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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 SERVICE"
      0.5 4.0/5 "Great!"
      I haev taken the health insurance policy with the HDFC ERGO GENERAL INSURANCE but i have not used this policy, i have not experienced with claim with this policy. I am holing this policy since from last 2 years. The medical coverage is for 5 lakhs where the premium i pay 7600k.
      Was this review helpful? 1
      , jaipur
      Reviewed on Nov 19, 2018
    • SBI General Health Insurance
      "Good insurance"
      0.5 5.0/5 "Blown Away!"
      My company has provided the health insurance policy with SBI General. They have given a coverage value of Rs. 5 lakhs. My entire family has been covered in this policy. I had a claim experience twice. I had submitted the documents to my company, they will proceed the claim. I have received the claim amount of Rs. 2 lakhs. Most of the major hospitals has been covered in this policy.
      Was this review helpful? 0
      , chennai
      Reviewed on Nov 18, 2018
    • HDFC Ergo Health Insurance
      "Good service"
      0.5 4.0/5 "Great!"
      I have been using my Health insurance with HDFC bank , and from past two years i have been using this insurance, there service is good, like i got this health insurance through my office as they only had created this health insurance for me and i use to pay premium per year, it use to get auto debited from my salary account.
      Was this review helpful? 0
      , new delhi
      Reviewed on Nov 18, 2018
    • Future Generali Health Insurance
      "Good service"
      0.5 4.0/5 "Great!"
      I have a health insurance with Future Generali Insurance from long time, i am not aware of the premium amount as it is to get auto debited on yearly bases and I do not have any claim experience but in terms for the features it is a good policy to have. It has been a very good experience with the Future Generali.
      Was this review helpful? 0
      , kolkata
      Reviewed on Nov 18, 2018
    • Star Health Health Insurance
      "Excellent policy"
      0.5 4.0/5 "Great!"
      I hold a health insurance policy with Star. This policy is taken for my family. They have given me a coverage amount of 3.5 lakhs. They have wide range of hospitals in my locality. I pay the premium amount of Rs. 11500. They are giving a cashless treatment facility anyway i had no claim experience with this policy
      Was this review helpful? 0
      , new delhi
      Reviewed on Nov 18, 2018
    • Oriental Insurance Health Insurance
      "Excellent"
      0.5 4.0/5 "Great!"
      I have a health insurance policy with Oriental which was provided by company.It is for entire family and policy coverage for per person is 2.5L.There is no claim experience. They have good network of hospital for the cashless facility. They cover all types of minor, major diseases and critical illness.
      Was this review helpful? 0
      , chennai
      Reviewed on Nov 17, 2018
    • ICICI Lombard Health Insurance
      "Good"
      0.5 4.0/5 "Great!"
      My company has provided me a health insurance policy with ICICI Lombard. Its been 2years now. It covers for entire family and policy coverage is 3L per person. There is no claim experience but I heard the claim process was good. Am not aware of the benefits.
      Was this review helpful? 0
      , chennai
      Reviewed on Nov 17, 2018
    • HDFC Ergo Health Insurance
      "GOOD"
      0.5 4.0/5 "Great!"
      I have been using with the health insurance policy with the HDFC ERGO GENERAL INSURANCE from past one year and i have paid the premium of 24k for this health insurance. They have provided me with the 12lakhs as medical coverage for my complete family.
      Was this review helpful? 2
      , new delhi
      Reviewed on Nov 16, 2018
    • Religare Health Insurance
      "Excellent service"
      0.5 5.0/5 "Blown Away!"
      I have a health insurance policy from the Religare Insurance company. I am paying a premium for a per year. I do not have any claim experience with this policy. Overall it has been a smooth experience with the policy so far. I'll have to wait and see how they respond to my request in future.
      Was this review helpful? 0
      , new delhi
      Reviewed on Nov 16, 2018
    • HDFC Ergo Health Insurance
      "GOOD SERVICE"
      0.5 5.0/5 "Blown Away!"
      I am using the health insurance policy with the HDFC ERGO GENERAL INSURANCE from past two years where i have no claim experience with this policy also added on that the premium i pay seven thousand rupees per year. The medical coverage is for six lakhs for complete family.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Nov 16, 2018
    • HDFC Ergo Health Insurance
      "GOOD SERVICE"
      0.5 5.0/5 "Blown Away!"
      I am using the health insurance policy with the HDFC ERGO GENERAL INSURANCE from past two years where i have no claim experience with this policy also added on that the premium i pay seven thousand rupees per year. The medical coverage is for six lakhs for complete family.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Nov 16, 2018
    • Religare Health Insurance
      "Necessary policy for all family"
      0.5 4.0/5 "Great!"
      I have no claim experience with Religare health insurance policy. I have purchased the policy 1 month before. They have offered me a coverage value of 5 lakhs. I have taken the policy for my family. I have no idea about the list of hospital. They are providing the cashless facility. I pay the premium of Rs. 11700.
      Was this review helpful? 0
      , faridabad
      Reviewed on Nov 16, 2018
    • review Health Insurance
      "Health insurance"
      0.5 4.0/5 "Great!"
      I have been holding the health insurance with Bharti AXA. My total family has been covered in this policy. They have given a coverage of 3 lakhs. The preety much hospitals has been covered in my location. My company has provided this policy around 6 months before. Since its a corporate policy, they have provided only to the employees.
      Was this review helpful? 1
      , mumbai
      Reviewed on Nov 16, 2018
    • Apollo Munich Health Insurance
      "Excellent service"
      0.5 5.0/5 "Blown Away!"
      I have a health insurance policy with Apollo Munich, this policy cover accident claim and there customer support team have explain me about this policy and the premium i pay 25,000-30,000 per year it nominal, i pay through on line, till now there service was good.
      Was this review helpful? 0
      , noida
      Reviewed on Nov 16, 2018
    • Star Health Health Insurance
      "Excellent service"
      0.5 5.0/5 "Blown Away!"
      I have a health insurance policy with Star health insurance, the premium i use to pay is up to 13,000 a per year its nominal for me, from past 1 year i have been using this insurance there customer service explain me about policy and i use to pay through on line like they use to send me the link i use to pay it.
      Was this review helpful? 1
      , mumbai
      Reviewed on Nov 16, 2018
    • HDFC Ergo Health Insurance
      "EXCELLENT"
      0.5 5.0/5 "Blown Away!"
      I have been using my health insurance policy with the HDFC ERGO GENERAL INSURANCE and the premium i am paying six hundred and thirty five rupees per month also it gives the coverage up to one crore rupees. It is a corporate policy, i am using from past 10 years but i had no claim experience.
      Was this review helpful? 0
      , bhubaneshwar
      Reviewed on Nov 16, 2018
    • Cigna TTK Health Insurance
      "Average"
      0.5 4.0/5 "Great!"
      I have chosen Health insurance with Cigna TTK. They provided me a cashless facility and reimbursement for my doctor bills. I have taken the policy for my entire family. I pay yearly 10K as a premium through ECS. The claim experience is excellent and the reimbursement was immediate. The policy coverage for me is 5L and rest of family members is 3L. They have more network of hospitals but they pay more attention on the medical bills.
      Was this review helpful? 0
      , thane
      Reviewed on Nov 15, 2018
    • Apollo Munich Health Insurance
      "Excellent"
      0.5 5.0/5 "Blown Away!"
      I had a health insurance for my family with Apollo Munich. My experience is good. Due to some reason, I was unable to pay the premium. The policy has been lapsed. I have paid 12K for a year. The payment mode is net banking. The policy coverage was 5L. It was covering almost all diseases, If I use even 5L at one time again they will provide 5L which was very good.
      Was this review helpful? 0
      , new delhi
      Reviewed on Nov 15, 2018
    • HDFC Ergo Health Insurance
      "Average service"
      0.5 3.0/5 "Satisfactory"
      I have been using HDFC ERGO health insurance for while , I never had any claim experience with the policy. I will have to wait and see how they respond to their claim requests in future, overall service was good it cover accidental policy and they charge nominal premium amount.
      Was this review helpful? 0
      , anantapur
      Reviewed on Nov 15, 2018
    • Star Health Health Insurance
      "Good service"
      0.5 4.0/5 "Great!"
      I have been using my health insurance with Star health insurance,there premium they charge is nominal only i use to pay my premium amount on monthly bases and it use to get auto debited with my bank account and they have explain me all policy which is cover in this policy clearly, till now i did not face any issue with this insurance.
      Was this review helpful? 0
      , bangalore
      Reviewed on Nov 15, 2018
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