Get assistance with Health Insurance claims

*Policybazaar is acting only as a facilitator and claims settlement shall be at the sole discretion of the Insurer.

Oriental Health Insurance Claim Process

The Oriental Insurance Company in its health insurance products provides the facility of both cashless treatment and reimbursement. In order to file a claim in both the cases, the insured needs to follow certain steps. Mentioned below are the steps:

Claim Process Planned Cashless Hospitalization:

The facility of cashless hospitalization is available only at the network hospitals of the Oriental Insurance Company. Therefore, it is requested to check the list of the network hospitals under the insurer. Enlisted are the steps to follow in order to file the claim for planned cashless hospitalization:

  • Intimate the TPA of the hospital at least 48 hours before the hospitalization.
  • At the time of admission in the hospital, fill the pre-authorization form and hand it over to the TPA cell at the hospital. With pre-authorization form, the insured needs to provide other relevant documents. This pre-authorization form is most of the times available with the TPA cell of Oriental Insurance at the hospital.
  • The TPA cell sends this pre-authorization form and other details submitted by the insured to the insurer.
  • The insurer now scrutinizes the information sent by TPA related to treatment and provides its authorization to the TPA/network hospital. However, if the insurer wants, it can ask for more details or can reject this application for cashless treatment. In case of rejection, the insured can pay the bills on their own and apply for reimbursement later.
  • After getting approval from the insurer, the insured can go for the cashless treatment in the hospital.
  • The final bill will be settled by the insurance company directly with the hospital as per the policy coverage.

Claim Process – Emergency Cashless Hospitalization:

  1. In case of emergency hospitalization, the insured or his/her family has to inform the insurance provider at least within 24 hours of the hospitalization.
  2. The insured or his/her family has to fill the pre-authorization form and submit it to TPA cell. With this form, the insured has to provide other relevant documents to the TPA as well.
  3. After scrutinizing and accessing all these medical information provided by insured via TPA, the insurance company approves this pre-authorization form. However, the insurance company may ask for more documents to the insured or can reject it. On rejection, an insured can pay the bills and opt for reimbursement.
  4. Upon approval of pre-authorization, the insured becomes eligible for cashless treatment at the network hospital.
  5. The final bill will be settled by the insurance company directly with the hospital as per the policy coverage.

Claim Process – Reimbursement

The reimbursement claim is filed when the insured pays for the treatment beforehand and asks for settlement afterward. The steps to get the reimbursement from Oriental Insurance Company are:

  • The insured has to file the reimbursement claim within 15 days after discharge.
  • Fill the claim form. The claim form is available on the website of the Oriental Insurance.
  • Submit the duly filled and signed claim form with all the necessary documents to the insurance provider.
  • As per the terms and conditions of the insurance policy, the insurance provider can approve or disapprove the claim for the reimbursement.

Documents Required:

  1. Duly filled claim form along with the photocopy of the health insurance card provided by Oriental Insurance.
  2. Photocopy of premium receipt and policy.
  3. Discharge summary issued by the hospital.
  4. Report of medical treatment.
  5. Test reports such as Sonography reports, EGG, X-Rays, etc.
  6. Other required documents as mentioned in the policy.