Get assistance with Health Insurance claims

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HDFC ERGO Health Insurance Claim

An insured can face two different treatment scenarios while using a health insurance policy. On one hand, where the first scenario is getting cashless treatment in network hospitals, on the other hand it is related to reimbursement of all the expenses incurred during the treatment.

Claim Process – Cashless Hospitalization:

To get the cashless treatment, one needs to be hospitalized in any of the network hospitals of HDFC ERGO. In this process, one needs to follow the steps mentioned below:

  1. Steps to File Claim (In Case of Both Emergency and Planned Hospitalization): The steps to file a claim in case of both emergency and planned hospitalization:
  2. The insured must approach any of the network hospitals with the health insurance card given by HDFC ERGO and get admitted there.
  3. For planned hospitalization, the insured must inform HDFC ERGO 2 days prior to the hospitalization. The insured or his/her family can inform HDFC ERGO by calling their TPA on 1800-200-1999 or 1800-2-700-700.
  4. For verifying the credentials at the time of hospitalization, the insured must provide the health card and a photo ID card to the hospital.
  5. After this, the insured or his/her family member has to fill the pre-authorization form and the attending doctor must sign this form. For planned hospitalization, the letter of authorization has to be provided.
  6. The hospital sends the filled pre-authorization form to HDFC ERGO with other needed details.
  7. After this, the hospital communicates with the insurance company for getting the updates on the status of the claim.
  8. Upon acceptance, all the medical expenses covered in the policy will get settled by HDFC ERGO, while those which are not covered will need to be paid by the policyholder.
  9. The insured has to sign all the original bills and must take the photocopy of the entire medical treatment.

Claim Process – Reimbursement after Hospitalization:

If an insured is taking treatment in a non-network hospital of HDFC ERGO, he/she needs to pay the bills from his/her pocket and then ask for reimbursement from HDFC ERGO. However, sometimes upon rejection of cashless treatment, one can ask for reimbursement. The steps to file reimbursement claim are:

Steps to File Reimbursement Claim:

  1. The policyholder must inform the insurance company immediately after the hospitalization by calling the TPA on 1800-200-1999 or 1800-2-700-700.
  2. In this case, the insured has to settle all the hospital bills and keep the original copies of all the bills and reports with him/her.
  3. For processing the reimbursement, the policyholder needs to submit the duly filled claim form to HDFC ERGO.
  4. If the information provided by the insured is correct and sufficient, HDFC ERGO reimburses all the bills/ medical expenses.

Documents Required:

The insured has to provide the following documents while filing a claim:

  • Hospital Bills: The policyholder must submit all the hospital bills duly signed and stamped by the hospital.
  • Claim Form: Submit the duly filled and signed the claim form.
  • Discharge Summary: The insured must provide the original discharge summary in case of reimbursement.
  • Details of Follow-Up: The policyholder must also submit the follow-up details provided by the hospital.
  • Details of the Hospital: In case of treatment in the non-network hospital, the insured must provide the details of the hospital. The details of the hospital must be taken in the official letterhead of the hospital.
  • Other Documents: Other details related to the treatment should also be submitted by the insured.
  • Documents for expenses pre and post hospitalization, if covered in policy