Customer needs to drop into a Vidal Health Insurance TPA Pvt. Ltd. network hospital to give a copy of his / her Vidal Health Insurance TPA ID card and Identity proof at Hospital reception. Pre-authorisation form has to be filled which has two parts. Part 1 needs to be filled by the patient or the patient's family and part 2 needs to the filled by the Hospital authority / Treating doctor. The completely filled form should be faxed or mailed to Vidal Health Insurance TPA Pvt. Ltd. (respective branches). Once pre-authorisation form is received by Vidal Health Insurance TPA Pvt. Ltd. the case will be processed within 4 hours and the initial authorization letter (approved or rejected) will be faxed / emailed back to hospital by Vidal Health Insurance TPA Pvt. Ltd.

Note:- For planned hospitalization: - Pre-authorisation form to be sent before 48 hours of hospitalization.
For Emergency: - Pre-authorisation form to be sent within 6 hours from the time of admission.

On the date of discharge hospital team have to send the final bill with break up and discharge summary to Vidal Health Insurance TPA Pvt. Ltd. After the receipt, within 2 hrs the enhancement (as per policy limits) will be processed after deducting the non medical expenses (paid by the patient) and approval letter will be sent to hospital fax or email.

Note:- Co pay (if applicable) has to be paid by the Policy holder.
Some of the Hospitals are Preferred Provide Network (PPN), Gipsa and Hospital tariff, if cashless is taken in those hospitals the final approval will be as per the respective tariff.

Once the shortfall is responded, within 2 hours the case will be processed.

Hospital team needs to send the letter / fax / email to Vidal Health Insurance TPA Pvt. Ltd., asking them to cancel the approval. The cancellation letter will be sent to hospital within 2 hours.

Yes. If it is a planned hospitalization then the pre-authorization request needs to be sent before 48 hours from the date of admission. In case of emergency the pre-authorisation request needs to send within 6 hours from the time of admission.

Yes. The policy holder needs to pay the non medical expenses and the co-pay amount (if applicable). He will need to pay the difference amount (difference between the final bill and approved amount).

Non Medical expenses are: Admission fees, Registration fees, gloves, blade, water, bed, food & beverages, extra bed etc.

Minimum 24 hours of hospitalization (if not day-care) with active line of treatment is required for cashless treatment However, there are a few specific ailments specified in the policy which can be covered even though the period of hospitalization is less than 24 hours. Such as Dialysis, Chemotherapy, Radiotherapy, Eye Surgery etc.

Rejection will be done as per the policy terms and coverage, the below are the few examples for rejection.

1. If hospitalization is for observation & investigation purpose.
2. If any particular aliment / disease /treatment is found not covered under policy term and condition.
3. If found that the treatment can be done under OPD basis.
4. If found that no active line of treatment is available.
5. If Shortfall and the policy holder has not responded within the given TAT.
6. If policy is invalid.
7. Rejection of cashless is not a denial of treatment.

In such a situation the policy holder will be liable to pay the difference amount. We will inform the hospital about the policy holder’s eligible amount and hospital will recover the amount over and above the credit amount from the policy holder directly.

Member Claim and Network Claim (for Hospital).

Policy holder has to intimate Vidal Health Insurance TPA Pvt. Ltd. before sending the claim documents if he/she wants to claim after discharge, Intimation has to be given within the TAT as per the insurance company.

Yes. If it is a planned hospitalization then the pre-authorization request needs to be sent before 48 hours from the date of admission. In case of emergency the pre-authorisation request needs to send within 6 hours from the time of admission.

Policy holder will need to download the claim form No 9 from our website www.vidalhealthtpa.com. The claim form contains 4 pages which includes medical certificate also. The medical certificate needs to be filled in by the Treating doctor with hospital seal and doctor’s signature. The policy holder should fill the claim form and should attach all his original bills and send a courier to Vidal Health Insurance TPA Pvt. Ltd. (respective branches).

Note:- The claim documents has to reach Vidal Health Insurance TPA Pvt. Ltd., within the TAT as per the Insurance company TAT For all United India Insurance policy holder ECS is mandatory, they have to send ECS form along with the cancelled cheque with the original claim documents.

Once Vidal Health Insurance TPA Pvt. Ltd. receives the claim documents, Claim will get processed within 21 working days.

Cheque will be dispatched within 7-10 working days from the date of approval.

Vidal Health Insurance TPA Pvt. Ltd. will assess the validity of the claim based on the documents submitted, validate the policy, validate the treatment undergone and settle the claim within the claim settlement parameters. In case of claim is not adhering with parameters, the case would be rejected.

Vidal Health Insurance TPA Pvt. Ltd. will correspond with you within 7 days of Claim receipt - If Documents are not completed then Vidal Health insurance TPA Pvt. Ltd. will request for the shortfall documents.

Note : If any bills and receipts are not supported by valid documents, then the claimed amount of that bill will not be processed.

Yes, you will be intimated on your claim status to your updated email id from our database.

You can login to your account in our web portal or you can call our call center to check the claim status.

You should submit the entire set of original documents like

1. Claim form duly signed.
2. Vidal Health Insurance TPA card (photo copy).
3. Identity Proof (photo copy).
4. Discharge summary with seal & signature of the hospital authority.
5. In-patient bills.
6. Doctor's prescription.
7. Pharmacy bills with break ups.
8. Investigation reports like MRI, ECG, CT scan, and X-Ray etc.
9. Laboratory reports.
10. Paid receipt with hospital seal & signature.
11. Hospital registration copy (if required).

Shortfall documents are those which are not submitted by the claimant, which is mandatory for further claim process.

You can send the shortfall documents to respective Vidal Health Insurance TPA Pvt. Ltd. branch through post / courier or by walking in to respective branch.

You should send within 7 working days from the date of receiving the S/F query / letter.

The amount which is not approved is disallowed amount such as non medical expenses, no proper bill break up, lab report not submitted aliment capping, exceeds sum insured / aliment limit etc.

Yes. If it is a planned hospitalization then the pre-authorization request needs to be sent before 48 hours from the date of admission. In case of emergency the pre-authorisation request needs to send within 6 hours from the time of admission.

• Refer cashless rejection, a part from those the below are the few reasons for claim rejection.
• Claim docs not submitted within the given TAT.
• Claim intimation not given.
• Date of inception is greater than date of admission.
• Fraud Case.

Day Care surgeries are those which do not require 24 hours of hospitalization such as Cataract (Eye) surgery, Dialysis, Kidney stone removal, Chemotherapy, D & C etc.

Depending on Insurance policy some of the day care surgeries are payable according to term and conditions.

You can login to your account in Vidal Health Insurance TPA web portal and download E-Card or call the call center and place the request.