, Haryana-121006.
Helpline No.: 0129-4289999,18001801444, 18001801555
Email: crcm@rakshatpa.com ​
​Raksha Public Disclosure.pdf​​
Public Disclosure Rakshak_RGI_21-22.pdf​​​​

5. MDIndia Health​ Insuranc​e TPA Private Limited​
S. No. 46/1, E-space, A-2 Building, 4th floor,Pune Nagar Road, Vadgaonsheri, Pune 411014.Maharastra​
​​Phone No: 022-27292041
UAN No:1860-233-4448
Toll Free No: 1800-233-1166,1800-233-4505​
​ Public Disclosure_MdIndia 2022-23.pdf
MD India TPA - Public Disclosure - FY 20-21.pdf​​
Public Disclosure Md India_RGI_22-23.pdf​​

6.Vipul MedCorp Insurance TPA Private Limited
515,Udyog Vihar,Phase 5Gurgaon,Haryana​
Pin Code : 122 016
Phone No : 0124-4833900
E-Mail : info@vipulmedcorp.com
​​Public Disclosure_Vipul & Vidal 2022-23.pdf​​

Reliance General Insurance Company Limited​ (Inhouse TPA)​
Public Disclosure
Inhouse Public Disclosures-FY 20-21.pdf​​​​
​

You may also Refer to the above TPA websites for more details on the claim form​s, claims process and contact details.
You can also write to RGICL at Rgicl.rcarehealth@relianceada.com for any assistance ​