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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

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  • United India Health Insurance
    "Good Policy"
    0.5 5.0/5 "Blown Away!"
    My company has given me a health insurance from united India. My entire family has been covered in this policy. I had no claim experience so far and i have not checked about the list of hospitals. I'm happy about the coverage amount they have given to me.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Jan 22, 2019
  • Apollo Munich Health Insurance
    "Good service"
    0.5 4.0/5 "Great!"
    I have taken my health insurance with Apollo Munich, there service is good, there agent had explain me about the policy which is covered in this insurance and they have tie up with many hospital and they have shared me there location , and the premium amount they have charged me up to 13,000, i use to pay through on line.
    Was this review helpful? 0
    , new delhi
    Reviewed on Jan 22, 2019
  • United India Health Insurance
    "Best Policy"
    0.5 3.0/5 "Satisfactory"
    I have chosen the United India health insurance policy without any reason. I got this policy for my entire family. I pay the premium amount of Rs. 16000 nearly. I have a claim experience with them and they have processed the claim in 3 days. They have given a claim upto 80%
    Was this review helpful? 0
    , bangalore
    Reviewed on Jan 22, 2019
  • review Health Insurance
    "Good service"
    0.5 4.0/5 "Great!"
    I have a health insurance policy with BHARATHI AXA , this policy cover accident claim and there customer support team have explain me about this policy . And the premium i pay per year it nominal, i pay through on line. Till now i have no claim experience with them, i have took the policy like in every five years they will reduces 5 % if i do not claim it, till now there service was good.
    Was this review helpful? 0
    , mumbai
    Reviewed on Jan 22, 2019
  • United India Health Insurance
    "Good Policy to take"
    0.5 5.0/5 "Blown Away!"
    I have purchased my United India health insurance in the year of 2002. I pay the premium amount of Rs. 12000. This is a primary plan. Me, my wife and my son has been covered in this policy. I have received the covered amount of Rs. 10 lakhs. I have not faced any issue in this policy.
    Was this review helpful? 0
    , ahmedabad
    Reviewed on Jan 22, 2019
  • HDFC Ergo Health Insurance
    "Average service"
    0.5 3.0/5 "Satisfactory"
    I have been using my health insurance with HDFC ERGO, they have charged me premium amount up to 500 rupees , this health insurance is a complimentary insurance issued my bank as i took this bank credit card, the premium amount it was to get deducted on yearly basis, and it use to get deducted from this bank credit card, and after that it converted in to Emi option, and till now i had no experience with this insurance, there is cash less treatment option available.
    Was this review helpful? 0
    , bangalore
    Reviewed on Jan 22, 2019
  • Bajaj Allianz Health Insurance
    "Good service"
    0.5 4.0/5 "Great!"
    I took my Health insurance with Bajaj allianz general insurance, they have tie up with many hospital, and they have shared me location regarding this, so far there was no claim experience with them . There is cashless treatment option available , the premium amount they have charged me previously on monthly basis, it was nominal premium charges, i have been paid for 4-5 years continuously, now maturity period got completed.
    Was this review helpful? 0
    , new delhi
    Reviewed on Jan 22, 2019
  • HDFC Ergo Health Insurance
    "Not satisfied with the service"
    0.5 1.0/5 "Really Bad"
    It was not quite a good experience i had with them where i had started this insurance policy in the year of 2009 and i had been paying the premium amount of 50,000 annually. There was not any single claim which i had made so far, until last year i had tried for a claim and the bill was around 40,000 and they had provided me with only 12,000 which was really a bad experience.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Jan 21, 2019
  • HDFC Ergo Health Insurance
    "Its Good"
    0.5 1.0/5 "Really Bad"
    Before four month my health policy got expired I don't have interest to renew it again. HDFC Ergo representative called me for the renewal. I don't have claim experience but I believe they provide ac room hospitalization for per day Rs. 3000 will be charged from the insured value and they do have no bonus feature.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Jan 21, 2019
  • Star Health Health Insurance
    "Good service"
    0.5 4.0/5 "Great!"
    I have been using my health insurance with Star health insurance, there service is good,i have applied two health loan , one for me and one for my parents, i had claim experience with it , as one year ago,i avail this insurance for my parents, there was cashless option available , and the premium amount they have charged me was nominal, for my parents i use to pay up to 27,000 as yearly basis, and for me 12,000 as yearly basis.
    Was this review helpful? 0
    , bangalore
    Reviewed on Jan 21, 2019
  • HDFC Ergo Health Insurance
    "Excellent service"
    0.5 5.0/5 "Blown Away!"
    I have been using my health insurance with HDFC ERGO , the agent that explain me clearly about the policy, and there benefits,and they have tie up with many hospital and they have shared me excel regarding this, i had claim experience on 2016 , my claim experience with this bank was good, the premium amount they have been charged on yearly basis,they have charged premium nominal.
    Was this review helpful? 0
    , bangalore
    Reviewed on Jan 21, 2019
  • Universal Sompo Health Insurance
    "Speedy claim recovery"
    0.5 4.0/5 "Great!"
    Holding my health insurance from Universal sompo. I'm not getting any mails or messages from Universal Sompo regarding the updates. The policy is really good. This is a 100% covered policy. They have processed the claim immediately with the cashless treatment. The hospital list is really good.
    Was this review helpful? 0
    , bangalore
    Reviewed on Jan 20, 2019
  • ICICI Lombard Health Insurance
    "Good service"
    0.5 4.0/5 "Great!"
    I have taken my health insurance with ICICI Lombard general insurance, there service is good, there agent had explain me about the policy which is covered in this insurance and they have tie up with many hospital and they have shared me there location , and the premium amount they have charged me was nominal,i use to pay on yearly basis.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Jan 20, 2019
  • HDFC Ergo Health Insurance
    "Good service"
    0.5 4.0/5 "Great!"
    I took my medi claim with HDFC ERGO, they have tie up with many hospital,and they have shared me the location regarding this,they have mention the location on excel,and the premium amount they have charged me is nominal,they have charged me on yearly basis.overall service is good.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Jan 20, 2019
  • Apollo Munich Health Insurance
    "Average Policy"
    0.5 3.0/5 "Satisfactory"
    My organization has given me a health insurance from Apollo Munich. I have not gone through about the documents and hospital list. My entire family has been covered in this policy. They have given me a satisfied coverage value. I have not contact the customer care so far.
    Was this review helpful? 0
    , gurgaon
    Reviewed on Jan 20, 2019
  • HDFC Ergo Health Insurance
    "Average Policy"
    0.5 3.0/5 "Satisfactory"
    I have purchased the health insurance from HDFC Ergo. For some enquiry, i have called the customer care service and they have resolved my query immediately. I have not made any claim experience so far. I pay the premium amount of Rs. 37000 and myself has been covered in this policy.
    Was this review helpful? 0
    , gurgaon
    Reviewed on Jan 20, 2019
  • Star Health Health Insurance
    "Less premium with Extra benefits"
    0.5 3.0/5 "Satisfactory"
    Taken my health insurance policy recently from Star. Till now i have not spoke with the customer care. Since my age is above 50, i made the premium amount of Rs. 17000. Myself, my wife and child has been covered in this policy. They have given me a coverage value of Rs. 4 lakhs. Almost major hospital has been covered in this list.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Jan 20, 2019
  • Reliance General Health Insurance
    "Overall Experience is good"
    0.5 4.0/5 "Great!"
    I'm using the health insurance from Reliance last 5 years. Since I'm the in charge of corporate insurance the customer care service is really fine. I made many claim from Reliance for other employee. As per the policy, they are fulfilling the customer needs. They are providing good cashless treatment facility. They used to send a updation on a regular basis.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Jan 20, 2019
  • Apollo Munich Health Insurance
    "Very Good Policy"
    0.5 5.0/5 "Blown Away!"
    I have a corporate covered health insurance policy from Apollo Munich. They have given me a coverage value of Rs. 4 lakhs. My entire family has been covered in this policy. This policy covers all the major hospitals in all over India. I have not made any claim so far.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Jan 20, 2019
  • ICICI Lombard Health Insurance
    "Average Policy"
    0.5 3.0/5 "Satisfactory"
    My health insurance was purchased from ICICI Lombard. To apply the claim, its a lengthy process. I had a claim experience and they have given the claim upto 80%. I pay the premium amount of Rs. 12500 every year. My entire family has been covered in this policy.
    Was this review helpful? 0
    , indore
    Reviewed on Jan 20, 2019
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