Raheja QBE India Health insurance

Raheja QBE Health insurance review

• Benefits under Raheja QBE Health insurance plans include:

  Some of the benefits under the Raheja QBE Health plans are below…
  • Cashless facility – Raheja QBE processes all cashless claims across 5,000 + quality hospitals in their network across India.
  • Inpatient Benefit / Hospitalization Benefit : Hospitalisation expenses for a period of more than 24 Hours.
  • Pre /Post Hospitalization Benefit : Medical expenses incurred upto fixed days specified as per SI Band/Plans .
  • Ambulance Charges: Upto a maximum of 2500/- based upon the SI & Plan opted .
  • Daily Cash Allowance : Hospital daily cash benefit of upto maximum of 6 days .
  • Organ Donor Benefit : Medical Expenses on harvesting the organ from the donor for organ transplantation..
  • Recharge/Replenish Benefit: Replenishment of the basic sum insured if the basic sum insured has been exhausted during the policy year.
  • Health Checkup: Free Health Checkup based upon the SI Selected irrespective of the claims .
  • Non Medical Expenses: Reimbursement of Non-Medical Expenses upto the limit specified. .
  • Sum Insured Increase: In case of Cashless claim we would reduce your limit only by 90% .
  • Domicillary Hospitalisation : Medical expenses incurred for availing medical treatment at home which would otherwise have required hospitalisation
  • Optional Addons:
    • Sublimit Wavier : On payment of additional premium as specified we would waive the sub- limits pertaining to room rent, ICU charges, Medical Practitioners’ fees and disease related sub-limits.
    • Special NCB : On payment of additional premium we would given you a special premium discount of 5% on renewal of policy for a claim free policy. (Upto maximum of 20% cumulatively).
    • Co Pay : If you opt for co-pay of 20% we would give you a premium discount.
  • Income Tax Exemption under section 80D if the Income Tax Act.

• How can one Buy a Raheja QBE Health insurance policy?

  There are many distribution channels that distribute Raheja QBE Health insurance products that include Agents, Banks and Brokers. One of the key distributors is the Web Aggregators which are online distributors of insurance and the advantage is that they offer a comparison of all insurance products to the customer, to allow them to compare the plans before opting for a health insurance plan that most suits his/her needs.

  • Step 1- Visit a product comparison website eindiainsurance to review and compare policy benefits, coverage and premium details online.
  • Step 2 - Seek information and clarity on the charges, inclusions, exclusions, other terms and conditions under the policy.
  • Step 3 - Fill the Raheja QBE online Health Insurance proposal form stating your personal details and health profile while ensuring the information given is complete and accurate.
  • Step 4 – If this is a Straight through proposal, the premium remitted online will be transferred directly to the insurance company, and the policy will be issued, dispatched and will reach you in 7 working days.
  • Step 5 – For Non Straight through cases, Raheja QBE will process the application forwarded to them. Based on the information provided, one may be required to undergo pre-policy tests at designated diagnostic centers or they may just levy a loading based on the health report.
  • Step 6 - If the proposal is accepted, the same will be issued accordingly.
  • Step 7 - The Policy Schedule, Policy Wordings, Cashless Cards and Health Guide will be sent to the insured’s mailing address mentioned on the proposal form in the prescribed Turn around time.

• Claim process

  TPA details

  Kindly get in touch on the below mentioned toll free number or email for any claim related queries or assistances.
  
  Toll Free Number : 1800-4259-449
  Email Address : info@mediassistindia.com
  Write To : Medi Assist Insurance TPA Pvt. Ltd, 4th Floor, Aarpee Chambers,
  Shagbaug, Off Andheri-Kurla Road, Next To Times Square, Marol,
  Andheri East, Mumbai, Maharashtra 400059
  (or)
  Medi Assist Insurance TPA Pvt. Ltd. IBC Knowledge Park,
  Tower D, 4th Floor, Bannerghatta Main Rd, 4/1, Bengaluru,
  Karnataka 560029
  
  You can also contact Raheja QBE Insurance through:
  Toll Free Number : 1800-102-7723
  Email Address : customercare@rahejaqbe.com
  
  

  List of documents needed for Registering a Health claim

  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
  • Submit documents at nearest Raheja QBE branch.

  Points to Remember
  For Cashless Claims	For Reimbursement Claims
  Avail the benefits of cashless service at Raheja QBE network hospitals.	Mention correct and complete communication address with the pin code on the claim form.
  Kindly ensure that the pre-authorisation form is completely filled and signed by the Insured and the attending doctor.	Always keep a photocopy of the claim documents submitted to RQBE.
  Kindly ensure to mention the mobile number on the pre-authorisation form.	Kindly ensure that the claim form is completely filled and signed by the insured and the attending doctor.
  In case of planned hospitalization, please send the pre-authorisation form in advance (not before 15 days of admission date).	Kindly ensure to mention the mobile number on the claim form.
  In case of emergency hospitalization, please send the pre-authorisation form within 24 hours from the time of hospitalization.	All claim documents are to be submitted in original within 30 days from the date of discharge.
  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.	Quote your claim number as reference in all future correspondence with RQBE.
  Do not refer to the network list of any other service provider.	Insured to bear any inadmissible expenses, co-payments and or deductions.
  Do not wait until the discharge time to raise the enhancement request.
  Insured to bear any inadmissible expenses, co-payments and or deductions.

• Exclusions under the policy

  Some of the General Exclusions under the Raheja QBE Health plans include:

  • Expenses related to any admission primarily for diagnostics and evaluation purposes.
  • Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment
  • Expenses related to any admission primarily for enforced bed rest and not for receiving treatment.
  • Expenses related to any treatment, including surgical management, to change characteristics of the body to those of the opposite sex.
  • Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for reconstruction following an Accident, Burn(s) or Cancer or as part of medically necessary treatment to remove a direct and immediate health risk to the insured. For this to be considered a medical necessity, it must be certified by the attending Medical Practitioner.
  • Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports, including but not limited to, parajumping, rock climbing, mountaineering, rafting, motor racing, horse racing or scuba diving, hand gliding, sky diving, deep-sea diving.
  • Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to commit a breach of law with criminal intent.
  • Expenses incurred towards treatment in any hospital or by any Medical Practitioner or any other provider specifically excluded by the Insurer and disclosed in its website / notified to the policyholders are not admissible. However, in case of life threatening situations or following an accident, expenses up to the stage of stabilization are payable but not the complete claim.
  • Treatments received in heath hydros, nature cure clinics, spas or similar establishments or private beds registered as a nursing home attached to such establishments or where admission is arranged wholly or partly for domestic reasons.
  • Dietary supplements and substances that can be purchased without prescription, including but not limited to Vitamins, minerals and organic substances unless prescribed by a medical practitioner as part of hospitalization claim or day care procedure
  • Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 diopters.
  • Expenses related to any unproven treatment, services and supplies for or in connection with any treatment. Unproven treatments are treatments, procedures or supplies that lack significant medical documentation to support their effectiveness.
  • Expenses related to sterility and infertility. This includes:
    • Any type of contraception, sterilization
    • Assisted Reproduction services including artificial insemination and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI
    • Gestational Surrogacy
    • Reversal of sterilization
  • Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during hospitalization) except ectopic pregnancy
  • War (whether declared or not) or invasion, acts of foreign enemies, hostilities, civil war, rebellion, revolutions, insurrections, mutiny, military or usurped power, seizure, capture, arrest, restraints and detainment of all kinds.
  • Nuclear, chemical or biological attack or weapons, contributed to, caused by, resulting from or from any other cause or event contributing concurrently or in any other sequence to the loss, claim or expense.