Claims Assistance & Documentation Guidance

Health Insurance Claim Workflow

Option A: Cashless Hospitalization (Network Hospital)

1. Show your Health E-Card & Government Photo ID at the network hospital Insurance / TPA desk.
2. Hospital sends Pre-Authorization request form to the insurer/TPA (48 hrs prior for planned, within 24 hrs for emergency).
3. Insurer issues initial cashless approval within 1 to 2 hours.
4. At discharge, hospital submits itemized bill to TPA for final cashless authorization (mandated within 3 hours by IRDAI).

Option B: Reimbursement Claim (Non-Network Hospital)

1. Intimate claim to insurer/RakshaPoint IMF within 24 hours of emergency admission.
2. Pay hospital bills upfront and collect all original bills, payment receipts, discharge summary, diagnostic reports, and doctor prescriptions.
3. Submit signed claim form with original documents to the insurer/TPA within 15–30 days of discharge.

Life Insurance Death Claim Workflow

1. Intimate the claim to the insurer/RakshaPoint IMF specialist immediately with policy number.
2. Submit official municipal Death Certificate, original policy document, claimant bank account details (cancelled cheque), and nominee KYC (Aadhaar & PAN).
3. In case of accidental/unnatural death, provide FIR copy, Post-Mortem report, and Police Inquest report.
4. IRDAI mandates life insurers to settle clean claims within 30 days of document submission.

Motor Accident & Cashless Garage Claim Workflow

1. Do Not Move Vehicle without taking photos/videos of the collision site.
2. Intimate claim to insurer immediately to generate a Claim Registration Number.
3. Tow vehicle to a recognized cashless network garage.
4. Insurer appoints a surveyor who inspects damage within 24–48 hours and approves repair estimate.
5. Garage completes repairs; insurer settles bill directly with workshop minus compulsory deductible.

Frequently Asked Questions on Claims