HDFC ERGO Health Insurance Claim Settlement Ratio

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      HDFC ERGO Health Insurance Claim Settlement Ratio

      HDFC ERGO General Insurance Company has an efficient in-house claim settlement team that decides on all the claims without third party administrator (TPA) involvement. As a result, the Company ensured an impressive HDFC ERGO health insurance claim settlement ratio of 95% in FY 2021-22.

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      The claim settlement ratio (CSR) indicates the total claims paid compared to the total number of claims received. Thus, the above CSR suggests that the insurance company paid 95% of the total claims received in the financial year ending March 31, 2022.

      Claim Process of HDFC ERGO Health Insurance Plans

      HDFC ERGO General Insurance Company has an easy and hassle-free claim process. Policyholders can either raise a cashless health insurance claim or a reimbursement claim. Take a look at the step-by-step guide to file a claim through both methods below:

      Cashless Claim Process:

      Follow the steps given below to file an cashless claim with HDFC ERGO health insurance:

      Step 1: Inform the Insurer

      Policyholders must inform the insurance company about their planned hospitalization at least 48 hours in advance and about emergency hospitalization within 24 hours.

      Step 2: Display Documents for Cashless Treatment

      Show your HDFC ERGO health card and a valid photo ID at the network hospital for cashless treatment.

      Step 3: Pre-authorization Form

      The network hospital will send the pre-authorization form to the HDFC ERGO General Insurance Company and seek approval for cashless treatment.

      Step 4: Cashless Claim Approval

      The insurer will go through the documents received by the hospital and will approve/reject your cashless claim request.

      Step 5: Document Submission

      If approved, the hospital will send the final bill and other required documents to the insurer for final authorization after your treatment.

      Step 6: Claim Settlement

      The insurer will verify all the documents and authorize the claim within 2 hours of receiving all the documents. The bill amount will be paid directly to the network hospital.

      Reimbursement Claim Process:

      Here are the steps to file a reimbursement claim with HDFC ERGO health insurance:

      Step 1: Inform the Insurer and Obtain Treatment

      Inform HDFC ERGO General Insurance Company about your hospitalization within the specified timeline and obtain the treatment.

      Step 2: Pay Hospital Bills

      While getting discharged from the hospital, pay all the medical bills and collect all the medical documents.

      Step 3: Upload All Documents

      Upload all the required documents to the insurer’s website for claim processing.

      Step 4: Claim Settlement

      The insurance company will review all the submitted documents and process the claims within 7 days. The claim amount will be paid to you online.

      Documents Required for HDFC ERGO Health Insurance Claims

      Take a look at the list of documents required to file an HDFC ERGO health insurance claim:

      • Duly filled and signed HDFC ERGO health insurance claim form
      • Original hospital bill with detailed break-up and payment receipts
      • Original hospital discharge summary
      • Original pharmacy invoices supported by doctor’s prescriptions
      • Original investigation reports, such as X-ray reports, blood test reports, etc.
      • Implant sticker/invoice
      • Past treatment documents, if any
      • FIR or Medico Legal Certificate (MLC) in case of accident claims
      • Nominee details in case of proposer’s death
      • Legal heir certificate if the proposer is a minor
      • NEFT details for online payment
      • KYC form with a photocopy of any one KYC document for claims of Rs 1 lakh and above
      • Other relevant documents, if any
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      • 30 minutes claim support*(In 120+ cities)
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      Disclaimer: Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.

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