• L&T Health Insurance Claims Procedure

     4.0 / 5.0   by 19 users
    Used this product? Write a review >>

    Cashless Treatment

    Customer Service

    Medical Coverage

    Claim Experience

    L&T allows you claim the health insurance in 2 ways, you can either opt for cashless claim or get a reimbursement for your claim. Cashless claims facility is made available with network hospitals of the Third Party Administrator that L&T is tied with. The network hospital will assist you in finishing the formality regarding the cashless request. You must contact the Third Party Administrator through the helpline number and you will have to quote your membership number provided to you and the TPA will guide you through the entire process. There are over 2,800+ network hospitals that provide cashless hospitalisation benefits.

    Incurred Claim Ratio of L&T Health Insurance:

    Incurred Claim Ratio is published by IRDA for all Health Insurance companies in India. Incurred Claim Ratio or ICR is the overall value of the claims that the company has paid divided by the total sum of premiums collected during that period. The following is the incurred claim ratio for L&T for the year 2014-15 and 2015-16:

    For 2015-16:

    Net Earned Premium (in lakhs INR) Net Claims Paid (in lakhs INR) Incurred Claims Ratio (Percentage)
    4940 2298 46.52

    For 2014-15:

    Net earned premium (in lakhs) Net claims paid (in lakhs) Incurred claims ratio
    3,502 1,819 51.93

    L&T has a low incurred claims ratio and it is making profit and is in a position to settle claims comfortably.

    Claim Procedure:

    L&T allows you to claim in the following ways:

    1. Cashless Claim:

      If you are opting for cashless claim, you do not have to settle the bill if you are hospitalised in a network hospital. L&T will be represented by the TPA. The TPA will coordinate with the hospital and settle the bill. The cashless claim process for emergency and planned admissions are different.

      • Cashless Claims Procedure for Emergency Admission:

        If you have been admitted in a network hospital on an emergency, then you can contact the TPA of L&T within 24 hours of admission and check if cashless claim is applicable. If you are allowed to make the cashless claim , then you will have to follow the following procedure to claim for emergency admission:

        • File the cashless pre-authorisation form that is available at the Cashless counter of the hospital.
        • Intimate the TPA. You can notify your claims by calling the TPA at 1800-209-5846 for intimation.
        • You will have to submit the pre-admission prescription and medical reports along with copy of the photo-ID and health card.

          Claims Process:

        • The claim reference number will be sent to you after the TPA decides to approve the claim or reject you.
        • The claim approval or rejection decision will be taken within 6 hours after receiving the documents.
        • If the cashless claims are approved, you will have to clear out the uncovered expenses before you leave the hospital.
        • If the claim is not approved, you will have to pay the bill and then file for a reimbursement for which you will get a response within 6 working days on receipt of the document.
      • Cashless Claims Procedure for Planned Admission:

        If you are getting any treatment in a network hospital, you must follow the following procedure to claim for planned admission:

        • Select the hospital from the network hospital list.
        • Intimate the TPA at least 72 hours before admitting. You can notify your claims by calling the TPA at 1800-209-5846 for intimation.
        • Fill up the cashless pre-authorisation form that is available at the cashless counter at the hospital.
        • You will have to submit the pre-admission prescription and medical reports, if any along with the copy of your photo- ID and health card.

          Claims Process:

        • Once you have faxed the form, you will receive a claim reference number along with the approval or rejection intimation.
        • You will receive the intimation within 6 hours from receiving the documents.
        • If the claim is approved, you will have to only pay for the uncovered expenses before leaving the hospital.
        • If the claim is not approved, then you must pay the entire bill and then claim for reimbursement. You get a response for the reimbursement claim within 6 days from receipt of the documents.
    2. Reimbursement of Treatment Expenses:

      Reimbursement of claim is done if you cashless claim is rejected or if you are getting treated at a non-network hospital. Reimbursement can be availed for planned hospitalisation as well as emergency hospitalisation. The reimbursement for planned hospitalisation must be intimated to L&T at least 72 hours before hospitalisation and the emergency hospitalisation reimbursement is to be intimated within 24 hours of hospitalisation.

      The procedure for claiming for reimbursement is as follows:

      • Submit the claim intimation. Intimate the TPA. You can notify your claims by calling the TPA at 1800-209-5846 for intimation.
      • Get your claim reference number.
      • Submit the claim form along with Policy number, name of the person who is availing the treatment, nature of the illness or disease or injury, address and name of the hospital or medical practitioner, date of admission and discharge, approximate of the claim expenses and relevant information, if any.
      • You will have to complete the treatment procedure and settle the bill and then collect the medical bills.

      Documents Required:

      If your claim is rejected and you want to claim for reimbursement, then you will have to submit the following documents:

      • Duly filled claim form
      • Copy of claim intimation.
      • Original hospital bill payment receipt and hospital discharge card or summary must be submitted.
      • Submit the basic hospital main bill and original hospital bill break up
      • You must also submit the original pharmacy bill with supporting prescription and the original bills and receipt if you are claiming for ambulance charges.
      • Submit the medical investigation report as well as the doctor’s consultation note.
      • If you are claiming for pre and post hospitalisation, then you must submit the claim form, if you are claiming it separately along with the pharmacy bills backed with prescription and medical investigation reports and doctor’s consultation reports.
      • The documents have to be mailed to Claim Servicing Office, L&T General Insurance Company Limited, 6th Floor, City 2, Plot number-177, CST Road, Near Bandra Kurla Telephone Exchange, Kalina, Santacruz East, Mumbai – 400 098.

      Claims Process:

      Once you have cleared out all the bill and have all the relevant documents, which you have submitted, the L&T TPA will intimate you the decision on if the reimbursement is approved or not within 6 days after receiving the documents.

    Do’s and Don’ts:

    While you are applying for a claim on your health insurance plan, do the following:

    • Obtain all necessary documents.
    • Forward the relevant reports for the claim.
    • Retain a copy of the hospital related documents for your record.

    Don’t do the following while you are applying for a claim:

    • Misrepresent or hide any information.
    • Providing incomplete information.
    • Hesitating to seek clarification on the deduction details.

    This Insurance Company has not partnered with BankBazaar.com. For more details, please visit its website/branch office. The trademarks, logos and other subject matters of intellectual property belong to their respective owners.

    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.

    L&T Health Insurance Claims Procedure Reviews

  • Page 1 of 1
    • L and T Health Insurance
      "Good medical coverage with low Premium"
      0.5 5.0/5 "Blown Away!"
      It is more recommendable insurance from L & T . Premium was very less but it has more features on it. I used to pay Rs. 3500 could claim upto hospitalization of 5 Lakhs. It covers for entire family it was good and useful for every one.
      Was this review helpful? 0
      , vadodara
      Reviewed on Nov 12, 2016
    • L and T Health Insurance
      "Highly inefficient and delay. Non issuance of policy-15days"
      0.5 0.5/5 "Unacceptable"
      Despite I paid full amount and provided all clarity and required documents/reports. L&T failed to provide a policy and highly inefficient in their response. For every email they want 3 business days to reply. So, I do not recommend insurer
      Was this review helpful? 1
      , pune
      Reviewed on Aug 17, 2016
    • L and T Health Insurance
      "Not yet used "
      0.5 5.0/5 "Blown Away!"
      Its good experience from L&T in case of health Insurance services.The documents related to the insurance were received within 10-15days.It takes 3years tenure for covering pre-existing disease in the Insurance.The critical illness also has some particular waiting period.
      Was this review helpful? 0
      , pune
      Reviewed on Aug 05, 2016
    • L and T Health Insurance
      "Average service "
      0.5 3.0/5 "Satisfactory"
      It was company provided Insurance through L&T General Insurance.For getting the claim processed we need to get the form from HR executives.There is very few hospitals listed under the Insurance which was not a convenient option as a customer.
      Was this review helpful? 1
      , chennai
      Reviewed on Jul 21, 2016
    • L and T Health Insurance
      "Very good"
      0.5 4.0/5 "Great!"
      From L&T I have taken a health plan for my mother which I took through online. There was no any medical check up. Overall process was completed in ten days and sent all the papers on time. After three years of time they will cover the pre existing.Cashless treatment facility is available.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Jul 02, 2016
    • L and T Health Insurance
      "Horrible than some of the govt owned insurance provider."
      0.5 1.0/5 "Really Bad"
      They Don't update call or let you know about the progress for getting the policy issued once you just swipe the card it takes more than 3 days for them to get dr.approval for fresh policy to be issued. It is only you have to call to get the update from them..
      Was this review helpful? 1
      , mumbai
      Reviewed on Apr 14, 2016
    • L and T Health Insurance
      "Good..."
      0.5 4.0/5 "Great!"
      Agent suggested and also compared as I liked the policy at L&T General insurance. The no claim bonus in a year is is 5% and it does not come down. Normally companies give 30% for no claim and if we claim anything the bonus will be not there. Though we claim, the bonus remains the same as 5%. Ayurvedic medicines and treatments also claimable.
      Was this review helpful? 0
      , thane
      Reviewed on Feb 20, 2016
    • L and T Health Insurance
      "Excellent Services"
      0.5 5.0/5 "Blown Away!"
      I hold a health insurance with L& T. The services are very good. It is a family floater policy. I have taken the benefits when I was hospitalized. The executive visited me at the hospital and processed everything. The cash less facility is good.
      Was this review helpful? 1
      , bangalore
      Reviewed on Feb 15, 2016
    • L and T Health Insurance
      "Very Good services"
      0.5 5.0/5 "Blown Away!"
      L&T General Insurance has been good in their services. I have taken my health insurance for them. It is a family floater policy. I have also had a claim experience. It was a reimbursement. I got the amount I had claimed for. It was a smooth process. The process took a month. The premium is on a yearly basis. They also have cashless facility.
      Was this review helpful? 1
      , mumbai
      Reviewed on Nov 14, 2015
    • L and T Health Insurance
      " Best health insurance "
      0.5 4.0/5 "Great!"
      Medical coverage is 2 lakhs for the whole family per year from L&T. Cashless treatment is available. Minimum 24 hour hospitalization is must. The listed hospital are nearby the location. I have taken the plan through the company. The customer service is excellent.
      Was this review helpful? 0
      , gadag
      Reviewed on Nov 07, 2015
    • L and T Health Insurance
      "Best service"
      0.5 5.0/5 "Blown Away!"
      I am paying around 15000 Rupees for the L&T health insurance. They are good with the service and it covers full family . The coverage is around 3 lakhs for every person in the family. They are having the enough number of the networking hospitals which is really good. I dont have any claim experience with them. They are having the cashless treatment facility on everywhere.
      Was this review helpful? 1
      , new delhi
      Reviewed on Sep 26, 2015
    • L and T Health Insurance
      "Very efficient..."
      0.5 3.5/5 "Pretty good"
      Infact this is a corporate offer and family floater where me and my spouse been covered. Entirely the coverage for both of us is 25lakhs. L&T General Insurance is not covering the existing diseases for two to three years. OPD cases are covering in certain cases. Health insurance is quite efficient.
      Was this review helpful? 0
      , mumbai
      Reviewed on Sep 15, 2015
    • L and T Health Insurance
      "Average"
      0.5 3.0/5 "Satisfactory"
      My health insurance is from L&T general insurance. The coverage is for my family and myself. The premium is on a yearly basis. I recently took the insurance with them. So not very sure of their benefits. The service was average from them.
      Was this review helpful? 0
      , mumbai
      Reviewed on Sep 10, 2015
    • L and T Health Insurance
      "Excellent"
      0.5 5.0/5 "Blown Away!"
      I have taken my health insurance with L&T general insurance. It is a corporate insurance got from the company I work for. The premium is on a yearly basis. It is of 6500. The coverage is of 5 Lakhs. It is for my family and myself.
      Was this review helpful? 0
      , chennai
      Reviewed on Aug 20, 2015
    • L and T Health Insurance
      "Good"
      0.5 5.0/5 "Blown Away!"
      I am having the health insurance with L&T.The coverage is really good.Its the coverage of 8 lakhs with the full of family.The process is really good with them
      Was this review helpful? 0
      , coimbatore
      Reviewed on Jun 26, 2015
    • L and T Health Insurance
      "Good"
      0.5 2.5/5 "Just OK"
      The health insurance from Larsen and Tourbo is good. The insurance covers almost all the health related issues and it has got upto 3.5 lakhs coverage for health. The insurance covers only in the case of hospitalization for 24 hours and also it covers accidents. Their toll free number is always working as they are able to provide me with clear solution.
      Was this review helpful? 1
      , chandigarh
      Reviewed on Jun 06, 2015
    • L and T Health Insurance
      "we strongly believe L&T COMPANY"
      0.5 4.5/5 "Excellent!"
      I have taken the policyl&T medi Classic 2 years back online I just call to direct l&T customer services they help me out for the understand all things. And I have received my soft copes so I am really Happy with the servicess. Before buying any insurance the wordings should be checked thoroughly. IT should cover all the medical needs of the family Nowadys in India medical insurance is heavily competitive Never ever take word of any insurance agent
      Was this review helpful? 2
      , hyderabad
      Reviewed on Apr 13, 2015
    • L and T Health Insurance
      "Good !!!"
      0.5 4.0/5 "Great!"
      Via online I purchased this health insurance and one of the executives suggested to take it with L&T General insurance. Ideally the coverage is of 80-90%. Normally L&T is not covering diabetics initially where they are covering post three years. In comparison to other insurance companies, coverage is very good but premium is bit high.
      Was this review helpful? 4
      , tirupur
      Reviewed on Apr 04, 2015
    • L and T Health Insurance
      "Better Insurance Product"
      0.5 5.0/5 "Blown Away!"
      I have taken Medisure Prime Insurance (Health Insuracne) with L&T. I had purchased this insurance L&T website and this is one of the best insurance policy in the industry since its covers 9 critical illness like cancer, first heart attack, coronary bypass surgeries, kidney failures and etc. This insurance poliy will also cover childbirth related expenses. It will provide free health check-up for every two years if your age is 45 and above, this is important option in Medisure Prime Insurance. The good news is it will cover the Donor Expenses for organ transplants. There are much more features available in this plan overall its one of the good health insurance plan in the market.
      Was this review helpful? 2
      , chennai
      Reviewed on Mar 09, 2015
    Common Loader Icon
    Page 1 of 1
  • reTH65gcmBgCJ7k
    This Page is BLOCKED as it is using Iframes.