Oriental Health Insurance Claim Settlement Ratio

Oriental health insurance claim settlement ratio reflects positively on the insurer’s dependency, which makes it a great choice to buy medical insurance online. The Oriental health claim ratio is 89%, which reflects positively on the insurer’s ability to settle the claims quickly and efficiently. Let’s check out more details related to Oriental health insurance claims.

Oriental Health Insurance at a Glance:

Key Features

Highlights

Network Hospitals

4300+

Incurred Claim Ratio

113.86

Renewability

Lifelong

Waiting Period

4 years

Claim Process of Oriental Health Insurance

Oriental health insurance follows a smooth claim settlement process. You can file both cashless and reimbursement claims in the most seamless manner. The procedure to file the claims is given below:

Oriental Health Insurance Cashless Claim Procedure

If you are undergoing treatment at a network hospital, then you can avail cashless claims. The steps to file cashless claims are given below:

  • Find a network hospital in the city where you can avail the medical treatment
  • Inform the Oriental Insurance Company in case of an emergency and before hospital admission for planned hospitalization
  • Showcase your cashless health card and a photo ID proof at the hospital
  • Get the pre-authorization form from the hospital, fill it and submit it
  • The hospital cross-checks your identity and then sends a pre-authorization form to the Insurer’s TPA
  • Third-party Administrator checks and approves the coverage
  • If the health insurance claim is approved, and the medical expenses will be taken care of by the insurer

Oriental Health Insurance Reimbursement Claim Procedure

Reimbursement claims can be filed in both network and non-network hospitals. You can follow the reimbursement claim process as given below:

  • Get admitted to any network or non-network hospital
  • Intimate Oriental Insurance Company about the hospitalization as soon as possible
  • Get the reimbursement claim form from the insurer or download it from their website
  • Provide the required details while filling the form
  • When getting discharged, pay the hospital bills
  • Collect all original bills, documents, and reports
  • Sign all documents and send them to the TPA service provider along with the claim form
  • On receiving the documents, the TPA service provider cross-checks the documents  
  • If everything is correct, the insurance company will settle the claim as per the policy terms and conditions
  • The payment will be done by the policyholder

Documents Required for Oriental Health Insurance Claims

The list of documents required for Oriental medical insurance claims are given below:

  • Submit all the medical bills, documents, cash memos, and reports to the TPA/company within 15 days of getting discharged from the hospital
  • Get original discharge certificate, medical bills, and receipts
  • All the documents related to doctor’s consultation, medical reports, and test
  • Medical history of the patient
  • Cash-memo from the hospital or chemists along with prescription letters
  • Radiology tests/pathological report receipts with supporting letter from the doctor that it is required as part of the treatment
  • Original receipts, bills, and diagnosis report from attending specialists, anesthetists, and consultants
  • Surgeon’s certificate confirming the diagnosis and the nature of the operation
  • Disability or death certificate ( if any)
  • Discharge summary
  • Any other document demanded by the insurer and TPA

Once all the documentation is complete, the TPA department will share the health insurance status with you.

Written By: PolicyBazaar - Updated: 15 April 2021

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