People's dread of having their insurance claims denied is typically related to how expensive medical procedures are. Many families look for a reputable insurer to purchase health insurance coverage from to make the procedure of filing health claims smooth.
Royal Sundaram's health insurance claim process is quite detailed and straightforward. Every policyholder, in the company's opinion, prefers a straightforward and efficient claim process. However, the claim processes for reimbursement and cashless therapy are different. For the advantage of its clients, Royal Sundaram ensures that two different types of claims can be filed. These are cashless and reimbursement claims. Let’s talk about the process involved in each of these two claims.
How to File a Claim for Cashless Treatment?
At more than 7,000 network hospitals, Royal Sundaram offers its members cashless hospitalisation so they can easily get direct healthcare services. Here’s how you should approach
- Locate a Royal Sundaram network hospital in the city where you wish to receive cashless care first.
- Intimate Royal Sundaram at least 48 hours before admission in the case of a planned hospitalisation. Whereas you need to intimate the insurer within 24 hours of emergency hospitalisation.
- Before going to the hospital, ensure you have a valid photo ID and a health insurance card. Bring the health card and a valid photo ID to the insurance desk at the hospital. Present the health card and a valid photo ID at the hospital's insurance department.
- Fill out the pre-authorisation request form entirely before submitting it to the hospital.
- The hospital alerts you and sends the pre-authorisation paperwork to Royal Sundaram Health Insurance Company.
- The Third Party Administrator (TPA) or insurer will assess your request. Within three hours, you will hear back.
- If the request is granted, the insurance company will pay your charge in full.
Treatment for Reimbursement
You need not be concerned if your claim application for cashless hospitalisation is denied or if you receive treatment at a non-network institution. Later, you can request repayment for the costs you incurred. Observe these recommendations:
- Within 72 hours of your anticipated hospital stay, notify your health insurance provider. However, in the event of emergency hospitalisation, the insurer must be contacted within 24 hours of admission.
- Within 30 days of the discharge date, send Royal Sundaram the completed claim form and any supporting documentation.
- Your request will be verified by the insurer, who will then determine whether to accept or reject it in accordance with the policy's terms and conditions.
- The costs involved during hospitalisation will be paid back to the proposer through a cheque.
Required Documents
The Royal Sundaram Health Insurance health insurance claim office must receive the following documentation:
- Accounts of the initial investigations
- Final hospital discharge summary
- Along with the prescription, pharmacy bills
- Authentic invoices, receipts, and a discharge report
- Indoor case files and a properly completed claim form
- Information about NEFT transaction or cancelled cheque
- A valid photo ID and the original hospital bills
- Original consultation notes and the treating physician's report
- The procedure type, together with the invoice and receipt from the doctor
- Test results, accompanied by a report from the treating physician or surgeon
Royal Sundaram Health Insurance's Incurred Claim Ratio (ICR)
The incurred claim ratio, often known as the ICR, is the ratio of net claims paid by an insurer to the net premiums received. The ratio essentially provides information about an organization's performance, assisting customers in making knowledgeable decisions. Royal Sundaram's incurred claims ratio (ICR) for FY 2018–19 is 61%.
The Procedure for Making a Claim for International Treatment of Critical Illnesses
Royal Sundaram health insurance provides worldwide treatment as well for certain conditions. Here is how to file claims in such situations:
- Upon receiving a diagnosis of any of the listed critical illnesses, notify the insurer right away. In order to receive medical care abroad, you must notify your insurance provider of your travel plans and request a pre-authorization.
- The processing of your request will depend on your eligibility.
- The insurer will work with the hospital administration to get permission.
- If the pre-authorization request is granted, Royal Sundaram General Insurance Company will pay the costs in full.
- The additional fees must be paid ( if any).
- You must notify Royal Sundaram General Insurance Company about an emergency hospitalisation within 24 hours of the admission.
- Additionally, if the hospitalisation is scheduled, the company must be notified 48 hours in advance.
Requirements for Royal Sundaram Health Insurance Claim Documents
The list of paperwork you must submit to Royal Sundaram Health Insurance is provided below. For a detailed list, please review the policy wording.
- Hospital receipts, invoices, and cash memoranda ( in original).
- Accounts of medical examinations, prescriptions from doctors, and medical advice on connected illnesses.
- All treatment-related reports, including ECG, MRI, X-ray, and pathology results, among others.
- Hospital case history, discharge and admission summaries, reports of the treatments administered, and hospital-issued medical advice.
- Submit the death summary provided by the hospital in the event of a death.
Conclusion
As you can see, submitting a claim for one of the Royal Sundaram General Insurance Company's health insurance plans involves a thorough procedure. The claim settlement procedure outlined in the policy wording is followed by the insurer. We hope that by reading this material, you will be better prepared to submit your Royal Sundaram health insurance claims. Their team of health insurance experts will walk you through the entire process.
Read more - Steps to Make Cashless Claims on Your Health Insurance?
