Aditya Birla Health Insurance Claim Settlement Ratio

When buying health insurance cover there is one important factor that you need to check that is the Claim settlement ratio of the Health Insurance Companies. Aditya Birla Health Insurance Co. Ltd has a claim settlement ratio of is 94%.

The claim ratio indicates how many claims a health insurance company can settle in a financial year. It is calculated based on the number of claims received vs. the number of claims settled.

Here is the formula: Health Claim Settlement ratio = number of claims settled/number of claims received * 100

For example, if a health insurance company receives 1000 claims and it settles 950 claims then the insurer’s health claim ratio will be 95%. Ideally, the claim ratio of 80% to 90% is considered good.

Claim Process of Aditya Birla Health Insurance

Aditya Birla Health Insurance Co. Ltd. accepts both cashless and reimbursement claim requests. In any of the network hospitals you can avail cashless treatment and for treatment in non-network hospitals, you claim to get compensation for the expenses incurred.  The claim process for Aditya Birla health insurance plans is given below:

Claim Process for Cashless Treatment

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

1. Check network Hospitals- You can check the list of network hospitals to avail cashless claim facility

2. Patient Identification- Show your health insurance cashless card and provide your health insurance policy number. For identification purposes, you can show your valid ID proof like PAN Card, Passport, and Voter’s ID, etc.

3. Post identification the network hospital will submit the Pre-authorization form or cashless form to the insurer. Fill the claim form and submit it online to the insurer

4. Emergency Hospitalization- Submit the cashless claim form within 48-hours of getting hospital admission

5. Planned Hospitalization- Submit the cashless claim form 3 days before getting hospitalized

6. Hospitalization Request Review- The insurer will review and provide the decision to the network hospital. You will receive intimation within 2 business hours. You can also check your claim status online

7. Claim Settlement-The insurer will process the claim with the hospital after completing all the formalities. You can also check your claim status online

Claim Process for Reimbursement Treatment

The claim process for reimbursement in a non-network hospital, or in case of rejection of cashless treatment is as given below:

  • Notify the insurer or Policybazaar team within 48 hours if it is an emergency.
  • If the treatment or surgery is planned then notify us or the insurer 3 days beforehand
  • Submit all the required documents from the hospital within 15 days of getting discharged from the hospital
  • Also, provide the duly filled reimbursement claim form
  • All the documents, proofs, and papers will be review and the decision will be taken accordingly.  You will get intimation over a call or email
  • Once the request is approved the 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:

  • Claim Form Part A filled by the insured ( you)
  • Claim Form Part B filled by the Insurer
  • 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 documents/pharmacy bills

For cashless claim, the paperwork is lesser.

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

Written By: PolicyBazaar - Updated: 01 February 2021

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