Edelweiss Health Insurance Claim Settlement Ratio

Every customer wants a quick and hassle-free settlement of claims. Edelweiss General Insurance Company ensures that the claims are settled most conveniently. With more than 5,500 network hospitals across India, the Insurance Company is committed to settling the claims in a lesser turn-around time. The health claim settlement ratio gives an idea of the number of claims that the insurer is capable to settle against the claim requests. And Edelweiss health claim ratio is 96.9%, which reflects positively on the insurer’s ability to settle the claims.

Whether it is an emergency hospitalization and planned treatment, the claims requests are approved quickly in both cases. Additionally, this insurance company offers a provision for both cashless and reimbursement health insurance claims. It directly pays the hospital if it is a cashless hospitalization and transfers the money to the policyholder’s account for reimbursement.  

Edelweiss Health Insurance at a Glance:

Key Features

Highlights

Network Hospitals

-

Incurred Claim Ratio

70.01

Renewability

Lifelong

Waiting Period

4 years

Claim Process of Edelweiss Health Insurance

When filing the health claim process with Edelweiss General Insurance Company you need to understand both cashless and reimbursement claim processes. The procedure to file the claim for

Edelweiss Cashless Claim Settlement Process

The cashless treatment facility is only available in Edelweiss General Insurance Company’s network hospitals. The insurer has a tie-up with several hospitals in India. Here is a quick step-by-step guide to help you file cashless health claims:

  • Firstly, select the Edelweiss network hospital in your city where you want to go for cashless treatment
  • The list of network hospitals is available online on the insurer’s site
  • You can inform the insurance company within 48 hours in case of emergency hospitalization and 72 hours before a planned hospitalization
  • You can carry your health card that is issued by the insurance company and a photo ID for the hospital visit
  • After that, you need to fill and submit the pre-authorization request form at the hospital help desk ( it is provided by the hospital itself)
  • Once your identity is cross-checked, the hospital sends the form to the Insurance company for verification
  • If the insurance company approves the claim, then the hospital settles the bills directly

Edelweiss Reimbursement Claim Settlement Process

Reimbursement claims can be filed in both network and non-network hospitals. And if you get admitted to any of the hospitals then you can file for reimbursement of bills as given below:

  • Inform Edelweiss General Insurance in case of both planned and emergency hospitalization. You need to inform 48 hours before in case of emergency hospitalization and 72 hours before in case of planned hospitalization
  • Collect hospital bills, discharge summary, invoices, medical reports, from the hospital. You need to make sure that the documents are hospital sealed
  • Download the ‘Claim Form’ from the insurer’s website, fill it and sign it properly
  • Annex a valid cashless and photo ID card
  • Send all the documents to the address of Edelweiss General Insurance
  • After reviewing the claim form and documents, the insurer approves the claim. However, the approval is subject to the policy terms and conditions

Document Required for Edelweiss Claim Settlement Process

Find a list of documents you should submit in case of the reimbursement claim:

  • Investigation reports (original)
  • Pharmacy bills along with the prescription
  • The discharge summary from the hospital
  • Post-mortem or FIR report, if any
  • Receipts, original bills, and discharge report
  • Indoor case papers and duly-filled claim form
  • Valid photo ID and hospital bills
  • Original consultation notes, and doctor's report
  • Nature of operation and surgeon's bill
  • Medical reports along with attending doctor’s report
  • Bank account details and a canceled cheque with your name

To know more about the policy details you can get in touch with our health experts at Policybazaar or speak to our helpline number at 1800-208-8787.

Written By: PolicyBazaar - Updated: 15 April 2021

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