{"id":2313,"title":"Health QuBE A la Carte Plan - Claim form","purpose":"claim","insurer":{"slug":"raheja-qbe-general-insurance","name":"Raheja QBE General Insurance Co. Ltd."},"source_pdf":"https://rahejaqbe.com/uploads/images/health-ala-carte/pdf/download/common-claim-form-V01.pdf","sha256":"07b17a68d87168482c5b17bdbe74413cefff1beb48ff3c769de43bc82002afe4","pages":8,"collected":"2026-10-17","instructions":{"about":"This form is used by the insured person to claim health insurance benefits under the Health QuBE A la Carte Plan. It is filled by the policyholder (insured) and the hospital.","notes":["Fill the form in block letters.","Use original bills only.","Use the specified date formats (dd-mm-yyyy or mm-yyyy) and time formats (hh-mm).","Attach all relevant documents as per the checklist.","For non-network hospitals, fill the additional section E.","Insurance is the subject matter of solicitation; read sales brochure carefully before concluding a sale.","No rebate is allowed as per Insurance Act 1938 Section 41."],"title":"Health QuBE A la Carte Plan - Claim form","submit":{"to":"Medi Assist Insurance TPA Pvt. Ltd","how":"submit the duly signed filled claim form along with original documents","address":"4th Floor, Aarpee Chambers, Shagbaug, Off Andheri-Kurla Road, Next To Times Square, Marol, Andheri East, Mumbai, Maharashtra 400059"},"purpose":"claim","sections":[{"title":"Details of Primary Insured (Section A)","fields":[{"help":"Enter the policy number as allotted by the insurance company","type":"text","label":"Policy No.:","options":[],"required":null,"pdf_field":""},{"help":"Enter the social insurance number or certificate number of social health insurance scheme","type":"text","label":"Sl. No./Certification No.:","options":[],"required":null,"pdf_field":""},{"help":"Enter full name of the policyholder (Surname, First name, Middle name)","type":"text","label":"Name:","options":[],"required":null,"pdf_field":""},{"help":"Enter full postal address including street, city and pin code","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"Enter the TPA ID number as allotted by IRDAI and printed in TPA documents","type":"text","label":"Company/TPA ID No.:","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Insurance History (Section B)","fields":[{"help":"Tick Yes or No","type":"yes-no","label":"Currently covered by any other Mediclaim/Health Insurance:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Use dd-mm-yyyy format","type":"date","label":"Date of commencement of first insurance without break:","options":[],"required":null,"pdf_field":""},{"help":"Enter full name of the insurance company","type":"text","label":"If yes, Company Name","options":[],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Have you been hospitalized in the last four years since inception of the contract?","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Use mm-yyyy format","type":"date","label":"Date:","options":[],"required":null,"pdf_field":""},{"help":"Enter diagnosis details","type":"text","label":"Diagnosis:","options":[],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Previously covered by any other Mediclaim/Health Insurance","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter full name of the insurance company","type":"text","label":"If yes, Company Name:","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Insured Person Hospitalized (Section C)","fields":[{"help":"Enter full name of the patient (Surname, First name, Middle name)","type":"text","label":"Name:","options":[],"required":null,"pdf_field":""},{"help":"Tick Male or Female","type":"choice","label":"Gender:","options":["Male","Female"],"required":null,"pdf_field":""},{"help":"Enter age in years and months","type":"number","label":"Age:","options":[],"required":null,"pdf_field":""},{"help":"Use dd-mm-yyyy format","type":"date","label":"Date of Birth:","options":[],"required":null,"pdf_field":""},{"help":"Tick the correct option or specify if Other","type":"choice","label":"Relationship to Primary Insured:","options":["Self","Spouse","Child","Father","Mother","Other (Please Specify)"],"required":null,"pdf_field":""},{"help":"Tick the correct option or specify if Other","type":"choice","label":"Occupation:","options":["Service","Self Employed","Homemaker","Student","Retired","Other (Please Specify)"],"required":null,"pdf_field":""},{"help":"Enter full postal address including street, city and pin code","type":"text","label":"Address (if different from above):","options":[],"required":null,"pdf_field":""},{"help":"Include STD code with telephone number","type":"phone","label":"Phone No.:","options":[],"required":null,"pdf_field":""},{"help":"Enter complete email address","type":"email","label":"Email ID:","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Hospitalization (Section D)","fields":[{"help":"Enter full name of hospital","type":"text","label":"Name of Hospital where Admitted:","options":[],"required":null,"pdf_field":""},{"help":"Tick the correct option","type":"choice","label":"Room Category occupied:","options":["Day Care","Single occupancy","Twin sharing","3 or more beds per room"],"required":null,"pdf_field":""},{"help":"Tick the correct option","type":"choice","label":"Hospitalization due to:","options":["Injury","Illness","Maternity"],"required":null,"pdf_field":""},{"help":"Use dd-mm-yyyy format","type":"date","label":"Date of injury/Date Disease first detected/Date of Delivery:","options":[],"required":null,"pdf_field":""},{"help":"Use dd-mm-yyyy format","type":"date","label":"Date of Admission:","options":[],"required":null,"pdf_field":""},{"help":"Use hh-mm format","type":"text","label":"Time:","options":[],"required":null,"pdf_field":""},{"help":"Use dd-mm-yyyy format","type":"date","label":"Date of Discharge:","options":[],"required":null,"pdf_field":""},{"help":"Use hh-mm format","type":"text","label":"Time:","options":[],"required":null,"pdf_field":""},{"help":"Tick the correct option","type":"choice","label":"If Injury give cause:","options":["Self Inflicted","Road Traffic Accident","Substance Abuse/Alcohol Consumption"],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"If Medico legal:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Reported to police:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"MLC Report & Police FIR attached:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter the system of medicine followed in treatment","type":"text","label":"System of Medicine:","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Claim (Section E)","fields":[{"help":"Enter amounts in rupees for: i) Pre-hospitalization Expenses, ii) Hospitalization Expenses, iii) Post-hospitalization Expenses, iv) Health-Check up Cost, v) Ambulance Charges, vi) Other (Code), and Total","type":"table","label":"Details of the treatment expenses claimed:","options":[],"required":null,"pdf_field":""},{"help":"Enter number of days","type":"number","label":"Pre-hospitalization period (days):","options":[],"required":null,"pdf_field":""},{"help":"Enter number of days","type":"number","label":"Post-hospitalization period (days):","options":[],"required":null,"pdf_field":""},{"help":"Tick Yes or No. If yes, provide details in annexure","type":"yes-no","label":"Claim for Domiciliary Hospitalization:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter amounts in rupees for: i) Hospital Daily Cash, ii) Surgical Cash, iii) Critical Illness Benefit, iv) Convalescence, v) Pre/Post hospitalization, vi) Others, and Total","type":"table","label":"Details of Lump sum/cash benefit claimed:","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Bills Enclosed (Section F)","fields":[{"help":"Enter Permanent Account Number as allotted by Income Tax department","type":"text","label":"PAN:","options":[],"required":null,"pdf_field":""},{"help":"Enter bank account number as allotted by the bank","type":"text","label":"Account Number:","options":[],"required":null,"pdf_field":""},{"help":"Enter full name of bank and branch","type":"text","label":"Bank Name and Branch:","options":[],"required":null,"pdf_field":""},{"help":"Enter name of beneficiary for cheque/DD","type":"text","label":"Cheque/DD Payable details:","options":[],"required":null,"pdf_field":""},{"help":"Enter IFSC code of bank branch","type":"text","label":"IFSC Code:","options":[],"required":null,"pdf_field":""},{"help":"List bills with Sl No., Bill No., Date, Issued By, Towards, Amount","type":"table","label":"Details of Bills Enclosed:","options":[],"required":null,"pdf_field":""}],"filled_by":"insured"},{"title":"Declaration by the Insured (Section H)","fields":[{"help":"Enter date in dd-mm-yyyy format","type":"date","label":"Date:","options":[],"required":true,"pdf_field":""},{"help":"Enter place","type":"text","label":"Place:","options":[],"required":true,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of the Insured","options":[],"required":true,"pdf_field":""}],"filled_by":"insured"},{"title":"Details of Hospital (Section A) - To be filled by Hospital","fields":[{"help":"Enter full name of hospital","type":"text","label":"Name of the Hospital:","options":[],"required":null,"pdf_field":""},{"help":"Enter hospital ID as allocated by TPA","type":"text","label":"Hospital ID:","options":[],"required":null,"pdf_field":""},{"help":"Tick the correct option","type":"choice","label":"Type of Hospital:","options":["Network","Non Network"],"required":null,"pdf_field":""},{"help":"Enter full name of treating doctor","type":"text","label":"Name of the treating Doctor:","options":[],"required":null,"pdf_field":""},{"help":"Enter educational qualification abbreviations","type":"text","label":"Qualification:","options":[],"required":null,"pdf_field":""},{"help":"Enter registration number with state code as allocated by Medical Council of India","type":"text","label":"Registration No. with State Code:","options":[],"required":null,"pdf_field":""}],"filled_by":"hospital"},{"title":"Details of the Patient Admitted (Section B) - To be filled by Hospital","fields":[{"help":"Enter full name of patient","type":"text","label":"Name of Patient:","options":[],"required":null,"pdf_field":""},{"help":"Enter insurance provider registration number","type":"text","label":"IP Registration Number:","options":[],"required":null,"pdf_field":""},{"help":"Tick Male or Female","type":"choice","label":"Gender:","options":["Male","Female"],"required":null,"pdf_field":""},{"help":"Enter age in years and months","type":"number","label":"Age:","options":[],"required":null,"pdf_field":""},{"help":"Use dd-mm-yyyy format","type":"date","label":"Date of Birth:","options":[],"required":null,"pdf_field":""},{"help":"Use dd-mm-yyyy format","type":"date","label":"Date of Admission:","options":[],"required":null,"pdf_field":""},{"help":"Use hh-mm format","type":"text","label":"Time:","options":[],"required":null,"pdf_field":""},{"help":"Use dd-mm-yyyy format","type":"date","label":"Date of Discharge:","options":[],"required":null,"pdf_field":""},{"help":"Use hh-mm format","type":"text","label":"Time:","options":[],"required":null,"pdf_field":""},{"help":"Tick the correct option","type":"choice","label":"Type of Admission:","options":["Emergency","Planned","Day Care","Maternity"],"required":null,"pdf_field":""},{"help":"Use dd-mm-yyyy format","type":"date","label":"If Maternity: Date of Delivery:","options":[],"required":null,"pdf_field":""},{"help":"Enter gravida status if maternity","type":"text","label":"Gravida Status:","options":[],"required":null,"pdf_field":""},{"help":"Tick the correct option","type":"choice","label":"Status at time of discharge:","options":["Discharge to home","Discharge to another hospital","Deceased"],"required":null,"pdf_field":""},{"help":"Enter total claimed amount in rupees","type":"amount","label":"Total claimed amount:","options":[],"required":null,"pdf_field":""}],"filled_by":"hospital"},{"title":"Details of Ailment Diagnosed (Primary) (Section C) - To be filled by Hospital","fields":[{"help":"Enter ICD 10 PCS code and description","type":"text","label":"ICD 10 PCS - Procedure 1:","options":[],"required":null,"pdf_field":""},{"help":"Enter details of the procedure","type":"text","label":"Details of Procedure:","options":[],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Pre-authorization obtained:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter pre-authorization number as allotted by TPA","type":"text","label":"Pre-authorization Number:","options":[],"required":null,"pdf_field":""},{"help":"Enter reason for not obtaining pre-authorization","type":"text","label":"If authorization by network hospital not obtained, give reason:","options":[],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Hospitalization due to injury:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Tick the correct option","type":"choice","label":"If yes, give cause:","options":["Self-inflicted","Road Traffic Accident","Substance abuse / alcohol consumption"],"required":null,"pdf_field":""},{"help":"Tick Yes or No. If Yes, attach report","type":"yes-no","label":"If injury due to Substance abuse/alcohol consumption, Test Conducted to establish this:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Medico Legal:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Tick Yes or No","type":"yes-no","label":"Reported to Police:","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Enter First Information Report number issued by police","type":"text","label":"FIR No.:","options":[],"required":null,"pdf_field":""},{"help":"Enter reason for not reporting to police","type":"text","label":"If not reported to police give reason:","options":[],"required":null,"pdf_field":""}],"filled_by":"hospital"},{"title":"Claim Documents Submitted - Check List (Section D)","fields":[{"help":"Tick if submitted","type":"checkbox","label":"Claim Form duly signed","options":[],"required":null,"pdf_field":""},{"help":"Tick if submitted","type":"checkbox","label":"Investigation reports","options":[],"required":null,"pdf_field":""},{"help":"Tick if submitted","type":"checkbox","label":"Original Pre-authorization request","options":[],"required":null,"pdf_field":""},{"help":"Tick if submitted","type":"checkbox","label":"CT/MR/USG/HPE investigation reports","options":[],"required":null,"pdf_field":""},{"help":"Tick if submitted","type":"checkbox","label":"Copy of the Pre-authorization approval letter","options":[],"required":null,"pdf_field":""},{"help":"Tick if submitted","type":"checkbox","label":"Doctor’s reference slip for investigation","options":[],"required":null,"pdf_field":""},{"help":"Tick if submitted","type":"checkbox","label":"Copy of photo ID card of patient verified by hospital","options":[],"required":null,"pdf_field":""},{"help":"Tick if submitted","type":"checkbox","label":"ECG","options":[],"required":null,"pdf_field":""},{"help":"Tick if submitted","type":"checkbox","label":"Hospital Discharge summary","options":[],"required":null,"pdf_field":""},{"help":"Tick if submitted","type":"checkbox","label":"Pharmacy bills","options":[],"required":null,"pdf_field":""},{"help":"Tick if submitted","type":"checkbox","label":"Operation Theatre notes","options":[],"required":null,"pdf_field":""},{"help":"Tick if submitted","type":"checkbox","label":"MLC report & Police FIR","options":[],"required":null,"pdf_field":""},{"help":"Tick if submitted","type":"checkbox","label":"Hospital main bill","options":[],"required":null,"pdf_field":""},{"help":"Tick if applicable and submitted","type":"checkbox","label":"Original death summary from hospital where applicable","options":[],"required":null,"pdf_field":""},{"help":"Tick if submitted","type":"checkbox","label":"Hospital break-up bill","options":[],"required":null,"pdf_field":""},{"help":"Specify any other documents submitted","type":"text","label":"Any other, please specify","options":[],"required":false,"pdf_field":""}],"filled_by":"hospital"},{"title":"Details in Case of Non Network Hospital (Section E)","fields":[{"help":"Enter full postal address including street, city and pin code","type":"text","label":"Name and Address of the Hospital:","options":[],"required":null,"pdf_field":""},{"help":"Include STD code with telephone number","type":"phone","label":"Phone No:","options":[],"required":null,"pdf_field":""},{"help":"Enter registration number with state code as allocated by Medical Council of India","type":"text","label":"Registration No. with State Code:","options":[],"required":null,"pdf_field":""},{"help":"Enter Permanent Account Number as allotted by Income Tax department","type":"text","label":"Hospital PAN:","options":[],"required":null,"pdf_field":""},{"help":"Enter number of inpatient beds","type":"number","label":"Number of Inpatient beds:","options":[],"required":null,"pdf_field":""},{"help":"Tick the correct options and specify others if any","type":"choice","label":"Facilities available in the hospital:","options":["OT: Yes","OT: No","ICU: Yes","ICU: No","Others (please specify)"],"required":null,"pdf_field":""}],"filled_by":"hospital"},{"title":"Declaration by the Hospital (Section F)","fields":[{"help":"Enter date in dd-mm-yyyy format","type":"date","label":"Date:","options":[],"required":true,"pdf_field":""},{"help":"Enter place","type":"text","label":"Place:","options":[],"required":true,"pdf_field":""},{"help":"Sign and stamp the form","type":"signature","label":"Signature and Seal of the Hospital Authority","options":[],"required":true,"pdf_field":""}],"filled_by":"hospital"}],"deadlines":[],"applies_to":"Health insurance claims under the Health QuBE A la Carte Plan","attachments":["Claim Form duly signed","Hospital Main Bill","Hospital Bill Payment Receipt","Pharmacy Bill","ECG","Investigation Reports (Including CT/MRI/USG/HPE)","Others","Copy of the claim intimation, if any","Hospital Break-up Bill","Hospital Discharge Summary","Operation Theatre Notes","Doctor’s request for investigation","Doctors Prescription","Original Pre-authorization request form","Copy of the Pre-authorization approval letter","Doctor’s reference slip for investigation","Copy of photo ID card of patient verified by hospital","MLC report & Police FIR","Original death summary from hospital where applicable"],"declarations":["The information furnished in this Claim Form is true and correct to the best of my knowledge and belief.","If any false or untrue statement, suppression or concealment of any material fact is made, the right to claim reimbursement shall be forfeited.","Consent and authorize TPA/insurance company to seek necessary medical information/documents from any hospital/Medical Practitioner who attended the person against whom this claim is made.","All bills/receipts for the purpose of this claim are included and no supplementary claim will be made except pre/post-hospitalization claim, if any.","The hospital declares that the information furnished is true and correct to the best of their knowledge and belief.","False or untrue statements by the hospital will forfeit the right to claim under this claim."],"dropped_labels":5},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"email","value":"customercare@rahejaqbe.com","label":"Claims service mail ID","level":null,"hours":"Monday to Saturday, 9 am to 8 pm","applies_to":"all","source_url":"https://rahejaqbe.com/claims","quote":"Commercial Lines Claims\nClick here\nto track you claim status\nClick here\nto Register a Claim\nIntermediaries\n18001027723\ncustomercare@rahejaqbe.com\nContact Us\nHospital\nLocator\nGarage\nLocator\nRegister\na Claim\nRegister\nComplaint With Us\nPolicy\nServicing\nLet us call you","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"info@mediassistindia.com","label":"Medi Assist TPA Email","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"TPA.\nContact number-\n1800-4259-449\n,\n9122-66620808\n,\n1800202022\n,\n1800220102\n,\n080-28004114/18004257878\nEmail address-\ninfo@mediassistindia.com\n,\ncontact.phs@paramounttpa.com\n,\nsupport@volohealthtpa.com\n,\ncustomersupport@healthindiatpa.com\n,\nhelp@vidalhealthtpa.c","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"cashless@mediassist.in","label":"Medi Assist TPA Cashless Email","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":", kindly visit\nhttps://www.medibuddy.in/claim\nToll Free Number :\n1800-4259-449\nEmail Address :\ninfo@mediassistindia.com\ncashless@mediassist.in\nCashless everywhere\nReimbursement claim registration :\nRetail\nCorp employee\nMedi Assist Insurance TPA Pvt. Ltd.\n4th Flo","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"contact.phs@paramounttpa.com","label":"Paramount TPA Email","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"4259-449\n,\n9122-66620808\n,\n1800202022\n,\n1800220102\n,\n080-28004114/18004257878\nEmail address-\ninfo@mediassistindia.com\n,\ncontact.phs@paramounttpa.com\n,\nsupport@volohealthtpa.com\n,\ncustomersupport@healthindiatpa.com\n,\nhelp@vidalhealthtpa.com\n,\nFor claim registration of","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"nonetwork.phs@paramounttpa.com","label":"Paramount TPA Non-network Email","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"ttpa.com/PolicyClaim/PolyClaimStatus.aspx\nToll Free Number :\n9122-66620808\nEmail Address :\ncontact.phs@paramounttpa.com\nnonetwork.phs@paramounttpa.com\nCashless everywhere\nReimbursement claim registration\nClaim tracker/status for all type of claims.\nParamount TPA Office","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"assistance@volohealthtpa.com","label":"Volo Health TPA Email","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"ed (Annual Disclosure) – Disclosures Data (22-23)\nTPA Details\nVolo Health\nToll Free Number :\n1800202022\nEmail Address :\nassistance@volohealthtpa.com\ncashlesseverywhere@volohealthtpa.com\nsupport@volohealthtpa.com\ncashless@volohealthtpa.com\nCashless everywhere\nReimburse","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"cashlesseverywhere@volohealthtpa.com","label":"Volo Health TPA Cashless Email","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"losures Data (22-23)\nTPA Details\nVolo Health\nToll Free Number :\n1800202022\nEmail Address :\nassistance@volohealthtpa.com\ncashlesseverywhere@volohealthtpa.com\nsupport@volohealthtpa.com\ncashless@volohealthtpa.com\nCashless everywhere\nReimbursement claim registration\nClaim tracker","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"support@volohealthtpa.com","label":"Volo Health TPA Support Email","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"202022\n,\n1800220102\n,\n080-28004114/18004257878\nEmail address-\ninfo@mediassistindia.com\n,\ncontact.phs@paramounttpa.com\n,\nsupport@volohealthtpa.com\n,\ncustomersupport@healthindiatpa.com\n,\nhelp@vidalhealthtpa.com\n,\nFor claim registration of other policies (\nSaral Surak","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"cashless@volohealthtpa.com","label":"Volo Health TPA Cashless Email","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"1800202022\nEmail Address :\nassistance@volohealthtpa.com\ncashlesseverywhere@volohealthtpa.com\nsupport@volohealthtpa.com\ncashless@volohealthtpa.com\nCashless everywhere\nReimbursement claim registration\nClaim tracker/status for all type of claims.\nVolo Health Insurance","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"customersupport@healthindiatpa.com","label":"HealthIndia Insurance TPA Email","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"004114/18004257878\nEmail address-\ninfo@mediassistindia.com\n,\ncontact.phs@paramounttpa.com\n,\nsupport@volohealthtpa.com\n,\ncustomersupport@healthindiatpa.com\n,\nhelp@vidalhealthtpa.com\n,\nFor claim registration of other policies (\nSaral Suraksha Bima\n,\nPravasi Bhartiya Bima Yoja","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"preauth@healthindiaindiatpa.com","label":"HealthIndia Insurance TPA Preauth Email","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"pa.com/CustomerCorner/ClaimStatus.aspx\nToll Free Number :\n1800220102\nEmail Address :\ncustomersupport@healthindiatpa.com\npreauth@healthindiaindiatpa.com\nCashless everywhere\nReimbursement claim registration\nClaim tracker/status for all type of claims.\nHealthIndia Insurance","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"help@vidalhealthtpa.com","label":"Vidal Health Insurance TPA Email","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"o@mediassistindia.com\n,\ncontact.phs@paramounttpa.com\n,\nsupport@volohealthtpa.com\n,\ncustomersupport@healthindiatpa.com\n,\nhelp@vidalhealthtpa.com\n,\nFor claim registration of other policies (\nSaral Suraksha Bima\n,\nPravasi Bhartiya Bima Yojana\n,\nGroup Hospital Cash\n,","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"claims@rahejaqbe.com","label":"Claims email for two wheeler bundled policy","level":null,"hours":null,"applies_to":"motor","source_url":"https://rahejaqbe.com/uploads/images/tw-bundle/pdf/download/tw-bundle-_Prospectus-V01.pdf","quote":"800-102-7723 or in writing at the nearest Offices or through an intermediary.\n• Alternatively, you can also reach us at claims@rahejaqbe.com You can report with vehicle/ report claim at network garage whereby claim registration shall be done by network garage","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"18001027723","label":"Claims call centre","level":null,"hours":"Monday to Saturday, 9 am to 8 pm","applies_to":"all","source_url":"https://rahejaqbe.com/claims","quote":"ims!\nExplore\nCommercial Lines Claims\nClick here\nto track you claim status\nClick here\nto Register a Claim\nIntermediaries\n18001027723\ncustomercare@rahejaqbe.com\nContact Us\nHospital\nLocator\nGarage\nLocator\nRegister\na Claim\nRegister\nComplaint With Us\nPolic","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800-4259-449","label":"Medi Assist TPA Toll Free Number","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"p Up\n,\nArogya Sanjeevani\n,\nGroup Health Insurance\n,\nGroup Health Super Top Up\n) kindly contact our TPA.\nContact number-\n1800-4259-449\n,\n9122-66620808\n,\n1800202022\n,\n1800220102\n,\n080-28004114/18004257878\nEmail address-\ninfo@mediassistindia.com\n,\ncontact.","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"9122-66620808","label":"Paramount TPA Toll Free Number","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"njeevani\n,\nGroup Health Insurance\n,\nGroup Health Super Top Up\n) kindly contact our TPA.\nContact number-\n1800-4259-449\n,\n9122-66620808\n,\n1800202022\n,\n1800220102\n,\n080-28004114/18004257878\nEmail address-\ninfo@mediassistindia.com\n,\ncontact.phs@paramounttpa","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800202022","label":"Volo Health TPA Toll Free Number","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"Health Insurance\n,\nGroup Health Super Top Up\n) kindly contact our TPA.\nContact number-\n1800-4259-449\n,\n9122-66620808\n,\n1800202022\n,\n1800220102\n,\n080-28004114/18004257878\nEmail address-\ninfo@mediassistindia.com\n,\ncontact.phs@paramounttpa.com\n,\nsuppor","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800220102","label":"HealthIndia Insurance TPA Toll Free Number","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"ance\n,\nGroup Health Super Top Up\n) kindly contact our TPA.\nContact number-\n1800-4259-449\n,\n9122-66620808\n,\n1800202022\n,\n1800220102\n,\n080-28004114/18004257878\nEmail address-\ninfo@mediassistindia.com\n,\ncontact.phs@paramounttpa.com\n,\nsupport@volohealtht","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"080-28004114/18004257878","label":"Vidal Health Insurance TPA Toll Free Number","level":null,"hours":null,"applies_to":"health","source_url":"https://rahejaqbe.com/claims/health-claims","quote":"Health Super Top Up\n) kindly contact our TPA.\nContact number-\n1800-4259-449\n,\n9122-66620808\n,\n1800202022\n,\n1800220102\n,\n080-28004114/18004257878\nEmail address-\ninfo@mediassistindia.com\n,\ncontact.phs@paramounttpa.com\n,\nsupport@volohealthtpa.com\n,\ncustomersupport@he","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800-102-7723","label":"Call centre for claims intimation","level":null,"hours":"9 am to 8 pm, Monday to Saturday","applies_to":"all","source_url":"https://rahejaqbe.com/uploads/images/two-wheeler-package/pdf/download/tw-package-prospectus-V01.pdf","quote":"ct numbers specified in the Schedule to the Policy.\n• Intimation of claim can also be made to Raheja QBE Call centre at 1800-102-7723 or in writing at the nearest Offices or through the intermediary.\n• Alternatively, you can also reach us at customercar","fetched_at":"2026-10-20"}],"how_to_use":"Ask the user for each field in order, in plain words; never invent an answer. Labels are as printed. If fillable_pdf is true, pdf_fields gives the PDF's own field names so the file can be filled directly. The printed form decides if anything differs.","url":"https://indiainsurances.com/forms/raheja-qbe-general-insurance/2313-health-qube-a-la-carte-plan-claim-form"}