• Royal Sundaram Health Insurance Claims Procedure

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    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 3 1 2 3
    • 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
      "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
    • Royal Sundaram Health Insurance
      "Good policy to use"
      0.5 4.0/5 "Great!"
      I have a health insurance policy with Sundaram insurance from last 1 month and it is a good insurance policy to use. I have to pay a premium of Rs 6800 every year. I do not have claim experience so far and i have not taken any cashless treatment. I have a coverage of Rs 3 lakhs and I am with the plan benefits of this policy.
      Was this review helpful? 0
      , ghaziabad
      Reviewed on Feb 02, 2018
    • Royal Sundaram Health Insurance
      "Need to improve customer service"
      0.5 1.5/5 "Bad"
      I have taken a Royal Sundram against my credit card ,they had deducted the premium amount without intimating,the premium amount is 2500 per annum.I have no claim experience with them,the policy coverage amount is three lakhs.They need to work on customer service is not transparent to the customers.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Feb 01, 2018
    • Royal Sundaram Health Insurance
      "Good insurance policy"
      0.5 4.0/5 "Great!"
      I have a health insurance policy with Royal Sundaram from last 1 month and it is a good insurance policy to use. I have to pay a premium of Rs 6009 every year for this insurance. I have a coverage amount of Rs 3 lakhs which is sufficient for this policy. I do not have claim experience so far as i have recently taken the policy.
      Was this review helpful? 0
      , mumbai
      Reviewed on Jan 25, 2018
    • Royal Sundaram Health Insurance
      "Average policy to use"
      0.5 2.0/5 "Expected more"
      I have a health insurance with Royal Sundaram from last 1 month and it is a average policy to use. This policy has to be renewed every year and i pay a premium of Rs 2500 for this insurance. I do not have claim experience so far and i have not taken any cashless treatment. I have a coverage of Rs 3 lakhs which is satisfactory.
      Was this review helpful? 0
      , jaipur
      Reviewed on Jan 25, 2018
    • Royal Sundaram Health Insurance
      "Good service "
      0.5 5.0/5 "Blown Away!"
      I have taken Health Insurance with Royal sundaram Insurance.I have not paid my first premkum as yet as i recently purchased this insurance they had explained the scheme details and its taken through my company.The process was very simple and easy with them.I have no claim experience with them.
      Was this review helpful? 0
      , chennai
      Reviewed on Jan 12, 2018
    • Royal Sundaram Health Insurance
      "Good policy"
      0.5 5.0/5 "Blown Away!"
      From ROYAL SUNDARAM GENERAL INSURANCE i have taken a health insurance. the premium amount is 3000 yearly. They do provide cashless treatment. The policy covers my family. i make my payment through credit card. I have no claim experience.
      Was this review helpful? 1
      , new delhi
      Reviewed on Dec 27, 2017
    • Royal Sundaram Health Insurance
      "Average"
      0.5 3.0/5 "Satisfactory"
      I am having the health insurance policy with the Royal sundaram general insurance company. I would like to say that the online information is not really in proper way while it comes to matter of services. I have not faced any such claims with them till now.
      Was this review helpful? 1
      , mumbai
      Reviewed on Dec 23, 2017
    • Royal Sundaram Health Insurance
      "Good insurance policy"
      0.5 4.0/5 "Great!"
      I have a health insurance policy with Royal Sundaram from last 1 month and it is a very good insurance policy. I have to pay a premium of Rs 300 every month for this insurance. I have a health coverage of Rs 6 lakhs and i am not aware of accident coverage. I have not taken any cashless treatment and i do not have claim experience so far. The coverage and benefits are very good in this policy.
      Was this review helpful? 2
      , mumbai
      Reviewed on Dec 20, 2017
    • Royal Sundaram Health Insurance
      "Average insurance policy"
      0.5 3.0/5 "Satisfactory"
      I have a health insurance with Royal Sundaram from last 2 months and it is a good policy to use. This policy has to be renewed every year and the premium amount is Rs 2945. I do not have claim experience so far. Customer service was very good and they explained all the details and gave the right information. I am also satisfied with the coverage of this policy.
      Was this review helpful? 0
      , new delhi
      Reviewed on Dec 11, 2017
    • Royal Sundaram Health Insurance
      "Good policy"
      0.5 5.0/5 "Blown Away!"
      I have taken a Health Insurance with Royal Sundaram.I have been using the policy service for last few years.i pay a premium amount of 12,000 annually.The policy is taken for the family members.I get a good policy coverage.I don't have claim experience so far.
      Was this review helpful? 0
      , bangalore
      Reviewed on Nov 29, 2017
    • Royal Sundaram Health Insurance
      "Very good policy to use"
      0.5 4.0/5 "Great!"
      I bought the health insurance policy with royal Sundaram around a month ago. I paid Rs,2500 to get this policy. This policy covers myself and I can claim the medical amount up to 3lakhs . The policy coverage and the cashless treatment options is available with this policy.
      Was this review helpful? 0
      , jaipur
      Reviewed on Nov 14, 2017
    • Royal Sundaram Health Insurance
      "Health insurance"
      0.5 3.0/5 "Satisfactory"
      ROYAL SUNDARAM HEALTH INSURANCE is good . I have not utilized this insurance . This insurance was offered against my credit card. I normally had to pay premium for this insurance on a yearly basis which is around rs2700. Fortunately there is no claim experience . The insurance amount is completely deducted from my credit limit.
      Was this review helpful? 0
      , chennai
      Reviewed on Oct 30, 2017
    • Royal Sundaram Health Insurance
      "Average policy to use"
      0.5 3.0/5 "Satisfactory"
      I am having the Royal sundaram Health Insurance policy for past 3years. The service is average with this policy,. This policy covers 4 member which is myself, ,my spouse and my parents. This policy has the medical coverage up to 5lakhs. I don't have any claim experience with this policy. I paid Rs,3000 to renew the policy.
      Was this review helpful? 0
      , mumbai
      Reviewed on Oct 24, 2017
    • Royal Sundaram Health Insurance
      "Good Health Insurance"
      0.5 5.0/5 "Blown Away!"
      Royal Sundaram is a largest insurance company, I jointed in 2005. I have a claim experience, my wife admitted in Ramachandra hospital at the time Royal Sundaram allocated Rs.75,000 for treatment, they gave me cash less treatment its good. I paid the premium of Rs.16,700 it covers my entire family.
      Was this review helpful? 0
      , chennai
      Reviewed on Oct 06, 2017
    • Royal Sundaram Health Insurance
      "Better Policy to use"
      0.5 4.0/5 "Great!"
      I got the Car insurance policy with Royal Sundaram around 2 ago. I paid Rs.10,000 to renew the policy this year. The customer service is good with royal . I never had any claim experience with Royal sundaram . The cash less option is available with this policy.
      Was this review helpful? 0
      , ahmedabad
      Reviewed on Aug 23, 2017
    • Royal Sundaram Health Insurance
      "Very good health Policy"
      0.5 5.0/5 "Blown Away!"
      Having the Health insurance with Royal sundaram general insurance health insurance for more than 4 years. I pay Rs.10,000 to renew the policy every year. This policy covers 3 members which is myself ,my spouse and my son. I had claim experience with this policy. I got the claim amount in a month time. I am satisfied holding the Health insurance policy with Royal Sundaram.
      Was this review helpful? 0
      , mysore
      Reviewed on Aug 23, 2017
    • Royal Sundaram Health Insurance
      "Good policy"
      0.5 4.0/5 "Great!"
      I have received a Health Insurance policy from Royal Sundaram general insurance very recently. This policy covers myself and my spouse. This policy was made top up with the amount of Rs.18,000, Every year I need to renew this policy . The plan benefits and the coverage's are good with the policy. I never had any claim experience so far,
      Was this review helpful? 0
      , vadodara
      Reviewed on Aug 11, 2017
    • Royal Sundaram Health Insurance
      "No benefit from Royal sundaram "
      0.5 1.0/5 "Really Bad"
      I have policy of health insurance since Sept 2016 with SBI card of Rs.3lac My wife was getting Abdominal pain and I have to admitted in hospital and found Acute Gastritis problem.when we claim after discharge from hospital ,royal sundaram rejected my claim and said it is preexisting disease .According Doctor it is not chronic disease .I would like to case in consumer forum and will cancel my policy.and I will not suggested for Royal sundaram. Regards Vivek Kumar Policy no-HSAA033532 9810546957
      Was this review helpful? 1
      , gurgaon
      Reviewed on Jun 15, 2017
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