Aditya Birla Health Insurance Claim Settlement Ratio

Aditya Birla Health Insurance Claim Settlement Ratio

Aditya Birla Health Insurance claim settlement ratio indicates how many claims the insurance company is likely to settle in a financial year. It is calculated with the help of the following formula:

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Claim Settlement Ratio (CSR) = (Number of claims settled/Number of claims received) * 100

For example, if the health insurer receives 1000 claims and settles 950 claims, then the claim settlement ratio will be 95%.

Ideally, a claim settlement ratio above 85% is considered good. Impressively, Aditya Birla Health Insurance Company has a claim settlement ratio of 93.7% in FY 2021-22.

Claim Process of Aditya Birla Health Insurance

Aditya Birla Health Insurance Co. accepts both cashless and reimbursement claim requests. You can avail cashless treatment at any of the network hospitals of the insurance company, but for treatments availed at non-network hospitals, you can raise a reimbursement claim. The claim process for Aditya Birla health insurance plans is given below:

Claim Process for Cashless Treatment:

Steps to raise cashless claims under Aditya Birla health insurance plans are given below:

1. Get admitted to a network hospital of your insurance company to avail cashless claim facility.
2. Notify Aditya Birla Health Insurance Company about your emergency hospitalization within 48 hours and planned hospitalization at least 3 days prior.
3. Show your health insurance cashless card and provide your health insurance policy number. For identification purposes, you can show valid ID proof like your PAN card, passport, voter’s ID, etc.
4. Post identification, fill up the cashless pre-authorization form and submit it to the network hospital. The hospital will submit the filled-in pre-authorization or cashless form to the insurer. 
5. The insurer will review the details and notify the decision to the network hospital. You will receive intimation within 2 business hours. You can also check your claim status online.
6. If approved, the insurer will process the claim and pay the bill amount to the hospital after you are discharged.

Claim Process for Reimbursement Treatment:

The process for reimbursement claims is as follows:

1. Notify the insurer within 48 hours of an emergency hospitalization. If the treatment or surgery is pre-planned, then notify the insurer at least 3 days beforehand.
2. Avail treatment and pay all the medical bills at the time of hospital discharge.
3. Submit all the required documents from the hospital, including the duly filled reimbursement claim form.
4. All the documents, proofs, and papers will be reviewed by the insurer and the decision will be taken accordingly. You will get an intimation over a call or email.
5. Once the request is approved, the claim amount will be reimbursed.

Documents Required for Aditya Birla Health Insurance Claim Settlement

The documents required for Aditya Birla medical insurance claims are given below:

• Duly filled out Aditya Birla health insurance claim form
• Policy copy/Health card
• KYC documents, i.e. address proof, age proof, and photo ID
• Copy of hospital registration Certificate
• Discharge summary
• Hospital bills/receipts/break-ups
• Invoice/Implant stickers
• Consultation papers
• Original prescriptions/pharmacy bills
• Doctor’s letter describing the insured’s medical condition and suggested treatment
• Original diagnostic reports
• Copy of FIR in case of accidents

To know more details, you can get in touch with the customer care team at Policybazaar on the helpline number- 1800-208-8787.