• Royal Sundaram Health Insurance Claims Procedure

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    Cashless Treatment

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    Medical Coverage

    Claim Experience

    Responsiveness

    One of the leading general insurance firms, Royal Sundaram offers a comprehensive range of health insurance plans with a number of benefits. Affordable and flexible, these schemes come with different sum insured options that come with a lump sum amount, to take care of large expenses incurred during hospitalization, be it for accidents or health ailments.

    With 1000+ hospital tie ups, health and medical insurance policyholders can enjoy cashless treatment benefits and reimbursements. The organization has registered quite a significant growth in the health insurance arena. With Third Party Administrators (TPA), licensed by IRDA, available at every tie-up hospital for a hassle-free claims process, Royal Sundaram has been servicing policyholders from rural and urban areas, since its inception.

    Incurred Claim Ratio for Royal Sundaram Health Insurance:

    The Incurred Claim Ratio (ICR) is a parameter where the performance of an organization can be monitored. By observing the ICR, prospective policyholders can have a clear understanding of the insurance company and the policies it offers. They can also chalk out a plan of their investments and what they can expect from the company. The incurred claim ratio of Royal Sundaram Health Insurance’s for the financial year 2014-15 and 2015-16 can be viewed in the table mentioned below:

    For 2015-16:

    Net Earned Premium (in lakhs INR) Net Claims Paid (in lakhs INR) Incurred Claims Ratio (Percentage)
    21565 12631 58.57

    For 2014-15:

    Net Earned Premium (in Lakhs) Net Claims Paid (in Lakhs) Incurred Claims Ratio (%)
    Rs 22,577 Rs 11,942 52.89

    By observing the ICR of Royal Sundaram Health Insurance it is clearly indicated that the company is able to clear all the claims that they received, without it being a burden on their finances.

    Claim Scenarios:

    A policyholder can avail a health policy and claim reimbursements under two scenarios - cashless treatment and expense reimbursement after treatment.

    In Case of Cashless Treatment:

    Cashless treatment under the insurance policy, is a scheme where the insurance company pays all the expenses incurred during the treatment of a life insured. Royal Sundaram offers cashless treatment claims, depending on the insurance cover. An individual can avail cashless claim facility at network hospitals the insurance company is tied with.

    1. Procedure to File a Claim (Planned/Emergency Hospitalization):

      • Royal Sundaram or TPA should be notified of the life insured’s planned hospital, before three days of admission, through the helpline number 1860 425 0000 (Toll free). The individual should also quote the Health Card membership number.
      • It is mandatory to carry the health card, which has to be submitted along with a photo ID as a part of the verification process.
      • Duly fill the “Cashless Request Form”, that can be availed from the hospital’s insurance help desk. Supporting medical records and the form should be faxed to the TPA, after getting it stamped and signed by the treating doctor.
      • The documents will be verified by the TPA and the decision taken will be conveyed to the hospital. Cashless requests or calls for additional documents can be sanctioned by the TPA. Twenty-four hours after the receipt of all duly signed and stamped documents, the cashless decision will be approved by the third party administrators (TPA).
      • Subject to policy limits, Royal Sundaram or the TPA, post approval, will directly settle the hospital bills. The life insured will have to take care of other inadmissible expenses such as attendant charges, food, and telephone charges etc.
      • The original bills and reports will have to be signed by the claimant. Photocopies of the same should be retained in case of future verification.
    2. Claims Process:

      Depending on the policy, Royal Sundaram will first scrutinize the request for claims and then approve or reject the same.The following process should be followed for reimbursement claims:

      • The claim should be requested and the TPA should be intimated once the policyholder has been discharged from the hospital.
      • The claim forms and a valid photo ID’s photo, along with a photocopy of a valid photo ID proof should be submitted.
      • Relevant medical certificates and other reports, that are signed and stamped by the doctor in attendance, should be mailed to the TPA. The company may also require the original discharge summary and reports in order to scrutinize the case.

    In Case of Reimbursement of Treatment Expenses:

    In some instances, the insurance company may reject the policyholder’s claims for reimbursement in case of cashless hospital and treatment. Reimbursements can still be claimed by following the mentioned process:

    1. Procedure to File a Claim:

      Sometimes insurance companies may not accept settlement claims, in case the policyholder is availing treatment or admitted in a hospital that is not tied up with Royal Sundaram’s TPA. In such a scenario, the person concerned can file for a reimbursement claim for the expenses incurred while at the hospital. Here’s is the process to file a claim:

      • Royal Sundaram should be notified immediately, and not a week after discharge, via the toll free, landline number or email about the admission. The numbers are - Toll free: 1860 425 0000; Landline: 91-44-7117 7117.
      • Post the treatment, all dues should be taken care of at the hospital. A claim for reimbursement can be filed along with all the original bills.
      • The relevant claim form, downloaded from the company’s website, should be duly filled with correct details and submitted to RCare for processing the reimbursement. If the claim complies with the regulations set by the insurance company, there will be no issues in getting the reimbursement.
    2. Documents Required:

      The following documents, along with duly filled claims form and doctor’s certificate, have to be submitted in case of reimbursement of the expenses incurred at the hospital. The claim processing team will get in touch with the policyholder in case more documents are required.

      • Discharge summary
      • Treatment and investigation bills.
      • Prescriptions.
      • Advance and final receipts
      • Diagnostic Test Reports, X Ray, Scan and ECG and other investigation reports.
    3. Claims Process:

      • Royal Sundaram insurance company or TPA has to be informed about the hospitalization within a week of the policyholder’s discharge.
      • In relevant scenarios, pre-authorization from the company should be availed.
      • Original bills, documents and any other relevant reports, should be submitted within 10 days post discharge, based on the company’s request. The documents should be sent to the following address:

        Royal Sundaram General Insurance Co. Ltd

        Vishranthi Melaram Towers

        No.2/319 , Rajiv Gandhi Salai (OMR)

        Karapakkam, Chennai - 600097

      In order to file a claim with Royal Sundaram insurance company, the above mentioned process should be followed. Claims will only be processed on the receipt of all necessary documents. The person insured may receive a cheque or repudiation letter, within 20 days of receiving and processing the documents.

    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.

    Royal Sundaram Health Insurance Claims Procedure Reviews

  • Page 1 of 8 1 2 3 4 5
    • Royal Sundaram Health Insurance
      "Good Service"
      0.5 3.5/5 "Pretty good"
      I've been using the health insurance policy from Royal Sundaram for a while. I am paying the premium of 8000, many of my friends recommended Royal Sundaram. I never had any claim experience with the policy. Overall it has been a smooth experience. I'll have to wait and see how they respond to my requirement in future.
      Was this review helpful? 0
      , chennai
      Reviewed on Jun 16, 2018
    • Royal Sundaram Health Insurance
      "Good policy to use"
      0.5 5.0/5 "Blown Away!"
      I got the health insurance policy from the ROYAL SUNDARAM GENERAL INSURANCE company and i have got it around 5 years. This policy covers 4members in my family and it has the medical coverage amount of Rs,3,00,000 . I pay the premium amount of Rs,8,000 to renew the policy every year.
      Was this review helpful? 0
      , bangalore
      Reviewed on Jun 13, 2018
    • Royal Sundaram Health Insurance
      "Good Service"
      0.5 2.0/5 "Expected more"
      I've a health insurance policy with the Royal Sundaram. I pay a premium of 3700. I do not have any claim experience with the policy after 5 months usage. Their services are good and they offered me an annual coverage of 3 lakhs with the policy. As of now I did not experience anything negative.
      Was this review helpful? 0
      , kolkata
      Reviewed on Jun 05, 2018
    • Royal Sundaram Health Insurance
      "Good Service"
      0.5 5.0/5 "Blown Away!"
      I've been using the Royal Sundaram Health Insurance for the past 4 months. I pay a premium of 9000 Per year, No claims 4 months,it is Convenient to make payments as the premium gets Auto debited from account. The policy offers full protection for me and they offer 40 lacs coverage annually.
      Was this review helpful? 0
      , chennai
      Reviewed on Jun 05, 2018
    • Royal Sundaram Health Insurance
      "Good Use for Health Insurance"
      0.5 5.0/5 "Blown Away!"
      I can Claim upto Rs. 3 lakhs. Cashless transaction is available. I took this policy for my family. I can utilize this policy for medical emergency. Tax benefitable policy. This covers the pre-existing disease also. Total I'm paying Rs. 295 every month.
      Was this review helpful? 0
      , new delhi
      Reviewed on May 29, 2018
    • Royal Sundaram Health Insurance
      "Good Policy"
      0.5 3.0/5 "Satisfactory"
      I have taken a health insurance policy with Royal Sundaram along with SBI credit card, i pay a premium of Rs 240 every month for this insurance policy. I have not claimed anything so far from this insurance and i am happy with the coverage value of Rs 3 lakhs for this policy.
      Was this review helpful? 0
      , secunderabad
      Reviewed on May 22, 2018
    • Royal Sundaram Health Insurance
      "Good service"
      0.5 4.0/5 "Great!"
      Using the ROYAL SUNDARAM GENERAL INSURANCE health insurance policy for the past 4 months . The customer support service and the response is average with the Royal sundram policy . This policy covers 4members in my family . This policy has the medical coverage amount of Rs,5,00,000 and I am satisfied with the service.
      Was this review helpful? 0
      , chennai
      Reviewed on May 22, 2018
    • Royal Sundaram Health Insurance
      "Good Service"
      0.5 3.0/5 "Satisfactory"
      I've been using the Rroyal Sundaram Health insurance before many years. When I Changed place the renewal notice wasn't received hence I change to a different provider. I don't have any claim experience with the policy. I never faced any other issues with their services.
      Was this review helpful? 0
      , chennai
      Reviewed on May 17, 2018
    • Royal Sundaram Health Insurance
      "Not satisfied"
      0.5 1.0/5 "Really Bad"
      Got my Health insurance policy form royal sundaram general insurance as they said they were tied up with sbi . After making payment for health insurance from sbi till now not received the health insurance card and documents . For medical claim am not able to do so As i have contacted their customer care but still there is no response from them.
      Was this review helpful? 0
      , new delhi
      Reviewed on May 13, 2018
    • Royal Sundaram Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have my health insured with Royal Sundaram from last 1 year, i am not aware of the premium amount as my company pays it. I have a coverage value of Rs 2.5 lakhs and i am satisfied with it. I have not claimed anything so far from this insurance policy.
      Was this review helpful? 0
      , ahmedabad
      Reviewed on May 08, 2018
    • Royal Sundaram Health Insurance
      "Good Policy"
      0.5 3.0/5 "Satisfactory"
      I have a health insurance policy with Royal sundaram from last 1 month, the coverage value of this insurance policy is 3 lakhs. I am not aware of the premium amount as my company pays it. I do not have claim experience so far with this insurance policy.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Apr 26, 2018
    • Royal Sundaram Health Insurance
      "Best policy"
      0.5 5.0/5 "Blown Away!"
      I have a health insurance with Royal Sundaram from last 1 year and it is a good insurance policy to use. I am not aware of the premium amount as my company pays it. I do not have claim experience so far with this health insurance. I have a coverage value of Rs 1 lakh which is satisfactory.
      Was this review helpful? 0
      , chennai
      Reviewed on Apr 02, 2018
    • Royal Sundaram Health Insurance
      "Good policy to use"
      0.5 4.0/5 "Great!"
      Recently I have got the health insurance policy from the ROYAL SUNDARAM GENERAL INSURANCE company. I have paid Rs,2500 to get this policy and it has the tenure of one year. The customer support service is good with the ROYAL SUNDARAM GENERAL INSURANCE. This policy covers 20 members in my family.
      Was this review helpful? 0
      , chennai
      Reviewed on Mar 14, 2018
    • Royal Sundaram Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have a health insurance with Royal Sundaram from last 2 years and it is one of the good insurance policy to use. This policy has to be renewed every year and i pay a premium of Rs 13000 for this insurance. I do not have claim experience so far with this insurance and i have a coverage of Rs 5 lakhs for this insurance.
      Was this review helpful? 0
      , bangalore
      Reviewed on Mar 12, 2018
    • Royal Sundaram Health Insurance
      "Best service"
      0.5 5.0/5 "Blown Away!"
      I have taken Health insurance with Royal sundaram,the premium amount is 3000 per month.The policy coverage amount is four lakhs.The policy is for one year.I have no claim experience with them.I get 100% cashless treatment.The policy is taken three months ago.
      Was this review helpful? 0
      , bangalore
      Reviewed on Mar 06, 2018
    • Royal Sundaram Health Insurance
      "Good Coverage"
      0.5 4.0/5 "Great!"
      I recently took a SBI credit card and along with it I got the additional optional option of taking this Insurance. I like the Insurance and decided to take 2 schemes from them. I have been paying Rs.6000 as an annual premium and the total coverage that I would be getting is Rs.6 Lakhs (i.e. 2 Rs.3 Lakhs coverages) for 4 people. I haven't received details about my second Insurance yet.
      Was this review helpful? 0
      , new delhi
      Reviewed on Feb 22, 2018
    • Royal Sundaram Health Insurance
      "Best insurance policy"
      0.5 5.0/5 "Blown Away!"
      I have taken Health Insurance with Royal sundaram.The premium amount is is 2500,the policy coverage is five lakhs,24 hours hospitalization. for any kind of claims.The payments is done online.I have no claim experience and cashless treatment is covered 95%.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Feb 20, 2018
    • Royal Sundaram Health Insurance
      "Average service"
      0.5 1.0/5 "Really Bad"
      I have taken Royal Sundaram Health Insurance policy,i purchased two months ago,the premium amount is is 6000 paid per annum,I dint receive the kit as yet.The policy coverage is three lakhs and they would cover 100% cashless treatment.
      Was this review helpful? 0
      , bangalore
      Reviewed on Feb 16, 2018
    • Royal Sundaram Health Insurance
      "Health insurance with ROYAL SUNDARAM"
      0.5 3.0/5 "Satisfactory"
      From ROYAL SUNDARAM GENERAL INSURANCE i have taken a health insurance policy and the premium amount is 7000. This policy covers my whole family. They provide cashless treatment facility.I make my payment through cheque. The customer service is good.
      Was this review helpful? 0
      , mumbai
      Reviewed on Feb 13, 2018
    • Royal Sundaram Health Insurance
      "Good"
      0.5 3.5/5 "Pretty good"
      I have a Health insurance policy for my mother from Royal Sundaram. I paid total premium around Rs. 6000 for half a year, sum assured is around Rs. 3,00,000. We haven't taken any claim yet so can't comment on that part. However the policy and their services so far looks satisfactory.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Feb 07, 2018
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