Frequently Asked Questions
Is IHA an Insurance Company?
IHA is a TPA (Third Party Administrator) that functions as an intermediary between the insurance provider and the policyholder. The main function of TPA is processing and settlement of medical claims. We are in-house Claim Administrator for National Life & General Insurance Company ICA.
Services Offering being In-house Claim Administrator
1. Member enrolment and issuance of health card
2. Cashless service facility at network facilities up to the authorized limit as per policy terms & conditions
3. Reimbursement Claim Processing.
4. Call center service 24 X 7 through toll free Number.
5. Customer service support
What is a Claim?
Claim is the payment made by the insurer to the insured or claimant on the occurrence of the event specified in the contract, in return for the premiums paid for the insured.
How to submit a reimbursement claim?
You can submit a reimbursement claim to your respective insurance company through by Email to email@example.com
You can also submit a reimbursement claim either through the IHA office, and make sure you have on hand the following: - Complete details of the availed medical services, such as the healthcare provider name, service date and description and the physician name. - All necessary supporting documents, including the medical report, itemized bills and original receipts.
What is a complete reimbursement claim submission?
• Member’s/patient’s details (Name, Member ID, Date of birth etc.)
• Detailed Medical Reports clearly specifying the Diagnosis, date of onset of disease, similar disease in the past. previous & current treatment details including the prescribed medications, investigations and prognosis.
• Treating doctor’s signature and stamp
• Original Itemized Invoices or receipts for the amount claimed (invoice must show cost per service).
• Copies of results of diagnostic tests.
• Referral Letter from the treating physician in case of prescribed physiotherapy.
• Valid Prescription from the treating physician for the prescribed medication.
• A copy of radiology/imaging reports, blood test results, other reports for special/diagnostic procedures etc. (where you have paid and are claiming for radiology/x-rays, imaging procedures e.g. Ultrasound, CT and/or MRI Scans, blood tests, etc.)
• Discharge summary /Operative notes in case of Hospitalization or surgery.
• Police Report /Firsthand information report in case of accident related claims.
What is the time limit to submit a reimbursement claim?
You must send us the claim within 15days from the date of treatment for the treatment was taken with in Afghanistan. For treatment outside Afghanistan, the claim must be submitted within 30 days from the date of treatment.
Can I Receive Cash payment for my Reimbursement Claim?
Yes, but under specific condition applied by IHA.
If my Claim is rejected? How will I be Notified?
In case your claim gets rejected due to incomplete submission or ineligibility, you will be notified by the Reimbursement team through email and a statement of account will be sent to you with explanation of benefit stating the reason of rejection. Please provide a valid email address in the claim form where the team will be able to reach you.
Why is my Reimbursement amount less than the amount I had claimed for?
IHA will reimburse you for the claimed expenses according to coinsurance, deductible, geographical scope and reasonable & customary basis that can be found in your policy provisions. Did you know that if you go within the network of approved medical providers, you will benefit from:
• Direct Payment Facility – Only pay your deductible and IHA covers the rest
• No claim forms to fill, no documents to collect
• Pre-approvals are arranged by the network medical provider
How can I follow up on my reimbursement claim?
You can easily follow up on your reimbursement claim either by emailing to firstname.lastname@example.org or by calling the Call Center number on the back side of your insurance card.
What is Claim Rejection?
Refer “What is Direct billing Rejection,” Along with the reasons listed in Direct Billings rejection, 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/Duplicate C
Can I visit a Hospital or Clinic outside my assigned list of network provider’s?
Certainly you can, if your policy allows reimbursement benefit. Please call IHA call center to verify your benefit. If your policy allows reimbursement, we would not be able to pay directly to your preferred clinic or Hospital. You shall have to pay upfront and apply for reimbursement. List of all the documents required for reimbursement are listed in the reimbursement claim form. You may download the form from our website – the customer service /reimbursement form. You shall be refunded for the eligible expenses as per your policy terms and conditions.
What shall I do in case an emergency treatment is required while travelling outside Afghanistan?
If your plan covers the particular region where you are and require assistance for your treatment. You can call the number behind your IHA access card i.e. IHA call centre number available 24 x 7 for assistance required for all in-hospital treatment. In case you require only out-patient treatment you shall pay for the same and apply for reimbursement with all the requisite documents mentioned on the reimbursement claim form. The same can be downloaded from our website
How can I submit an Inquiry or a Complaint?
Go to Contact Us, Provide the required details and add your Inquiry or Complaint in the “Your Message“ text box and click on “Submit“. IHA Customer Service Team will revert within the maximum of 24 hours. You may also email us at email@example.com
What if I have lost my Insurance Card?
Contact your Corporate HR immediately if your insurance card is lost.
What do I do in an emergency?
Please contact our local Call Center number available at the back side of your insurance card. Our customer executives will provide assistance and clarify procedures.
How do I arrange direct settlement for planned in-patient treatment?
• Member visits the provider and consults with the physician.
• Provider will submit the request for elective in-patient services via email.
• Claim adjudication is done as per policy terms and conditions.
• Provider is replied back with the decision on claim within 24 hours for elective case.
• Provider receives the decision from IHA and informs members accordingly to plan the date and timings of service/s to be provided.
Do I need to Present any Photographic Identification along with my Health Insurance Card?
Yes. You are required to present your any government issued photographic identity (ID/passport) as per local health rules and regulations.
What is Pre-Existing and Chronic Conditions?
A pre-existing medical condition is a disease, illness or injury for which you have received medication, advice or treatment for, or experienced before availing for the medical insurance policy. chronic condition is a disease or illness that requires long-term treatment to control or manage the symptoms. It may or may not have a known cure and may continue indefinitely and is likely to come back once.
What is the Outpatient Procedure to be followed for Direct billing/Cashless directly with the Network facility?
Direct Billing/Cashless service can be availed at the network facilities. The procedure mentioned below needs to be followed while availing Cashless /Direct Billing. Choose network facility by contacting helpline. Show Insurance ID card and collect Pre-Authorization form from the hospital. Fill up personal details and the rest to be filled up by the hospital treating doctor along with contact number. If the services are upto the authorized limit as per agreement, Network Facility extend the service or else will send request to Inhouse TPA for approval. Inhouse TPA shall process the claim as per policy terms and conditions and send an approval letter to the hospital. Avail the treatment without any payment except for non-payable items as per policy terms. Please ensure claim form is filled and duly signed and final bill is signed before leaving the facility. Payment will be made directly to the Network Facility.
What are the documents required to avail Direct Billing/Cashless facility?
Office Photo ID proof, Health Insurance ID
What is Direct Billing Rejection?
Rejection will be done as per the policy terms and coverage, the below are the few examples for rejection. If hospitalization is for observation & investigation purpose. If any particular aliment/disease/treatment is found that are not covered under policy term and condition. If found that the treatment can be done under OPD basis. If found that no active line of treatment is available. If Shortfall and the policy holder has not responded within the given TAT. If policy is invalid. Rejection of Direct billing is not a denial of treatment.