Reliance Health Insurance Claim
There are three easy steps to file Reliance Health Insurance claim:
- Step 1: Hospitalization on Doctor’s advise
- Step 2: Intimate the health insurance claim
- Step 3:
- Cashless Claim: Only available at Network Hospital
- Reimbursement Claim: Go for the treatment in the non-network hospital and make payments by self.
- For cashless treatment: In this case, the insured has to contact the TPA desk of the network hospital for making the arrangements for cashless treatment.
- For reimbursement: In this case, the insured has to submit all the required documents within 15 days of discharge.
Description of Claim Process
The detailed description of the claim process of Reliance Health Insurance is:
- Claim Intimation: In order to make claim process smooth and fast, Reliance serves its customers through RCare Health (the in-house health claim unit of Reliance). Moreover, Reliance also appoints a Third-Party Administrator Desk licensed from IRDA for the same. In order to file the claim request, the insured has to contact Reliance through the phone numbers mentioned on the policy schedule or health card issued by the company. The insured needs to keep the following information ready while making a call for intimation process:
- Policy number
- Name of the insured
- Contact details of the insured (phone number, address, email id, landmark, etc.)
- The hospitalized person’s relationship with the insured.
- Hospital’s name.
- In case of an accident – nature of the accident, its date & time, and location of the accident.
- In the case of health claims – nature of ailment and the date on which the symptoms of ailment occurred.
Claim Process - Cashless
- The insured must be admitted in any of the network hospitals of Reliance General Insurance.
- There the insured has to show the health card issued by Reliance to the TPA helpdesk of the hospital.
- After that, it is required to fill the “Cashless Request Form”. This form is available with the TPA desk of the network hospital.
- At the time of hospitalization, submit the copy of the health card with an authorization form to the hospital (the insured is required to have photo ID).
- Wait for the hospital's authorization. For this, the hospital co-ordinates with the TPA or RCare Health.
- The hospital emails or faxes the pre-authorization form to the TPA or RCare Health with necessary medical details.
- The insured verifies all the medical bills and signs them all.
- The hospital keeps all the original copies of the discharge summary and other investigation reports in the hospital.
- The insured must keep the photocopies of all the records.
Claim Process - ‘Cashless Hospitalization’ is Rejected by RCare Health/TPA:
Follow the below process in this case:
- Settle all the medical bills in the hospital.
- Get all the original bills, documents, and reports from the hospital at the time of discharge.
- Lodge a reimbursement claim with RCare Health or TPA.
Claim Process - Emergency Cashless Hospitalization:
- Get admitted in any of the network hospitals of Reliance.
- Get the pre-authorization form from the hospital.
- Fill this form and get it signed by the attending doctor.
- The hospital faxes or emails the pre-authorization form to the TPA or RCare Health with all the required medical details.
- The insured must verify and then sign all the bills.
- It is required to leave the original discharge summary and all other investigation reports in the hospital only.
- Keep the photocopies of all the records.
Note: The insured is required to pay all the expenses that are mentioned as non-payable in the terms and conditions section of the policy.
Claim Process - Planned Cashless Hospitalization:
- The insured is required to coordinate with his/her doctor as well as the hospital and send all the required details related to planned hospitalization such as estimated cost, treatment plan, etc. to the TPA or RCare Health two days prior to the hospitalization.
- Provide the photo ID card and authorization letter to the hospital while admitting.
- The hospital faxes or emails the pre-authorization form to the TPA or RCare Health with all the necessary medical details.
- The insured signs and verifies all the bills.
- Do not take the original discharge summary and other investigation details in the hospital only.
- The insured must keep the photocopies of these documents for the record.
Claim Process - Reimbursement In Case of Emergency Hospitalization:
- The insured needs to be admitted in the hospital.
- Intimate about the claim at the call center of RCare Health or email RCare Health as soon as possible.
- Settle all the hospital bills as needed.
- The insured is required to collect all the original bills and related medical documents from the hospital at the time of discharge.
- After that lodge the claim on RCare Health/TPA for reimbursement by filling the form for the claim and attaching all the required documents as per the claim form.
Claim Process - Reimbursement In Case of Planned Hospitalization:
- For planned hospitalization, intimate RCare Health/TPA.
- After that get the insured hospitalized.
- Settle all the medical bills of the hospital.
- The insured is requested to gather all the original bills and related reports/documents at the time of discharge.
- Lodge the claim on RCare Health/TPA for reimbursement and processing.