United India Health Insurance Claims Procedure

This is a public-sector general insurance provider formed in 1938 and was nationalised in 1972. The company has since bolstered its presence across the country by expanding its distribution network. It now has over 1,340 offices channelling a variety of insurance products to a customer-base of over 1 crore clients. In addition to serving urban and semi-urban clients, United India actively participates in government-run programmes aimed at extending insurance to rural market segments. It also services lower economic strata through micro-offices which they have established in over 200 towns.

Health insurance policies form an integral part of its product portfolio. These policies couple coverage with affordability, making them viable insurance products for a large cross-section of the Indian insurance market. United India Health Insurance offers a series of health insurance products, based on the requirements of the Indian family, health care and lifestyle. Some of their leading health insurance plans include Family Medicare, Family Medicare 2014, Individual Mediclaim, Platinum, Senior Citizen and some other products such as Super Top-up, Top-up and UNI Criticare.

Incurred Claim Ratio for United India Health Insurance:

The Incurred Claim Ratio (ICR) of any specified insurance providing company indicates the company's performance in simple words. It basically allows prospective customers get a better understanding about what to expect in terms of health insurance. The Incurred Claim Ratio for United India Health Insurance products for the time 2016-17 and 2017-18 has been mentioned in the table:

Incurred Claims Ratio of United India Health Insurance for the Year 2016-17:

Net Earned Premium (in Crore) Net Claims Paid (in Crore) Incurred Claims Ratio (in %)
4575.93 crore 6338.24 crore 138.51%

Incurred Claims Ratio of United India Health Insurance for the Year 2017-18:

Net Earned Premium (in Crore) Net Claims Paid (in Crore) Incurred Claims Ratio (in %)
4638.13 crore 5146.18 crore 110.95%

Based on the understanding of ICR, it is clearly visible that the numbers are impressive and the ICR is quite good. However, the net earned premium is lower that net claims paid. This is indicative of the fact that claim settlement is higher than the earnings, which means that the company does not make up its finances. However, being a government or a public sector institution it is not a much of a problem since these companies have a socialistic approach towards their customers.

How to Claim?

There are two situations that may occur when claiming health insurance. The cashless treatment is one that allows the policyholder to use the insurance as money to seek their treatment without having to pay any money upfront for treatment. The other scenario that is possible is in the case that the treatment has been already done and paid for but claim settlement requires to be made to allow the individual to be returned the money spent for treatment.

To Claim for Cashless Treatment:

Cashless treatment is basically utilized for a disease or illness, which is covered by the insurer including medical expenses for the treatment but on an individual basis, but independent of the patient is a part of a group health insurance or a . The patient requiring the treatment claim for a cashless facility at any of the network hospitals enlisted by United Health Insurance on their website, or policy brochure, across the country.

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

    Here is what is needed to be done for a cashless claim:

    1. Get in touch with the network hospital and ensure that you have the health card issued by USGI and seek admission.
    2. Intimating, is an important part of the filing process for the cashless facility. It can be done easily. All one needs to do is simply contact the number mentioned on the card or the health insurance helpline number 1-800-425-33333.
    3. In the case of a planned hospitalization one needs to reach out to the company, 2 days prior to admission.
    4. It is then required to provide the hospital with the health card as well as an ID proof with photo who will then start the verification of your credentials.
    5. Once this process is completed, a pre-authorization form needs to filled with appropriate details by the hospital. This form will require the signature from the attending doctor. In cases of planned hospitalisation, an authorisation letter is required to be submitted.
    6. The pre-authorization form, once is filled, signed and overall completed needs to be sent to the the insurance provider with relevant information by the hospital.
    7. The insurance providing company will then contact the relevant bank to update the status of the claim made, which will be either accepted or rejected or possibly a request for additional information or documentation.
    8. On acceptance, the medical bills covered under the policy is settled by New India Assurance, while things that are not covered will have to be taken care of, by the patient/card holder.
    9. The policy holder needs to then take a thorough look verify and sign the original bills and at the same time keep a photocopy of the entire hospitalisation record.
  • Claims Process:

    Here is how the claim process for United India health insurance works:

    1. It is required to register the claim within 7 days of the patient’s or the covered individual’s discharge, and immediately let New India Assurance know about it.
    2. You need to fill and submit the Claims Form, providing a photocopy of a valid ID proof along with it.
    3. Then you must send the required medical certificates along with diagnosis reports which has been signed by a doctor.
    4. All the reports as well as the discharge summary i.e. original copy has to be submitted for verification.

    The insurance provider will then approve or reject it based on the policy in place.

For Reimbursement of Treatment Expenses:

The insured individual can claim a reimbursement for the expenses incurred for the treatment with a few simple steps, after receiving the treatment and paying for the treatment.

  1. Procedure to File a Claim:

    Here is what you need to do to file a claim for reimbursement of medical bills through your mediclaim:

    • The insurance company has to be informed immediately once the person covered under the mediclaim is being hospitalised.
    • After the treatment is completed, all hospital bills have to be settled by the policyholder, along with keeping all the bills and reports.
    • Submit the duly filled claims form to United India Insurance for processing and reimbursement. The insurer will reimburse all bills if as long as all the information provided is given correctly.
  2. Documents Required:

    The following documents need to be submitted to United India Health Insurance:

    • Bills: All the original hospital bills, with stamps and signatures from the hospital has to be submitted.
    • Claim form: The claim form which needs to be filled with relevant details, signatures and finally be submitted.
    • Discharge Report: The original discharge report has to be submitted as well.
    • All other originals reports related to the treatment (including medicine bills and investigation reports) has to be submitted.
    • The future line of treatment as well as follow-up check-ups by the relevant doctor should be sent as well.

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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.

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