HITPA – Health Insurance TPA of India to open for public in September

Register on HITPA website to get 100% insurance benefits, before 23 September – hitpa.in.

Health Insurance TPA of India Ltd is a joint venture of public sector Non-life insurance companies – National Insurance Co. Ltd, The Oriental Insurance Co. Ltd, The New India Assurance Co. Ltd, United India Insurance Co. Ltd and GIC of India.

The Company was incorporated on August 14, 2013 with two key objectives – to enhance customer experience and to bring in greater efficiency in health insurance claims processing. Health Insurance TPA is headquartered in New Delhi and shall develop its footprint/branches in different cities in due course.

Health Insurance TPA of India Ltd, set up to manage the health claims of public sector general insurers, will begin operations in September. With this, 10-12 per cent of the claims handled by external third party administrators (TPAs) are expected to move to the new body, helping reduce the turnaround time.

HI TPA shall provide ID cards with unique ID number (UHID) to each insured member of a policy. This UHID will be used to validate the member’s identity for efficient and timely claims processing.

HI TPA is committed to process Cashless and Reimbursement Claims of its members in the most efficient way. In the section below we have listed key steps for processing of Cashless and Reimbursement Claims.

Cashless Claim

HI TPA shall provide the Pre- Authorization to the insured member for availing treatment on Cashless basis at Network hospital.

4 easy steps for Cashless claim

1

Member shows the card at hospital

2

Hospital fills the Pre-Auth request & sends it to HI TPA

3

HI TPA receives the Pre-Auth request & reviews it

4

Approval obtained for cashless Hospitalisation

Cashless claim process

  1. Member selects the network Hospital where he wishes to be treated. (For updated network hospital list check HI TPA website www.healthinsurancetpa.co.in)
  2. Member ID card is shown to the hospital TPA desk.
  3. Hospital asks member to fill the Pre-Authorization Request form for cashless claim.
  4. Insured member fills pre-authorisation request form with relevant information.
  5. Hospital sends Pre Authorisation Request Form, ailment details & treatment estimate duly signed by treating doctor to HI TPA.
  6. HI TPA provides Pre-Authorisation Approval to hospital based on policy coverage, terms and conditions.
  7. Card Holder avails cashless treatment, fills up the claim form and gets discharged from the hospital after paying towards co-pay, non-payable items etc.
  8. Hospital submits all the claim documents in original like Preauthorisation Approval Form, Claim Form, Discharge Summary, Patient Bills, Reports, etc. to HI TPA.
  9. HI TPA team processes the claim documents and Insurance Company makes the payment to the hospital.
  10. Insured can also claim pre and post hospitalisation expenses as per policy terms and conditions from HI TPA by submitting claim documents, relevant bills etc.
  11. If the insured desires to have the original medical reports back the same can be collected from HI TPA office.
  12. If due to any reason the cashless facility is not availed or is not approved Insured member pays for the treatment upfront, Reimbursement of claim shall be filed with HI TPA after submission of Claim Documents as per documents checklist provided in the Claim Form/Website.

Reimbursement Claim

HI TPA shall process reimbursement claims of its members for the medical treatment availed by them in Non-Network Hospitals or for cases where cashless is not availed or denied.

The process for settling reimbursement claims is:

1

Member undergoes Hospitalisation

2

Collect & send the Discharge summary, claim form & bills to HI TPA

3

HI TPA receives the documents & reviews it

4

On Approval the member is reimbursed

Reimbursement claim process

  1. The insured member undergoes treatment at a hospital meeting the policy criteria.
  2. Insured member informs the HI TPA/Insurer within 24 hours of hospitalisation.
  3. Insured member makes the payment to hospital & collects all original bills & reports and gets claim form filled and counter signed by treating doctor.
  4. Insured member Submits the copy of Member id card, original Claim form, original bills, reports Etc. to HI TPA as per documents check list provided in the claim form/website/FAQ’s.
  5. Claim is processed as per policy T&C and payment is made to the Insured through NEFT.