How does a TPA work?
TPA functions as intermediaries between the insurance provider and the policyholder and its key function is processing of claims and settlement.
The TPA issues ID cards to policyholders, which have to be shown to the hospital authorities before availing any cashless hospitalization services.
Who can submit claims online?
All the Medi Assist members, retail and group, can submit claims online through the MediBuddy App (available in Android and iOS) and MediBuddy Portal.
How do I submit a claim online?
Online claim submission can be done by logging into the portals mentioned above or through the MediBuddy App, available for iOS and Android.
Do I need to courier original documents if I submit a claim online?
A few insurers still ask for original documents. The same will need to be couriered to us within 15 days of claim submission online. You can courier the documents to your nearest Medi Assist Branch. You can find a list of our offices and our addresses here.
Can I submit COVID claims online as well?
Yes, COVID related claims can be submitted online too. Use the cashless/reimbursement options the same way you would for other claims.
How can I download an Ecard?
- You can either log on to ecard.medibuddy.in and click ‘Download E-Card’ or download your E-card post logging in to the MediBuddy portal
- Enter your Medi Assist ID/employee ID/ policy number or your claim ID.
- Fill all the other mandatory fields and click ‘View’ to verify and confirm your details.
- You can now download the E-Card.
- Alternatively, go to the MediBuddy app on your phone. Click the ‘ECard’ tile and enter your details. You can now view the E-Card on your app.
Which are the network hospitals that are applicable to me?
As a Medi Assist member, when you log into MediBuddy, the network hospital search feature enables you to filter hospitals by location, radius and specialty!
- You can further filter network hospital on the basis of:
- Hospital packages/procedures along with the prices, according to room types
- Photos and description of the hospitals
- You can also directly intimate the hospital of a eCashless hospitalization, and plan your cashless hospitalization in advance with MediBuddy.
How to avail Cashless facilities and whom do we contact at the time of cashless?
You can look at the procedure mentioned below to avail Medi Assist’s Cashless facilities:
- You opt for an eCashless using your MediBuddy mobile app or through the web portal
- Open portal.medibuddy.in on your browser and enter your username and password
- Click on the “Ecashless” on the home screen
- Fill in all the necessary details in the form. You can also choose your preferred hospital and room type.
- Upload the required documents on the portal/app and click on the Plan Button
- Once your cashless request is submitted, you will receive a success message
- The selected hospital receives this request from Medi Assist, confirms availability of room and provides an estimate for the treatment.
- Based on the confirmation from the hospital, Medi Assist sends a passcode protected provisional preauthorization request to the hospital.
- Simultaneously, you will receive a secure passcode on the mobile app.
- The hospital provides an early estimate for the treatment and forwards your request to Medi Assist.
- Medi Assist releases a provisional preauthorization to the hospital.
- On the date of admission, you walk into the hospital and show your secure passcode at the insurance desk.
- The hospital “unlocks” your provisional approval with your passcode and instantly hands over the preauthorization.
How to Intimate for Reimbursement?
Log into your MediBuddy portal or app and click the ‘Reimbursement’ tile. Fill in the required details and click ‘Intimate’.
What is the timeline for the same?
Claim intimation should be submitted within 7 (seven) days from the date of hospitalization/injury.
How do we claim reimbursement?
- Notify us in advance of your upcoming claim. Log into your MediBuddy portal or app and click the ‘Reimbursement’ tile. Fill in the required details and click ‘Intimate’.
- Upload your documents online
- Await confirmation on completeness of documents
- Send hard copies of your claim documents
- Intimate us about your impending claim.
- Present your Medi Assist Ecard at the hospital during admission along with any other legally accepted identity card.
Or, you can log into your Medi Assist online portal and click Generate E-Card to instantly generate and print out an e-card for any beneficiary.
- Submit your reimbursement claim online within 7 days from the date of discharge.
- Send the original documents to Medi Assist within 30 days from the date of discharge from hospital.
- Track your claim in real-time.
- The medical team at Medi Assist will process the claim.
- In case of approval, the amount is reimbursed either via NEFT or cheque (sent to the address mentioned in your policy).
- In case your claim is denied, the denial letter is sent to you by courier / post / email quoting the reason for denial of your claim.
*Medi Assist begins the process of settling your claims once you upload the scanned copies of documents on MediBuddy app/portal. However, do not forget to send us the hard copy of all your bills and documents you have uploaded within 15 days from the date of discharge, as claims can be settled only upon receipt and validation of the hard copies.
Where to submit the Reimbursement?
- You can submit the reimbursement claim on the MediBuddy portal.
- Click the ‘Reimbursement’ tile and upload the soft copies of all your documents.
- Take a print of the generated bar-coded claim form.
What is the List of Documents for the Reimbursement claim submission?
The following are the documents that you would have to submit while claiming a reimbursement:
- Original hospital final bill
- Original numbered receipts for payments made to the hospital
- Complete breakup of the hospital bill
- Original discharge summary
- All original investigation reports along with prescriptions
- All original medicine bills with relevant prescriptions
- Original signed claim form
- Copy of the Medi Assist ID card or current policy copy and previous years’ policy copies (if any)
- Covering letter stating your complete address, contact numbers and email address (if available).
How to track your claims?
Through MediBuddy app
Sign in to your MediBuddy app, click the ‘Claims’ tile, and start tracking your claims, in real-time.
Through the MediBuddy portal
Log into your MediBuddy online portal to track claims instantly. Visit track.medibuddy.in
When a family member or friend to get the claim status on your behalf
Login to track.medibuddy.in, to get the current claim status by entering details such as claim number, employee code, etc. All personal information is masked to ensure privacy.
Send us an SMS
SMS ‘CLAIMS (Claim Number)’ to +91 96631 49992 to get instant claim status via SMS.
Whom to contact at the time of claim submission?
You can Send us an SMS, SMS ‘CLAIMS (Claim Number)’ to +91 96631 49992 to get instant claim status via SMS or reach out to us at 1800 425 9449