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Religare Health Insurance Claims Procedure

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Cashless Treatment

Customer Service

Medical Coverage

Claim Experience

Responsiveness

Health insurance policies are often as good as their claims are, because the financial aspect of one’s illness and ailment often bears down on a family and the policyholder after the treatment is done with. Claims considering Religare Health Insurance have an easy process that is done online and is completely hassle-free. With nearly 4900 hospitals in its expansive list of healthcare facilities, Religare Heath Insurance also offers an easy process for claims disbursement.

Incurred Claim Ratio for Religare Health Insurance:

Though the claim ratio is a highly touted measure of how effective and reliable an insurer is, it is not the only yardstick through which health insurers should be chosen. Irrespective of that, a good incurred claim ratio indicates the speed of the overall process and the efficiency through which an insurer operates. The incurred claim ratio for Religare Health Insurance is shown in the table below –

For 2015-16:

Net Earned Premium (in lakhs INR) Net Claims Paid (in lakhs INR) Incurred Claims Ratio (Percentage)
28773 16472 57.25

For 2014-15:

Net Earned Premium (in lakhs INR) Net Claims Paid (in lakhs INR) Incurred Claims Ratio (Percentage)
15,372 9.397 61.13

Generally a value from 50% to 90% is a good figure concerning ICR (Incurred Claim Ratios). That indicates Religare actually has built up a good pool of resources from where it can meet the claims that are being generated. It will not be taxing the financials of Religare in any condition.

Claim Scenarios:

Claim scenarios normally come up in two forms, either in cashless treatment or in case of reimbursement of expenditure that happens during a treatment. Let’s take a look at how the situations would be in each scenario pertaining to health insurance.

Cashless Treatment:

This kind of treatment can be availed across the network of hospitals that have tie-ups with Religare Health. In such cases, one doesn’t need to pay for the treatment as the bills generated are sent across to Religare Health itself.

Procedure to File a Claim (Planned/Emergency Hospitalisation):

  1. The provided cashless treatment card should be carried on person, or the policy number and member ID should be provided at the network hospital
  2. One should call and inform Religare at the number 1800-200-4488 within 24 hours of admission in case of an emergency hospitalisation
  3. One should either intimate Religare on 1800-200-4488 or write to the customer helpdesk on customerfirst@religarehealthinsurance.com in case of a planned hospitalisation at least 48 hours before
  4. One would need to furnish personal details and policy ID or member ID to the hospital’s insurance desk and fill up the Pre-Authorisation form in the customer’s section
  5. Once the balance details are filled up by the hospital, the Pre-Authorisation form will be faxed to Religare at 1800-200-6677
  6. The Religare in-house medical team will review the case and documents received and intimate the guardian and hospital in case of approval, pending approval or rejection
  7. In case of pending approval cases, Religare will contact the hospital to furnish more details and in cases of rejection, a claim reimbursement process needs to be followed

Claims Process for Cashless Treatment:

  1. Post the filling up of the pre-authorisation form, the requisite details will be verified by the hospital and the TPA
  2. Upon submission of the pre-authorisation form, all communications will be taken care of by Religare pertaining to the settlement of the bill
  3. If in case some expenses are not covered or are beyond the scope of the policy, the same will be intimated to the patient before or post release from hospitalisation

Reimbursement of Treatment Expenses:

In case one has to resort to a hospital that is not in the panel of networked hospitals of Religare or the pre-authorisation form has been rejected, one could file a claim for reimbursement of expenses. The procedure for the same and important points to consider are mentioned below.

Procedure to File a Claim:

  1. In case of an emergency admission, Religare should be informed of the same within 24 hours of admission on the number 1800-200-4488. If the hospitalisation is planned, the intimation should be done 48 hours in advance on the number 1800-200-4488 or the email address customerfirst@religarehealthinsurance.com
  2. The details required during this procedure will be the following –
    • Policyholder’s name
    • Claimant’s name and customer ID
    • Details of the hospital
    • Details of diagnosis and treatment
    • An approximation of the claim amount
    • Date of admission

Documents Required:

The claim form can be downloaded from Religare’s website and along with the filled up form, the following documents need to be provided –

  1. The original copy of the claim form, fully filled and duly signed
  2. Government approved valid photo ID proof
  3. Referral letter from medical practitioner advising hospitalisation
  4. Letter from medical practitioner detailing the list of tests, medications and consultations if any
  5. Original copies of bills, receipts and discharge card from the hospital or the medical practitioner
  6. Original copies of bills or receipts from pharmacies or druggists involved
  7. Original copies of tests and reports done along with payment receipts
  8. Indoor case papers
  9. If applicable, the First Information Report and the Final Police Report
  10. Original copy of the post mortem report, if conducted

The above list of documents are the bare minimum necessities. Religare might require additional documentation as and when needed.

The above mentioned list of documents and the claim form needs to be sent via post to the address at –

Religare Health Insurance Company Limited,

Claims Department,

GYS Global, A-3, 4, 5, Sector-125, Noida,

Uttar Pradesh - 201 301

Claims Process for Reimbursement Cases:

Once the filled claim form along with the relevant documents is received by Religare, the claims process is initiated and the following happens –

  1. The in-house medical team of Religare reviews the case and documents received
  2. The case if approved, will cause the reimbursement of funds to be processed and the procedure will be completed within a week and a fortnight. Intimation of the same will be sent to the claimant
  3. In case the request has incomplete information, the same will be intimated to the claimant and requisite details will be requested to ensure claim resolution at the earliest
  4. In case of request rejection, the reason will be mentioned for the same and an intimation sent to the claimant. If there are further documents to strengthen the case, the same will be studied and the claim can be reopened for review.

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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.

Religare Health Insurance Claims Procedure Reviews

Page 1 of 12 1 2 3 4 5
  • Religare Health Insurance
    "Good service"
    0.5 4.0/5 "Great!"
    I have been using my health insurance with Religare insurance from past few years, there service is good, they have tie up with many hospital , and they have shared me an excel with there location, and the agent had explained me clearly about the policy benefit, my company pay this health insurance premium.
    Was this review helpful? 0
    , hosur
    Reviewed on Dec 08, 2018
  • Religare Health Insurance
    "Good service"
    0.5 4.0/5 "Great!"
    I have been using my health insurance with National insurance from past few years, there service is good, they have tie up with many hospital , and they have shared me an excel with there location, and the agent had explained me clearly about the policy benefit, my company pay this health insurance premium.
    Was this review helpful? 0
    , hosur
    Reviewed on Dec 08, 2018
  • Religare Health Insurance
    "very bad experience"
    0.5 0.5/5 "Unacceptable"
    I am struggling to get my claim passed from Religare. When I submitted the documents they reply that some documents are missing.when I submitted missing documents and they said need more docs. Last time they demand for "Descharge Summary" when I submitted it and they told me that we need "Descharge Detail" so I think this is endless. Also religare team is already veryfied all the case papares but still they are not cleared.
    Was this review helpful? 2
    , ahmedabad
    Reviewed on Dec 04, 2018
  • Religare Health Insurance
    "Best policy"
    0.5 5.0/5 "Blown Away!"
    I have a health insurance policy with Religare health from last 1 year, a premium of Rs 10000 has to be paid for this insurance policy every year. They cover Rs 10 lacs for accidental insurance and Rs 5 lacs for medical insurance. I had no claim experience so far with this insurance.
    Was this review helpful? 1
    , pune
    Reviewed on Nov 30, 2018
  • Religare Health Insurance
    "GOOD"
    0.5 3.0/5 "Satisfactory"
    I am using the health insurance policy with the RELIGARE HEALTH from more than one year and the premium i pay for this health insurance is nominal and they have offered the medical coverage of 3 lakhs for self and for spouse. The listed hospitals are good with this bank.
    Was this review helpful? 0
    , bangalore
    Reviewed on Nov 20, 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
  • 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
  • Religare Health Insurance
    "Good Coverage"
    0.5 4.0/5 "Great!"
    I have taken health insurance through online portal, the medical value is fine. They gave me Rs. 5 lakhs for health coverage. The service is good the documentation process was very smooth and I got my card on time. Religare health is providing cash less hospital because they have good networks.
    Was this review helpful? 1
    , bangalore
    Reviewed on Nov 14, 2018
  • Religare Health Insurance
    "Good protection for health"
    0.5 4.0/5 "Great!"
    Major factor to avail Religare health is because of the premium amount is low and few more options are good with them. But there is a waiting period for pre existing disease benefits however I got the medical card on time with the coverage value of Rs.5 lakhs.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Nov 10, 2018
  • Religare Health Insurance
    "Good Policy"
    0.5 4.0/5 "Great!"
    I hold a health insurance policy with Religare from last 1 year, i am not aware of the premium amount for this insurance. I have not claimed anything so far from this insurance policy. I have a coverage value of Rs 3 lacs for this insurance.
    Was this review helpful? 0
    , kolkata
    Reviewed on Nov 01, 2018
  • Religare Health Insurance
    "Good Policy"
    0.5 5.0/5 "Blown Away!"
    I have a health insurance policy with Religare from last 4 months, i am happy with the coverage value of this insurance policy and it is a Family health policy. I have no claim experience so far with this insurance and i pay a premium of Rs 12500 for this card. Coverage value is Rs 5 lac + 5 lac for this policy.
    Was this review helpful? 1
    , new delhi
    Reviewed on Oct 08, 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? 2
    , ahmedabad
    Reviewed on Sep 12, 2018
  • Religare Health Insurance
    "Good policy"
    0.5 4.0/5 "Great!"
    I have taken health insurance , am satisfied with the premium amount which am making . I am getting benefits of Cashless hospitalization and pre disease cover . Even they listed the network of hospital . Their customer representative explained the policy . Overall am satisfied with this policy.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Sep 05, 2018
  • Religare Health Insurance
    "Good Policy"
    0.5 4.0/5 "Great!"
    I have a health insurance policy with Religare from last 2 years, i am happy with the coverage value of this insurance policy. I have not claimed anything so far from this insurance policy. I am not aware of the premium amount as company pays it. The coverage value of this insurance is Rs 5 lacs.
    Was this review helpful? 0
    , mumbai
    Reviewed on Aug 30, 2018
  • Religare Health Insurance
    "Normal Service"
    0.5 3.0/5 "Satisfactory"
    I've been using the health insurance policy from the Religare. I am paying of 12000, there hasn't been any claim experience with the policy. The policy is offering a coverage of 5 lacs for me me my wife and children.
    Was this review helpful? 2
    , ahmedabad
    Reviewed on Aug 24, 2018
  • Religare Health Insurance
    "Good policy"
    0.5 4.0/5 "Great!"
    From Religare health insurance i have taken health insurance , am satisfied with the premium amount which am making . I am getting benefits of Cashless hospitalization and pre disease cover . Even they listed the network of hospitals . Their customer representative explained the policy . Overall am satisfied with this policy.
    Was this review helpful? 1
    , new delhi
    Reviewed on Aug 22, 2018
  • Religare Health Insurance
    "WORST CLAIM SETTLEMENT AFTER PAYING 8 YEARS PREMIUM"
    0.5 0.5/5 "Unacceptable"
    This is one of the Worst Health Insurance paid total >2 lacs apprx for 8 years. they dnt settle claims they say that some or ther other reasons.. I SUGGEST DNT BUY FROM them its one of the worst insurance company as im a regular premium payer for the year of 2010 to till date ... but no use of them..
    Was this review helpful? 11
    , bangalore
    Reviewed on Aug 20, 2018
  • Religare Health Insurance
    "Excellent Service"
    0.5 5.0/5 "Blown Away!"
    I've a health insurance policy with the Religare. I am paying the premium of 12500 for an year, for the entire family. It offers annual coverage of 5 lacs. I do have a claim experience with the policy on that occasion I was able to claim 59000 and the whole claim process was easy and hassle free.
    Was this review helpful? 4
    , faridabad
    Reviewed on Aug 04, 2018
  • Religare Health Insurance
    "Very Good Service"
    0.5 4.0/5 "Great!"
    IT had been a good experience with them so far, i had been making the premium payments online and it had been easy. The premiums had been paying online and the medical coverage with the insurance also had been good as well. Most of the hospitals has been covered with this insurance policy in my locality.
    Was this review helpful? 0
    , noida
    Reviewed on Jul 30, 2018
  • Religare Health Insurance
    "Good Service"
    0.5 4.0/5 "Great!"
    I've a health insurance policy with the Religare Health Insurance.I have paid a premium of 10000 for the first three years. I do not have any claim experience with the policy so far. It has been a hassle free experience with the policy so far. .
    Was this review helpful? 1
    , mumbai
    Reviewed on Jul 26, 2018
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