ManipalCigna Health Insurance Claim Settlement

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Understanding the claim procedure and all the associated information is crucial when it relates to a health insurance policy. ManipalCigna's claim procedure is simple, quick, and hassle-free. The insurer provides policyholders with a high ManipalCigna health insurance settlement ratio and adequate information to enable comfortable completion of the process. The health insurance sector has given ManipalCigna high marks for its products and claim resolution. Like other medical insurance providers, ManipalCigna offers customers two options for resolving claims: a cashless process or a reimbursement process.

The Claim Process for Cashless Treatment for ManipalCigna Health Insurance Claim Settlement

With over 6,969 hospitals in its extensive network, Cigna Health Insurance Company is one of the nation's largest health providers and has such a high ManipalCigna health claim ratio. This makes extremely high-quality medical care and operations available. Treatment under this sort of institution should be received at network hospitals.

During this process, you are not required to pay anything linked to the medical cost. The payments associated with the medical costs covered by the medical insurance policy are immediately owed to the health insurer. 

Here is a step-by-step breakdown of the cashless claim treatment:

The best thing about cashless insurance claims is that, in the case of an emergency, policyholders can be transported to any partner hospital or healthcare facility and get medical treatment without worrying about paying for it.

Here's how to submit a cashless ManipalCigna health insurance claim settlement:

Cashless claims can be planned or in an emergency. 

Planned Cashless ManipalCigna Health Insurance Claim Settlement Process

For planned hospitalisation, you need to contact the hospital a minimum of 3-4 days in advance with the doctor’s advice for hospitalisation and fill up their pre-authorisation form. On receiving the same, the hospital will connect with the TPA desk at the hospital, who will send the documents to the insurer for initial approval. Once the approval comes in, you can avail of cashless treatment at the network hospital.

Emergency Cashless ManipalCigna Health Insurance Claim Settlement Process

Since no prior intimation is possible for emergency hospitalisation, you need to rush the patient to the hospital's emergency wing. Once the resident medical practitioner confirms the need for hospitalisation, you need to proceed to the admission counter and provide the necessary documents. This is when you need to fill up the pre-authorisation form and submit it along with the remaining documents. This claim intimation needs to be done within 24 hours of admission for the cashless claim to be processed.

The cashless claim procedure after admission:

  1. The hospital TPA will send your pre-authorization application and related medical records to the insurance provider.
  2. Your hospital operations might start after you acquire the first permission following the evaluation of your claim request.
  3. The required documentation must be forwarded to the TPA of the hospital, who will then review it with your insurance provider for permission if there is a need to increase the allowable cashless sum while the patient is in the facility.
  4. On the date of discharge, the hospital TPA will send your final billing and discharge statement to the company.
  5. After a final review of your claim submission, the insurance company or its TPA (third-party administrator) issues an improved/final authorization for the entire bill amount.
  6. There will be certain non-payable expenditures that, by rule, are not covered by your insurance plan once the total clearance is granted. These will be charged to you at the hospital.

List of Documents Required for ManipalCigna Health Insurance Cashless Claim

Here are some of the documents that need to be provided at the time of hospitalisation in order to process a cashless claim:

  1. The doctor prescribing hospitalisation
  2. Health card provided by ManipalCigna for cashless hospitalisation
  3. The age and identity proof of the insured and the policyholder, if they are different
  4. All tests and reports for diagnosis done prior to hospitalisation

The hospital would then take care of the rest of the documents on your behalf to process your cashless claim.

How to Check ManipalCigna Health Insurance Policy Claim Status?

ManipalCigna Health Insurance Company allows customers to track the status of their insurance claims. ManipalCigna health insurance claim ratio is good, but there are other aspects that need to be considered while checking the claim status.

The following is a breakdown of both the online and offline processes of the ManipalCigna health insurance claim settlement status check:

The Online Process for ManipalCigna Health Insurance Claim Settlement Status

  1. Visit the official ManipalCigna Insurance site and navigate to the claim area.
  2. Then, to monitor the progress of your claim, provide information like your health insurance policy number and your date of birth.
  3. After that, click 'Submit.' You will be displayed the status of your ManipalCigna health insurance claim settlement.

The Offline Process for ManipalCigna Health Insurance Claim Settlement Status

A policyholder can always check their insurance claim progress by calling ManipalCigna’s toll-free number 1800-102-4462 or visiting any local branch of the company. Nevertheless, an online claim verification procedure is always advised because it indicates the insurance claim's real-time status. Aside from that, it saves the policyholder significant time and effort. They may track insurance claims from the convenience of their home or workplace, eliminating the need to find or visit any local branch office.

The Claim Process for Reimbursement Treatment for ManipalCigna Health Insurance Claim Settlement

The treatment must be paid for before filing a reimbursement insurance claim. The hospitalisation, medical expenditure receipts, and other supporting paperwork must be presented when you file the claim. After reviewing the bills, the insurance company will transfer the funds to your specified bank account.

No matter where you had your medical care, the nicest part about reimbursement insurance claims is that you'll receive your money back no matter where the policyholder was admitted. So, the best course of action is to file a reimbursement claim if there is no network hospital in your locality.

Here is how to submit a claim for reimbursement:

  1. You need to first pay the entire bill of the hospital out of your own pocket and then file for the claim.
  2. Download the ManipalCigna health insurance claim settlement form and collect all original bills and medical treatment paperwork.
  3. Send the required documents to the local ManipalCigna branch that is most accessible for you for the claim to be processed.
  4. After the approval of your insurance claim, the refund amount is deposited into the bank account you specified.

List of Documents Required for ManipalCigna Health Insurance Reimbursement Claim:

The following information must be submitted to ManipalCigna at the moment of claim filing:

  1. Name of the patient/policyholder
  2. Policy number
  3. Identity of the insured individual with whom the insurance claim is being filed
  4. Illness / Injury type
  5. Name and location of the attending physician and hospital
  6. Admission date
  7. Any further information needed by the firm

The following papers must be submitted to ManipalCigna for a simple and hassle-free settlement of claims:

  1. The doctor’s prescription for hospitalisation
  2. Authentic investigation reports
  3. Summary of final hospital discharge
  4. FIR or a post-mortem report (if necessary)
  5. Original prescription and the pharmacy bills
  6. All reports and diagnostics test bills
  7. Original invoices and receipts, as well as the discharge statement
  8. Properly completed claim form, duly signed by the policyholder
  9. Verified hospital bills as well as a valid picture ID
  10. Authentic consultation notes and the attending doctor's report
  11. Nature of the procedure conducted, as well as the surgeon's invoice and receipt
  12. Test reports, as well as the doctor or surgeon's report
  13. The identity proof of the insured and the policyholder
  14. The bank account details of the policyholder, along with a cancelled cheque for transferring the claim amount.

Please note the company can ask for additional documents of verification during the claim filing or processing.

Incurred Claim Ratio (ICR) of ManipalCigna Health Insurance

Consumers' premiums are how a health insurance company makes money. The companies also settle claims with this money. The Incurred Claim Ratio or ICR is the ratio of earnings and payments in a medical insurance company. This also indicates a company's financial stability, as revenue is the sum remaining after the payments are paid from revenues. Also, since this is the official data published by the IRDAI, this is a valid source of understanding the company’s financials. ManipalCigna Medical Insurance's ICR for the fiscal year 2020-21 is 61.13%.

ManipalCigna Health Insurance Claim Settlement Ratio (CSR)

ManipalCigna health claim settlement ratio defines how likely is the company to settle your insurance claims. It is the total number of claims resolved divided by the overall number of claims submitted. This data is not published by the IRDAI but is often declared by individual insurers. 

The claim settlement ratio of ManipalCigna health insurance does not provide how long it takes to clear the claim, but ManipalCigna proudly claims to settle the claim for 99.96% of claims in less than 3 months and 0.03% of claims in more than 3 months.

ManipalCigna Health Insurance Claim Settlement FAQs

  • 1. How long is the time limit for settling a claim in ManipalCigna?

    In general, the firm responds to claims within 7 working days of receiving the last 'required' document. However, in some circumstances, the deadlines are extended. These should take no longer than 30 days.

  • 2. What are the causes for the claim amount being reduced?

    The amount of the claim can be reduced for any of the following reasons:

    1. Non-Medical costs such as phone bills, refreshments, and so forth are not reimbursable
    2. Absence of valid documents or prescriptions
    3. Exhaustion of the insured sum
    4. Exceeding the defined sub-limits
    5. If a co-payment is required
    6. Cost limits for any given treatment or benefit
    7. Authentic reports/bills are no longer available
    8. Expenses for any studies or therapy that are unrelated to the condition for which the patient is hospitalisedease or accident that happens during a policy year.

    This information is only illustrative and may differ depending on your coverage plan.

  • 3. Will my ManipalCigna claim be approved if I fail to submit it on time?

    In some cases, yes. Generally, the completed claim form and paperwork must be submitted to the firm within the specified timeframes. If the deadline is missed, but the policyholder can demonstrate that the lag was legitimate and unavoidable, accompanied with evidence, the claim will be approved.

  • 4. Is there any inquiry that takes place after the ManipalCigna claim is filed?

    For cashless claims, the hospital resolves all queries, so there isn’t any further enquiry. However, for reimbursement claims, the insurer can choose to enquire about the claim if there is any suspicion regarding the legitimacy of the claim. So, to avoid all confusion, you need to submit all relevant documents and claim only if the same is legitimate. 

  • 5. What are the most prevalent reasons for ManipalCigna claim rejection?

    The following are the most prevalent reasons for claim rejection:

    1. If the claim is raised within the waiting period for the policy.
    2. If there is an exclusion for pre-existing illness and a claim is raised for the same.
    3. If there has been a non-disclosure or misrepresentation of material facts regarding any pre-existing ailment, diagnosis, or treatment for the same.
    4. If you violate the terms and conditions of the policy as defined in the policy document.
    5. If all documents are not provided on time, or there has been a delay in the claim intimation.
    6. If there has been a sub-limit or an exclusion for any particular ailment.

    In fact, there could be multiple reasons for the rejection of a claim. But if you follow the process to the tee and submit all relevant documents, your claim will be cleared on time without delay.

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