HDFC ERGO Health Insurance Claim Settlement

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At the time of purchasing an HDFC ERGO health insurance policy, you can easily get the benefits of the simple and comfortable claim settlement procedure that is offered by them. The company also has very impressive HDFC ERGO health insurance settlement ratio statistics in recent years, which is very praiseworthy. Similar to other insurers, HDFC ERGO also provides both cashless, and reimbursement claim options and more about this matter can be found in the section below, along with HDFC ERGO health claim ratio details.

The Claim Process for Cashless Treatment for HDFC ERGO Health Insurance Claim Settlement

HDFC ERGO has one of the most highly accessible, quality cashless claim systems that can be availed through the mode of cashless treatment from the huge range of network hospitals under the company. They have more than 13,000 network hospitals across the country, where you can avail the benefits of a top-grade, cashless treatment facility. In this type of claim, you can get your treatment from any of the affiliated hospitals under the insurance company and not worry about paying the cost of the treatment and hospitalisation bills from your own savings. 

Guide to the Cashless Claim Treatment

To claim for cashless treatment, you will need to get admitted to an affiliated hospital and let HDFC ERGO know about the procedure by submitting the documents needed for the cashless claim.

This is how you can submit a cashless HDFC ERGO health insurance claim settlement:

There are two types of cashless treatment claim settlement, one is for planned hospitalisation, and the other one is for emergency hospitalisation. They both have different cashless claim settlement procedures. 

Planned Cashless HDFC ERGO Health Insurance Claim Settlement Process

In the event that you are scheduled for treatment happening a few days or if you are pre-planning to get a certain medical procedure done, you can make use of the planned cashless claim settlement. In this case, you will need to contact the chosen network hospital under HDFC ERGO a few days in advance. After that, you will have to take out the pre-authorisation form, duly fill it in and submit it. After the submission, the hospital will send the required documents to the TPA desk, and they will forward the papers to the insurance company for preliminary permission. Soon after receiving the approval, you will be able to use the cashless treatment at the HDFC ERGO network hospital.

Emergency Cashless HDFC ERGO Health Insurance Claim Settlement Process

In case of an emergency-induced hospitalisation and need medical treatment, you can also make use of a cashless treatment facility. In this case, too, you will have to go with an HDFC ERGO network hospital option. First, you will need confirmation from the medical practitioner that states the need for hospitalisation and provide the related documents, health card details and the pre-authorisation form. After the approval for treatment comes in from the HDFC ERGO, the cashless treatment claim can be made. 

The Cashless Claim Procedure After Admission

  1. Once the admission is made, the pre-authorisation form will be sent out to the HDFC ERGO, attached with other related documents, by the TPA at the hospital.
  2. Soon after the initial approval for treatment is received, the operation will commence.
  3. The TPA might then ask you for some additional documents to obtain further permission from the HDFC ERGO in case an extension of the approved cashless sum limit is required.
  4. HDFC ERGO or the TPA will verify all the documents and relay their final stand on the claim procedure at the date of patient discharge.
  5. The hospital will send the final bill to HDFC ERGO, who will verify it and give you the final authorisation for endorsed transactions to the hospital. Some expenses, which are not included in coverage under the health insurance company's terms and conditions, will be charged directly to you by the hospital.

List of Documents Required for HDFC ERGO Health Cashless Claim

In case of a cashless claim settlement, you will need to provide some of this important paperwork to avail of this feature: 

  1. The doctor’s prescription for the need for hospitalisation.
  2. The health card issued by HDFC ERGO for cashless hospitalisation.
  3. The proof of identity, address and age of the patient and the policyholder, in case they are different.
  4. All the medical reports and test details were made before the hospitalisation.

The hospital will take care of the rest of the documentation on your behalf during a cashless claim settlement.

How to Check HDFC ERGO Health Insurance Policy Claim Status?

The HDFC ERGO health insurance claim ratio is highly remarkable, which is a great sign indicating the chances of getting your claims settled with the company. If you have filed an insurance claim with HDFC ERGO and want to know about its status, follow the steps mentioned below.

The Online Process for Knowing the HDFC ERGO Health Insurance Claim Settlement:

  1. Visit the official website of HDFC ERGO health insurance and navigate your way toward the “Claims” section.
  2. Then find and select the “Health Insurance” section and click on it.
  3. In the new webpage, find and select the “Track Claim” option.
  4. Enter either the HDFC ERGO policy number, the registered mobile number or the registered email address to sign in.
  5. Press “Continue”, provide the OTP and your claim status will be presented on the next screen.

It is vital to know that the HDFC ERGO health claim settlement ratio is great, so your claims have a higher chance of getting settled. 

The Offline Process for Knowing HDFC ERGO Health Insurance Claim Settlement:

If you are looking to track your HDFC ERGO health insurance claim status through the offline method, you can do so quite easily. You can get in contact with the company’s trained professionals by dialling 022-6234-6234 or 0120-6234-6234 for any claim-related queries. You can also visit any of the HDFC ERGO health insurance branch offices near your location and talk with the executives about your claim status. Regardless, the online procedure is the most convenient to know about HDFC ERGO health insurance claim settlement status in real-time.

The Claim Process for Reimbursement Treatment for HDFC ERGO Health Insurance Claim Settlement

Sometimes, the cashless claim options can be unavailable to some people. But there’s nothing to really worry about as you can still avail of financial backup with the help of an HDFC ERGO health insurance reimbursement claim. The most common reason individuals go with the cashless claim is that they were unable to locate a network hospital near them for treatment in case of an emergency, as the cashless treatment facility is not offered at non-network hospitals. In this alternative method, you will have to pay for all the medical treatment costs and hospitalisation bills from your own money. After that, you can apply for a reimbursement claim with the HDFC ERGO, which will compensate you with the money after verification.

Here is how to submit the claim for reimbursement with HDFC ERGO health insurance:

  1. You will have to cover all the bills related to the treatment and hospitalisation initially and maintain all the actual invoices.
  2. Soon after the official hospital discharge is made, you can register for a reimbursement claim with your HDFC ERGO and send them all the original bills and documents associated with the treatment.
  3. HDFC ERGO will run a verification check on the provided documents and invoices.
  4. After the official approval for the claim settlement is made by HDFC ERGO, they will send the endorsed claim amount to your registered bank account within a few days.

List of Documents Required for HDFC ERGO Health Reimbursement Claim

The general details required at the time of filing a reimbursement claim are;

  1. Name of the patient
  2. The HDFC ERGO health insurance policy number
  3. The proof of identity and age of the insured
  4. The details of the patient’s injury or illness type
  5. The date of hospital admission
  6. The name of the attending doctor
  7. Other additional details as per the insurer

These are the documents which you will need to submit to HDFC ERGO for reimbursement claim settlement:

  1. The duly filed claim form with your proper signature
  2. Valid proof of identity
  3. The prescription of the doctor declaring the need for hospitalisation, medical reports and tests, medicines, etc.
  4. All the original bills of the hospital, doctors, diagnostic reports, medicines, etc. and their receipts
  5. Patient discharge summary, investigation reports and the case papers
  6. A police FIR/medico-legal case (MLC) report or post-mortem report if applicable in this case
  7. The bank account details and proof through cheque book, bank statement or passbook

This is the general list of documents required for filing a reimbursement claim. You might have to provide additional documents if HDFC ERGO demands.

HDFC ERGO Health Insurance Incurred Claim Ratio (ICR)

HDFC ERGO’s Incurred Claim Ratio (ICR) is the ratio value of two important factors, the total value of settled insurance claims and the total value of insurance premiums collected by the HDFC ERGO within a given period. This is a very crucial report that gives an idea of the company’s revenue and its financial stability. This data is published by the IRDAI and according to their report, the ICR of HDFC ERGO health insurance for the financial year 2020-21 was 79.30%, which is a good indication.

HDFC ERGO Health Insurance Claim Settlement Ratio (CSR)

Now, let’s come to the part of the Claim Settlement Ratio (CSR), which is the ratio value of the total number of resolved insurance claims and the total number of submitted insurance claims. The HDFC ERGO health claim ratio will help you to understand how likely your health insurance claims are going to be settled under the company. IRDAI doesn’t publish this data and the CSR is generally declared by the respective insurers. Though the claim settlement ratio of HDFC ERGO health insurance doesn't properly indicate the total time it takes to clear an insurance claim, the company disclosed to have settled 99.8% of its claims within the initial 3-month period and only 0.2% of claims required more than 3 months for settlement in the fiscal year 2019-20. This means both the HDFC ERGO health insurance claim settlement ratio and claim settlement time are great.

HDFC ERGO Health Insurance Claim Settlement FAQs

  • 1. What is the contact number of HDFC ERGO health insurance for claim-related queries?

    Here are the numbers for claim-related queries with the HDFC ERGO health insurance, 022-6234-6234 and 0120-6234-6234.

  • 2. Can I apply for a cashless claim settlement at a non-network hospital with HDFC ERGO health insurance?

    No, you can only apply for a cashless claim settlement through a network hospital under HDFC ERGO.

  • 3. Will I be required to pay for anything during the HDFC ERGO cashless claim facility?

    The majority of the medical expenses will be paid by your insurer and you will only be required to pay for certain non-included expenses that the HDFC ERGO health insurance doesn’t cover under the cashless claim feature. 

  • 4. Where can I learn more about the claim process with HDFC ERGO health insurance?

    You can learn more about the claim process OF HDFC ERGO on the website.

  • 5. Does the company’s CSR tell how likely the HDFC ERGO is going to settle the insurance claim?

    Yes, with the HDFC ERGO health insurance settlement ratio, you can get a general idea of how likely your insurance claims are going to be settled.

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