The health claim settlement ratio of HDFC Ergo Health Insurance is 97% for the fiscal year 2019. Your insurer’s claim settlement ratio can tell you how trustworthy the company is when it comes to claim settlement.
For health insurance companies, a health claim ratio ranging from 80% to 90% is a good indicator of the insurer’s capability to address its customer’s claims during a financial year. Read to know more details about HDFC Ergo Health Insurance claim settlement procedure.
You as a policyholder can avail of treatment in both network and non-network hospitals. The procedure for a planned and unplanned hospitalization is different.
For cashless hospitalization treatment needs to be taken in any of the network hospitals. And for hospitalization in non-network hospitals, a claim for reimbursement needs to be registered. The procedure for both cashless and reimbursement claims is given below:
When you undergo treatment in a network hospital the claim procedure goes as follows:
Step 1-Get admitted to the hospital and begin with your treatment
Step 2- As soon as possible inform the insurer and Policybazaar’s claim team. Also, coordinate with the hospital to have the detail sent to the insurance provider for cashless service.
Step 3- Get authorization for cashless treatment
Step 4- At the time of getting discharged pay for the non-reimbursable expenses including the co-pay
Step 5- Sign on the authorization letter, verify all the bills and sign them
Step 6- Leave the investigation reports and original discharge summary with the hospital and keep a photocopy with you for records
Step 7- Sign the Claim Form
Step 1: In case of a planned treatment you need to align with your hospital/doctor and share the details of your treatment, an estimate of the cost involved, etc. the insurer. 7 days before your treatment, another important thing is to indicate the fax number or address to where the authorization is to be sent. Provide your mobile number for all points of communication and to receive authorization and updates related to claims.
Step 2: Once the insurer approves the cashless treatment, you can provide the authorization letter to the hospital with a photocopy of an ID proof
Step 3- When getting discharged you only pay for expenses that are not covered, cross-check your hospital bills, and sign them
Step 4- Leave the investigation reports and original discharge summary with the hospital and keep a photocopy with you for records
Step 5- If authorization for a cashless claim is not provided you can register for claim reimbursement
When you undergo treatment in a non-network hospital the claim procedure goes as follows:
Follow the process as given below for claims related to emergency hospital admission:
Step 1- Get admitted to a non-network hospital
Step 2- Inform the insurer about the hospitalization or speak to our health insurance customer care team for claim settlement
Step 3- At the time of getting discharged from the hospital; settle your hospital bills, and collect your documents, reports, and bills
Step 4- Lodge your medical insurance claim request with our claim processing team for settlement
Follow the process as given below for claims related to a planned treatment:
Step 1- Inform the insurer 7 days prior to hospital admission. You can also inform our health insurance claim team regarding this planned treatment at least a week in advance.
Step 2- Get admitted to a non-network hospital
Step 3- When getting discharged from the hospital; settle your hospital bills and collect all the hospital documents, reports, and bills
Step 4- File your health claim request with our claim team for reimbursement
Documents Required for Cashless Claims:
Documents Required for Claim Reimbursement:
For detailed information and understanding, you can get in touch with our medical insurance experts over email, and call.