The fear of claim rejection in people is mostly associated with the high cost involved in medical procedures. To make the health claims a seamless process, many families seek a reputed insurer to buy a health insurance cover. Royal Sundaram Health insurance plans are designed specifically to provide the most reliable and comprehensive health cover with an easy claim settlement process. For cashless claims, reimbursement, and critical illnesses, the claim process is clearly defined. If you have a medical insurance policy then you can check out the processes given below:
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The procedure for both is different. Let’s have a look
For claiming cashless benefits, the insured must avail of the treatment from a network hospital only. Royal Sundaram health insurance hospital list is provided at the time of purchasing the policy. You need to fill an authorization form provided by the hospital authority or TPA and follow the given formalities in the prescribed form.
If it is a reimbursement claim, then the insurer has to be informed about the incident and provide the estimate of the expenses incurred. The insured needs to fill and submit a claim form along with the discharge summary, doctor’s prescription, and the medical bills.
1. If the hospitalization was planned, you need to inform the TPA about it and get a cashless authorization in minimum of 72 hours before hospitalization.
2. In case of an emergency, the TPA should be informed within 24 hours of the hospitalization.
3. Fill the cashless authorization form provided by the TPA. The TPA will first check the coverage and your eligibility to avail the claim.
4. Attach all the necessary documents along with the duly filled claim form and submit it to the TPA department. If there is any discrepancy, the TPA will coordinate with you within 4 hours of receiving the form.
5. Pay the expenses that are not covered in the Royal Sundaram health insurance plan
6. In case a specific ailment is not covered in this plan, a rejection letter will be issued to you within 2 hours.
1. In case of an emergency hospitalization overseas, inform the insurer within the 24 hours of the hospitalization
2. The eligibility to file a claim would be verified by the company and you will receive a call from the insurer to initiate the claim
3. If the pre-authorization request is approved, the hospital expenses will be directly compensated by the insurance company
4. And if there is an additional cost attached to it, it has to be borne by you
If the treatment was taken in a non-network hospital and you want to make a claim, then you need to follow these steps to file a claim
1. Submit the duly filled and signed claim form within 30 days of discharge from the hospital.
2. If the insurer finds everything appropriate, then the claim amount will be recompensed within 30 days of lodging the claim.
3. In case of any discrepancy or rejection, a letter of rejection will be sent to you within 7 days of claim submission.
4. The payment will be made in the name of the applicant/proposer.
5. All the documents need to be submitted at the branch office.
Royal Sundaram health insurance also offers international treatment for some specified illnesses. Here is how to lodge claims under any such circumstances-
1. Immediately inform the insurer upon diagnosis of any specified critical illness. If you are planning to travel overseas, you need to inform the insurance company and request for a pre-authorization to avail of the medical treatment abroad.
2. Depending on your eligibility the request will be processed.
3. The insurer will coordinate with the hospital authorities to seek approval.
4. If the pre-authorization request is approved, the expenses will be directly settled by Royal Sundaram General Insurance Company.
5. You just need to pay the additional charges ( if any).
6. In case of emergency hospitalization, you need to inform Royal Sundaram General Insurance Company within 24 hours of the admission.
7. And if it is a planned hospitalization, the company should be informed within 48 hours prior to hospitalization.
Here is a list of documents that you need to furnish to lodge a claim with Royal Sundaram health insurance. For a detailed list please refer to the policy wordings.
1. Hospital bills/receipts/cash memos ( in original).
2. Reports of medical test/ doctor prescriptions/ medical consultations for related illness.
3. All reports related to the treatment such as ECG, MRI, X-rays, and Pathology etc.
4. Hospital discharge summary/ case history/ discharge and admission summary, reports of the treatment is given, and medical advice issued by the hospital.
5. In case of death submit the death summary issued by the hospital.
As you can see filing a claim for Royal Sundaram health insurance plans with Royal Sundaram General Insurance Company is a detailed process. The insurer follows the claim settlement process that is laid out in the policy wordings. Hope with this article you will provide you with prior knowledge of registering your Royal Sundaram health claims. You can speak to Policybazaar’s health insurance customer care team for any clarifications and grievance redressal. Our team of health insurance experts will take you through the entire process.