Search for details of RELIGARE HEALTH network hospitals in India.
Religare Health Insurance (RHI) is a health insurance company specialising in offering health insurance products to individual customers, corporate employees, and customers who are liable for financial inclusion. The company was launched in July 2012, and has made a good amount of progress in the short time span following that. Today, the insurer has an extensive network of 56 offices around the country and a strength of above 2200 employees. They also have an alliance with more than 4900 leading hospitals around India.
The promoters of the insurance company are also founders of SRL Diagnostics, Fortis Hospitals, and Religare Wellness. Since these are front-end pharmacy and wellness retailers, the management has an excellent history of providing healthcare services in the country.
In the event of a claim the insurer attends to the request without involving any third-party in between; hence ensuring that the claim process is executed in an efficient manner. RHI also offers the best-of-breed health insurance products in the market today, to cater to the varied needs of customers. RHI provides four types of health insurance plans, namely:
Care - This plan brings you an elaborate set of benefits, such as a sum assured of up to Rs.60 lakh. Customers can also avail an increase in sum assured of 150% if they are eligible for a No Claim Bonus. The plan also offers annual health check-ups for policyholders, irrespective of their claims history. The insured can also avail direct cashless claim settlement at any of the network hospitals in a hassle-free manner.
Care Freedom - A distinct feature of this plan is the low waiting period of 2 years in the event of pre-existing diseases. There is no need to undergo a pre-policy check-up for customers of all ages. The plan also provides an annual health check-up for members, regardless of their claim history. Customers can also avail cashless claim settlement at any of the 4900+ hospitals in the network.
Enhance - This plan offers the flexibility of choosing deductibles and a wide range of options for the sum assured. Effectively, policyholders can avail up to Rs.60 lakh, which is an aggregate of the sum assured and deductibles. With the Enhance Anywhere feature, customers can benefit from selected medical treatment across the globe. Policyholders can also avail hassle-free cashless claim settlement from the vast network of hospitals affiliated to the insurance company.
Joy - Unlike the other schemes, this plan offers the customer newborn and maternity coverage. Customers can avail two types of coverages under the Joy Today and Joy Tomorrow schemes. This plan also provides ambulance cover and hospitalisation expenses, which include Inpatient and Day Care treatments. The plan can be purchased with a long-term policy tenure of 3 years. If the customer chooses to purchase the optional cover, No Claim Bonanza, he/she can avail 100% increase in sum assured as well.
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Religare Health Insurance Cashless Network Hospitals
A cashless network hospital is one with which the insurance company has a tie-up, so that when the policyholder needs to be hospitalised, he/she can avail treatment without having to pay for the medical expenses upfront. So, a cashless hospital is effectively similar to a non-partner hospital, except for the way in which the medical costs are settled.
The medical bills would be settled against the Sum Assured of the health insurance policy of the patient, and this amount would be borne by the insurance company. This is, however, subject to the treatment being covered under the health insurance policy that the patient is in possession of. The policyholder only has to inform the insurance company of the hospital where he/she would like to avail cashless treatment from. He/she would also be required to produce identification in the form of the policy document or an identity card issued by the insurer.
As mentioned above, RHI has a network of 4900+ network hospitals spanning across various cities in India. Customers can avail an extensive range of medical treatments on a cashless basis at these hospitals. The extent of coverage is predefined in each of the health insurance plans offered by the insurer.
What are the types of claims that can be done at Religare Health Insurance network hospitals?
The following types of claims can be executed at RHI network hospitals:
Cashless Claims - If the insured is hospitalised at a network hospital, he/she need not pay for the medical expenses, as per the coverage opted for, up to the sum assured predefined under the policy. The insurer co-ordinates with the hospital directly and settles the bill on behalf of the policyholder.
Reimbursement Claims - If the insured is hospitalised at any hospital, he/she can choose to pay the treatment expenses at the time of discharge. Subsequently he/she will have to file a claim with RHI for the reimbursement of these expenses. The insurer will review the claim and if admissible, will pay the insured the cost of treatment.
The claim process for a cashless hospitalisation is as follows:
If emergency hospitalisation is required, you should inform RHI within 24 hours of admission to the hospital. If it is a planned hospitalisation, RHI should be informed 48 hours before admission.
You should fill in the pre-authorisation form available at the hospital’s insurance desk or the RHI website. The form will be updated further by the hospital’s insurance desk, and will be faxed to the insurer.
The medical team of the insurance company will review the pre-authorisation document and provide their approval for the claim. The claim may not be approved if there is insufficient information or the like. In this scenario, the insured can raise a claim after discharge from the hospital for the reimbursement of expenses.
The claim process for reimbursement hospitalisation is as follows:
The insurer should be informed of the hospitalisation within 24 hours of admission if it is an emergency. If the hospitalisation is a planned one, RHI should be intimated 48 hours before admission. At the time of claim intimation, the claimant will be provided a reference ID from RHI for all future communication related to the claim.
The claim form is available at the insurer’s website. This form should be duly filled in and submitted along with some other documents. These should be mailed to the insurer’s address.
The insurer’s medical team will review the documents received from the claimant. If the claim is approved, the insured will be informed the same. In case of any deficiency in information, the insurance company will get in touch with the claimant.
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Procedures offered/covered in Religare Health Insurance network hospitals across India
The medical procedures covered under the RHI policies include certain operations on the eyes, ears, nose and sinus, tongue, bones, and skin. Procedures such as chemotherapy, radiotherapy, haemodialysis, coronary angiography, and lithotripsy are also usually covered. RHI policies also cover treatment of cerebrovascular disorders, surgeries for BPH, and treatment for total knee replacement.
However, the specific coverage varies according to the policy chosen, and this information will be available under the terms and conditions of the policy documentation.
Exclusions under Religare Health Insurance network hospital services
The standard exclusions to the RHI policies are as follows:
Pre-existing ailments will not be covered for at least 24 months after the date of policy issuance.
Diseases contracted within the first 30 days of the start date of policy (except those due to accidents) will not be covered.
OPD treatments are not covered.
Expenses from treatment for self-inflicted injury or attempted suicide will not be covered.
Expenses due to alcohol or drug abuse will not be included under the coverage.
Cost of contact lenses, spectacles, or dental treatment that does not require the insured to be hospitalised will not be covered.
Expenses for the treatment of AIDS will not be covered.
Treatment for pregnancy, miscarriage, or childbirth is not included under the coverage.
Treatment for congenital diseases are not covered.
Infertility treatments are not covered.
Non-allopathic treatments are not covered.
Certain other treatments, such as joint replacement procedures and non-infective arthritis are included under the coverage only after the policy has completed two consecutive years.
In the case of a reimbursement hospitalisation claim, what information does the claim form include?
The insured is required to submit a duly filled in claim form to the insurance company for a reimbursement hospitalisation claim. The format of the claim form is available at the Religare Health Insurance website. The claim form varies for the type of plan chosen by the insured.
The format generally contains personal details of the primary insured, his/her medical history, information regarding the hospitalisation, expenses incurred, details of the bills enclosed, and bank account information of the primary insured. The claim form also has a section that is required to be updated by the hospital where the treatment was availed. Additionally, it includes a consent letter from the insured to the hospital, authorising the insurance company to seek medical records regarding the ailment for which the treatment was provided.
At the time of a reimbursement claim, in addition to the claim form, what other documentation is required to be submitted?
The following documents should be submitted to the insurer for a reimbursement claim:
Doctor’s referral letter that indicates hospitalization
Original bills, discharge card, and receipts from the hospital/doctor
Indoor case papers
Original diagnostic tests reports/pathological/radiology reports and payment receipts
Post mortem report, if applicable
First information report, final police report, if applicable
Any other document as required by the insurance company
What is the difference between a critical illness, family floater and hospital cash insurance?
The family floater or the individual health insurance plans pay you for only your medical expenses at the hospital. These work on the principle of indemnity. The hospital cash insurance or the critical illness insurance pays you the amount insured, irrespective of the expenses for medical treatment. These are hence, referred to as benefit-based policies.
What is a No Claim Bonus?
If the policyholder has not made any claims in a policy year, then he/she is eligible to receive a No Claim Bonus that amounts to an increase in the sum insured for the subsequent year, with no change in premium. This amount increases with each passing year. If the insured raises a claim, the accumulated bonus is decreased by 10%.
How can I cancel my health insurance policy?
RHI offers a free-look period during which the policyholder can review the terms and conditions within the policy documentation. If he/she is not in agreement with these terms, then he/she can return the policy to the insurer. When the insurance company receives the returned policy, they will initiate the process for premium reimbursement. You can also cancel your policy any time after the free-look period. The premium will be refunded to you based on the short scale grid that is specified in the policy terms and conditions. If you have raised any claim under the policy, you will not be refunded the premium after the policy cancellation.
What is co-payment?
After you turn a certain age, you would be required to co-pay for your health insurance policy. Co-pay is the portion of the claim amount that the policyholder agrees to bear. This can be defined in terms of percentage or as an absolute amount. For instance, if you have opted for co-pay of 20% and raise a claim for Rs.10,000, you will have to bear Rs.2,000 (i.e., 20% of Rs.10,000) while the insurer pays Rs.8,000.
How do I find the list of RHI network hospitals?
You can find a list of the Religare Health Insurance network hospitals at the insurer’s website. You can also contact the insurer at 1800-200-4488 if you require further details.
How do I track my health insurance claim?
You can track your claim at the RHI website or by contacting their customer care desk at 1800-200-4488. You can also step into their branch or write to them at firstname.lastname@example.org for the same.
How many claims can I make during a policy year?
There is no limit on the number of times you can make claims in a policy year. However, the sum of the claim amounts cannot exceed the policy sum insured.
Why are there deductions in my claim amount?
Your claim amount may have been deducted due to the following reasons:
Inclusion of non-medical expenses, such as snacks, telephone bills, etc. which are non-payable.
Treatment details did not include prescription or proper bills.
You have exhausted the sum insured for the policy year.
The claim amount was exceeding certain pre-defined sub-limits.
Co-payment was applicable on the policy.
Expenses for any specific treatment was capped.
Original bills or reports were not submitted.
Expenses related to other treatment or investigations (not related to the ailment) were included under the claim.