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  • Apollo Munich Health Insurance Claims Procedure

    Apollo Munich Health Insurance

    Apollo Munich health insurance policies not only offer comprehensive healthcare packages for their customers but also provide a hassle free claim process in order to get the competitive edge in the market. There are two main types of claims that are provided by Apollo Munich - Cashless claims for either planned or emergency visits, and reimbursement claims where policyholders claim for refund of cash already spent towards hospitalization and other charges. Apollo Munich also boasts a large list of network hospitals where one can claim cashless hospitalization benefits. Whenever a policyholder applies for a claim it is advisable that they keep a copy of the documents they have submitted towards the claim.

    Incurred Claim ratio of Apollo Munich Health Insurance:

    ICR or Incurred claim ratio is the overall amount or value of claims paid by the company divided by the total sum of premiums collected by that company for a specified period. This data is published by the IRDA and the below table showcases the Incurred Claim ratio of Apollo Munich for the year 2014-15

    Net earned premium (in lakhs) Net claims paid (in lakhs) Incurred claims ratio
    65,558 41,343 63.03%

    The ICR of Apollo Munich is in good stead and shows that they have made a quality high selling product.

    Claim procedure:

    With Apollo Munich Insurance, the claims procedure by far and large remains the same for almost all policies with slight differences for each policy. Policyholders can avail cashless claims or claim for expenses already incurred. The following claim procedure highlights the necessary steps required to file the claim.

    1. Cashless claim:

      In cashless claim, one need not settle the bill themselves. They needn’t even pay cash the insurance company will be represented by a TPA who will settle the bill with the hospital directly. The procedure for cashless emergency claims and cashless planned claims vary

      • Cashless claims procedure for emergency admission:

        Emergency hospital visits are a cause of worry itself and to worry about insurance claims and money spent out of pocket will only add to it. Upon admission, one will have to check with Apollo Munich if cashless claims can be made. If the hospital of admission falls in the network of cashless hospitals supported by Apollo Munich then the following procedure needs to be followed.

        Intimate Apollo Munich of the emergency hospital admission within 24 hours. Reach out to the hospital insurance help desk and have them fill in the details of the cashless claim and send it over to Apollo Munich for a cashless claim. This claim needs to be certified by the attending doctor. The hospital insurance helpdesk will either send over the insurance claim themselves or one can fax it to Apollo Munich. The fax number can be availed by calling the toll free number and requesting for it. The toll free number is 1800-102-0333.

        • The TPA will then review the documents submitted. If additional documents are required, the TPA will request for their submission. If the TPA approves the claim, then the hospital bills and all expenses covered under the policy will be settled by the TPA and other expenses not covered by the policy will need to be settled by the patient/policyholder
        • For some reason if the claim is not supported, then the bills need to be settled by patient or policyholder and a request for reimbursement can be made. Decisions for rejection will be provided through a rejection letter. Rejection of a cashless claim does not signify rejection of the reimbursement
      • Cashless claims procedure for planned admission:

        If the patient or policyholder plans on getting a particular treatment at a hospital on the network panel and intends to avail the cashless claim then they need to follow the planned cashless claim procedure which is as follows:

        • Select the hospital from the network hospital list.
        • Then you must intimate Apollo Munich at least a minimum of 48 hours prior to admission. The patient or policyholder will be required to provide certain details such as policy number. Intimation can be done by calling the toll free number 1800-102-0333
        • The cashless request form must then be filled in by the patient or policyholder and faxed to Apollo Munich. The form needs to be submitted with a certification from the attending doctor along with the required medical records.
        • Apollo Munich will review the submitted documents and request and convey their decision to the hospital. In certain cases Apollo Munich may also request for additional documents. In case it is approved the hospital bill will directly be settled by Apollo Munich. In case of rejection, the bills need to be paid by the patient and then a claim for reimbursement can be made.
    2. Reimbursement of treatment expenses:

      When cashless claims are rejected, the bills paid by the patient or policyholder can be reimbursed by claiming for reimbursement of expenses. Cashless claims may be rejected for lack of supporting documents or because the hospital may not be on the network of cashless claim hospitals covered by Apollo Munich. The following procedure needs to be followed to make reimbursement claims:

      • You will have to intimate Apollo Munich on admission or treatment within a stipulated time frame. More often than not the sooner one intimates the insurance provider, the better the chances are of the claim being approved. The toll free number can be called to intimate claims for reimbursement. The toll free number is 1800-102-0333
      • Patients or policyholders must provide key information such as policy numbers while making intimations
      • You must quote the policy number while intimating.
      • The claim form can be downloaded from the website or be availed through the agents at the office locations. The claim documents may vary depending upon the policy held by the patient. These claim forms need to be submitted to the Apollo Munich office address. Mailing address can also be availed from the toll free number.
    • Documents required:

      Documents required while applying for reimbursement claims are as follows:

      • The fully filled claim form along with the attending doctor’s certificate
      • Discharge summary along with other related documents such as hospital bills, pre and post hospitalization reports and their corresponding receipts, prescriptions notes along with their receipts and other documents as mentioned in the claim form
    • Claims process:
      • The claim processing team will check the above documents and ask for additional documents if required. Additional documents if requested will be given a period of 7 days to be submitted
      • If the claim is admissible, the cheque will be dispatched within 30 days
      • If the claim is not admissible you will get a rejection letter stating the reasons for rejection.
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