Royal Sundaram Health Insurance Claim Settlement Ratio

Health claim settlement ratio refers to the number of claims that the insurance company settles in relation to the total number of claims filed during the policy term. A higher claim ratio indicates positively of the insurance companies’ ability to settle the claim requests received.

Royal Sundaram General Insurance has a claim settlement ratio of 85% (2018-2019), which makes it a suitable option. Any claim ratio between 85% and 95% is considered good.

Royal Sundaram Health Insurance at a Glance:

Key Features

Highlights

Network Hospitals

3000+

Incurred Claim Ratio (2018-19)

61%

Renewability

Lifelong

Waiting Period

3 years

Policy Tenure Options

1,2,3 years

Restoration of Sum Insured

Up to the base sum insured

Grace Period

30 days

No-claim-Bonus

In some plans the No-claim-bonus is 10% to 50% and in some plans, it ranges from 10% to 100%

Daycare procedures

Up to 200

Vaccination Charges

In case of animal bite

Royal Sundaram Health Insurance Claim Process

There is no restriction on the number of claims that can be filed in a year up to the sum insured limit. There are two ways a policyholder can claim for health policies:

  • Cashless Claims
  • Reimbursement Claims

To avail cashless claims the treatment must be availed in a network hospital. The list of network hospitals is available online. To claim the benefits submit the authorization form to the TPA/ Insurance Company.

To file for reimbursement of expenses, a claim form needs to be provided along with the bills. More details are given below:

Claim for Cashless Treatment

  • If it is a planned hospitalization you can intimate the TPA and apply for cashless authorization before 72 hours of getting admitted to the hospital.
  • For emergency cases requiring hospitalization, the TPA needs to be intimated in 24 hours of getting admitted
  • After that fill and submit the cashless authorization form within 3 hours.
  • Furnish all the medical documents and duly filled form and submit it to the Insurer/TPA. In case more documents or information is required, the TPA department will get in touch with you.
  • Pay for anything that your insurance policy does not cover and make payment for the necessary expenses, which are excluded under the policy.
  • In case the treatment is excluded, a letter of rejection will be issued. And you can file for reimbursement. If the claim is approved then the insurer will settle the claim directly.

Claim for Reimbursement Treatment

For treatments availed in non-network hospitals, you can file reimbursement claims. And the steps to file a reimbursement claim are given below:

  • You need to submit a duly filled and signed claim form
  • The claim will be rejected only if there is a discrepancy and the insurer will issue a rejection letter within 7 days
  • On approval, your claim request will be processed within 30 days of submitting the claim. 
  • The insurer will then reimburse the expenses

Documents Required for Royal Sundaram Health Insurance Claims

Here are some of the crucial documents that you need at the time of claim. For complete list you can refer to the policy wordings or speak to Policybazaar’s health claim team. Some of the documents are given below:

  • Doctor’s prescriptions and test reports of medical consultations related to the undergoing treatment.
  • Medical history, admission-discharge summary describing the nature and duration of the treatment, discharge summary, etc.
  • All the medical reports like ECG, X-rays, MRI, CT Scans, Pathology reports etc., should be submitted
  • It includes doctor’s prescription advising medical tests/ investigations. In case of death a death summary of the insured person from the hospital needs to be submitted as well
  • Original copies of hospital bills/receipts/cash memos in Original (including hospital receipts final and advance both).

For more details you can speak to our customer care team at 1800-208-8787 or write to us at This email address is being protected from spambots. You need JavaScript enabled to view it..

Written By: PolicyBazaar - Updated: 15 April 2021

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