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  • Reimbursement & Cashless Claims Procedure

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    Cashless Treatment

    Customer Service

    Medical Coverage

    Claim Experience

    Responsiveness

    Cashless Claim Process:

    In order to avail the cashless claim facility, the insured has to be treated in an empanelled hospital. By providing the details of the health insurance policy and presenting the e-card or other physical proof of the health insurance taken in the name of the policyholder, he or she can avail cashless hospitalization and treatment, if the illness/ injury is covered under the policy. Once the patient is discharged from the hospital, all the medical bills are sent to the insurance provider by the hospital. The insurance provider then evaluates the expenses and settles the payment.

    The claims process for treatment at a cashless network hospital varies according to the type of treatment – Planned or Unplanned. Unplanned medical treatment at a cashless network hospital usually happens in case of an emergency.

    • Claims Process for Planned Treatment at the Cashless Network:

      Usually, the insured has to inform the insurance provider of the hospitalization or treatment requirement ahead of time in order to avail cashless treatment. The company should be informed at least 4 days before the treatment date. A cashless claim request form should be submitted at the relevant address of the insurance provider – mostly via post, e-mail, or fax. For more information you can contact the customer care of your health insurance provider. Once these steps are completed, the insurance provider will notify the insured as well as the concerned hospital regarding the policy cover and eligibility. On the day of admission in the hospital, the policyholder has to display his/her health insurance card and the confirmation letter. The medical bills will be paid by the insurance provider, directly to the hospital.

    • Cashless-and-Reimbursement-Claims-in-Health-Insurance
    • Claims Process for Emergency Treatment at the Cashless Network:

      The policyholder can contact the customer care help desk of an insurance provider in order to get information about the nearest network hospital. By displaying your health insurance card, you can avail cashless hospitalization. The hospital has to fill in the cashless claim request form and submit it at the relevant address of the insurance provider – mostly via post, e-mail, fax or through customer care. An Authorization Letter will then be issued by the insurance provider to the hospital, indicating the policy coverage. The medical bills will be paid by the insurance provider, directly to the hospital. In case of rejection of the claim, a letter will be sent to the insured, stating the reasons for rejection.

    Reimbursement Claim Process:

    The reimbursement claim for health insurance can be made if the policyholder opts to go to a hospital of his/ her choice, which is a non-empanelled hospital. In this case, the cashless claim facility cannot be used. Therefore, the insured has to pay all his/ her medical bills and other costs involved in hospitalization and treatment and then claim reimbursement. In order to avail reimbursement claim you have to provide the necessary documents including original bills to the insurance provider. The company will then evaluate the claim to see its scope under the policy cover and then makes a payment to the insured. In case the treatment is not covered under the policy, the claim will be rejected. The insurance provider generally provides reasons for the rejection.

    Documentation:

    The following documents are required in order to make a health insurance claim:

    • Duly filled claim form
    • Medical Certificate/ Form which is signed by the treating doctor.
    • Discharge summary or card (original), availed from the hospital.
    • All bills and receipts (original)
    • Prescription and cash memos from pharmacies/ the hospital.
    • Investigation report
    • If it is an accident case, then the FIR or Medico Legal Certificate (MLC) is required.

    GST rate of 18% applicable for all financial services effective July 1, 2017.

    Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.

    Health Insurance Claims Procedure Reviews

  • Page 1 of 50 1 2 3 4 5
    • HDFC Ergo Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have a health insurance policy with HDFC ERGO from last 2 years, i am happy with the coverage value of this insurance policy. I have no claim experience so far with this insurance policy. A premium of Rs 6000 has to be paid for this insurance and the coverage value is Rs 3-4 lacs.
      Was this review helpful? 0
      , vadodara
      Reviewed on Sep 17, 2018
    • Star Health Health Insurance
      "Average Service"
      0.5 3.0/5 "Satisfactory"
      I was using the health insurance policy with the Star Health. I am paying a premium of 35K per year. On one occasion I claimed the policy and they were able to reimburse only 75% of the amount claimed which wasn't satisfactory.
      Was this review helpful? 3
      , hyderabad
      Reviewed on Sep 15, 2018
    • Reliance General Health Insurance
      "Average Service"
      0.5 3.0/5 "Satisfactory"
      I've a health insurance policy with the Reliance General Insurance. I am paying a premium of 27000 per year. It is for the entire family. There hasn't been any claim experience so far. I will have to wait and see how they respond to my requests in future if I will have any.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Sep 15, 2018
    • New India Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      My health insurance is with New India Assurance from last 1 year, i am not aware of the premium amount as my company pays it. I have no claim experience so far with this insurance policy and the coverage value is Rs 2 lacs for individual.
      Was this review helpful? 1
      , bangalore
      Reviewed on Sep 14, 2018
    • Apollo Munich Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have a health insurance policy with Apollo Munich from last 7-8 years, i have no claim experience so far with this insurance policy. I pay a premium of Rs 12000 for this insurance policy and the coverage value is Rs 5 lacs for this policy.
      Was this review helpful? 0
      , pune
      Reviewed on Sep 12, 2018
    • Cigna TTK Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have a health insurance policy with CIGNA TTK from last 2 years, i am happy with the coverage value of this insurance policy. I pay a premium of Rs 12000 for this insurance policy. I have no claim experience so far with this insurance and the coverage value of Rs 4.5 lacs.
      Was this review helpful? 0
      , bangalore
      Reviewed on Sep 12, 2018
    • Max Bupa Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have a health insurance policy with MAX BUPA from last 6 years, i am happy with the coverage value of this insurance policy. I have no claim experience so far with this insurance and i get no claim bonus every year. The coverage value for this insurance is Rs 15-20 lacs.
      Was this review helpful? 0
      , faridabad
      Reviewed on Sep 12, 2018
    • ICICI Lombard Health Insurance
      "Good Policy"
      0.5 3.0/5 "Satisfactory"
      I have recently taken a health insurance policy with ICICI LOMBARD. I have to pay a premium of Rs 15000 on yearly basis. This policy i got it along with the personal loan taken from Fullerton. They gave a coverage of Rs 3 lacs for this insurance policy.
      Was this review helpful? 1
      , rajahmundry
      Reviewed on Sep 12, 2018
    • Star Health Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      My health is insured with STAR health from last 1year and it is a good policy to use. It is a family policy where the coverage value is Rs 3 lacs per individual. I do not have claim experience with this insurance and i pay a premium of Rs 15000 for this insurance.
      Was this review helpful? 1
      , coimbatore
      Reviewed on Sep 12, 2018
    • Religare Health Insurance
      "Best policy"
      0.5 5.0/5 "Blown Away!"
      I have a health insurance policy with Religare from last 1.5 years, a premium of Rs 14000 has to be paid for this insurance policy and it is a family coverage. My claim experience was very good and they covered 100%. Coverage value is Rs 5 lacs +5 lacs (auto refill) for this insurance.
      Was this review helpful? 0
      , ahmedabad
      Reviewed on Sep 12, 2018
    • Reliance General Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have my health insured with Reliance general insurance from last 3 months, i pay a premium of Rs 10000 for 2 individuals and each one has the coverage value of Rs 5 lacs. It is a good policy to use and i have not claimed anything so far from this insurance.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Sep 12, 2018
    • National Insurance Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I hold an Individual health insurance policy with National insurance from last 4 years, i have not claimed anything so far from this insurance policy. I pay a premium of Rs 3000 for this insurance policy and the coverage value is Rs 1.5 lacs for this insurance.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Sep 12, 2018
    • HDFC Ergo Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have my health insured with HDFC ERGO from last 1.5 months, i am happy with the coverage value of this insurance policy. A premium of Rs 6000 has to be paid for this insurance policy. I have no claim experience with this insurance the coverage value is Rs 5 lacs.
      Was this review helpful? 0
      , palanpur
      Reviewed on Sep 12, 2018
    • ICICI Lombard Health Insurance
      "Normal Service"
      0.5 4.0/5 "Great!"
      I've a health insurance policy with the ICICI Lombard. I am paying low premium, there hasn't been any claim experience with the policy so far. Considering the premium I pay it has been a normal experience with the policy so far.
      Was this review helpful? 1
      , udaipur
      Reviewed on Sep 11, 2018
    • ICICI Lombard Health Insurance
      "Good Service"
      0.5 5.0/5 "Blown Away!"
      I've a health insurance policy with the ICICI Lombard, I am paying the premium and I do not have any claim experience with the policy so far. I'll have to wait and see how they respond to my claim requests in future. It has been a hassle free experience so far.
      Was this review helpful? 0
      , bangalore
      Reviewed on Sep 11, 2018
    • Star Health Health Insurance
      "Start Health Insurance Fraud"
      0.5 0.5/5 "Unacceptable"
      My father purchased Star health insurance for family safety and was paying premium from last 2 years but when time came insurer refused to give claim stating that throughout the hospitalization and all investigation reports are within normal limits. My brother was admitted in family hospital delhi for 24 hours, doctors diagnosed him and billed approx 13500.
      Was this review helpful? 3
      , new delhi
      Reviewed on Sep 08, 2018
    • Chola Ms Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have my health insured with Cholamandalam health insurance from last 2 years, i am happy with the coverage value of this insurance policy. I am not aware of the premium amount as my company pays it. It is a family coverage and they cover up to Rs 5 lacs for this insurance.
      Was this review helpful? 0
      , bangalore
      Reviewed on Sep 08, 2018
    • Apollo Munich Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have a health insurance policy with Apollo Munich from last 3 months, i am happy with the coverage value of this insurance. I am not aware of the premium amount as my company pays it. The coverage value is Rs 10 lacs for accidental policy and Rs 10 lacs for death policy.
      Was this review helpful? 0
      , pune
      Reviewed on Sep 08, 2018
    • National Insurance Health Insurance
      "Very Good Service"
      0.5 4.0/5 "Great!"
      I had taken this insurance policy almost ten years back and the premium had been paying online. The premium amount has not been higher and it was nominal. Their customer support and their staff responses also had been good as well. They also covers most of the hospitals in our locality.
      Was this review helpful? 0
      , coimbatore
      Reviewed on Sep 07, 2018
    • ICICI Lombard Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have an Individual health insurance policy with ICICI Lombard from last 4 years, i pay a premium of Rs 6500 for this insurance policy. I have not claimed anything so far from this insurance policy. The coverage value for this policy is 7 lacs.
      Was this review helpful? 1
      , faridabad
      Reviewed on Sep 06, 2018
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