Royal Sundaram Health Insurance Claim Settlement

The Royal Sundaram health insurance claim settlement process is quite detailed and straightforward. According to the firm, each policyholder prefers to have a quick and simple claim process, and thanks to the high Royal Sundaram health claim settlement ratio, this is made possible. Cashless therapy and reimbursement have different claim procedures, nevertheless. Royal Sundaram makes sure that two different forms of claims may be lodged for the benefit of its clients. They are the reimbursement claim and the cashless claim. 

The Claim Process for Cashless Treatment for Royal Sundaram Health Insurance Claim Settlement

The cashless claim process comes in handy when you are in a distressing situation. You will be able to avail the process at any network hospital closest to you and the pressure of having to pay for the medical expenses will be removed from your shoulders immediately. As long as you admit to a network hospital under the company, you will be able to avail the process of The Royal Sundaram health insurance claim settlement and will be covered based on the plan you are insured for. For the cashless claim process, you have access to more than 7,000 hospitals around the nation, which will help you resolve your payment for the claim without having to pay upfront, with a reassurance of a high Royal Sundaram health claim ratio. The procedure of the Royal Sundaram health insurance claim settlement can be done in two ways, Planned or Emergency. The only difference is in the case of emergency hospitalisation, inform Royal Sundaram within 24 hours, and at least 48 hours prior to admission in the case of a scheduled hospitalisation. The following is the process of cashless Royal Sundaram health insurance claim settlement:

1. In order to receive cashless care, first, locate a Royal Sundaram network hospital located in the city you wish to visit.
2. You can contact the company for the Royal Sundaram health insurance claim ratio through 1860-258-0000, 1860-425-0000 (From Monday to Saturday 08:00 to 21:00 and Sunday 08:00 to 17:00.) or email them through customer.services@royalsundaram.in
3. Carry a valid photo ID and a health card before visiting the hospital. At the hospital's insurance desk, provide the health card and a legitimate photo ID.
4. Completely fill out and submit the pre-authorization request form that is accessible at the hospital.
5. The hospital notifies you and sends Royal Sundaram health insurance company the pre-authorization paperwork.
6. After receiving the required documentation, TPA will verify your eligibility for coverage and deliver a cashless authorization letter to the hospital in three hours. Within three hours of receiving the documents, any deficiencies in the supplied documentation will be reported to the hospital.
7. Before being released from the hospital, you must pay the non-medical and uninsured charges.
8. A denial letter would be provided to the hospital in the event that the condition or treatment is not covered by the policy.
9. If the request is granted, the insurance company will pay your charge in full.

The Cashless Claim Procedure After Admission

After you have submitted the Royal Sundaram health insurance claim settlement to the hospital, the medical details and the authorized claim will be forwarded to the company or by the TPA in charge. If your claim request has been reviewed and approached, medical care may begin immediately. In order for the TPA to decide if your sum insured will be enough or if you'll have to change the registered cashless sum, you have to submit all the required documentation while you are admitted to the hospital. On the day of your discharge, the TPA will forward the invoice and your discharge certificate to the company for the Royal Sundaram health insurance claim settlement. The company or the TPA will register a big authorization for the complete invoice amount after the amount of your Royal Sundaram health insurance claim. The company will pay for all the amount you are insured for, leaving the few expenditures prohibited by law. 

List of Documents Required for Royal Sundaram Health Cashless Claim:

The required documents for the cashless claim are as follows:

1. Patient's insurance information
2. Evaluation
3. Name, address, and contact information for the hospital
4. The name and phone number of the treating physician
5. The day you were hospitalised
6. Anticipated discharge date

Please remember the hospital reserves the right to request further documentation if necessary.

How to Check Royal Sundaram Health Insurance Policy Claim Status?

You have three ways that you can complete the claim status check process. You can contact the service number provided to you and get in touch with the agents, they will help you check the status of your claim. You can send an email to the company through their official email mentioned on the website or you can utilize their official online portal for a claim status check. Even with the fairly high claim settlement ratio of Royal Sundaram health insurance, you need to look at several factors while checking up on your claim status. 

The following procedure will help you keep track of your Royal Sundaram health insurance claim settlement offline and online:

The Online Process for Royal Sundaram Health Insurance Claim Settlement

1. Visit the Royal Sundaram official website through the browser of your choice.
2. You have to choose the “Notify Claim” option on the home page of the official website of Royal Sundaram which will lead you to the submission portal of claim settlement.
3. You can follow up with the customer service number through 1860 258 0000 | 1860 425 0000, or email them through customer.services@royalsundaram.in to make the claim settlement.
4. Additionally, you can click on the “Health/Hospital Cash Claim Notification Form”.
5. All you need to do is fill in the blanks with the required information like the insured’s name, policy number, hospital name, place, date of admission and discharge, and complete the text verification to find the Royal Sundaram health insurance settlement ratio.

The Offline Process for Royal Sundaram Health Insurance Claim Settlement

To complete the Royal Sundaram health insurance claim settlement process offline, you will have to visit the nearest branch of Royal Sundaram health insurance. If you don't know the location of any branch near you, you can contact the customer care service (1860 258 0000 | 1860 425 0000) to inquire about the location. You can download the claim form and fill it up with the required details and submit it to the agent present. The agent in charge of your Royal Sundaram health claim ratio might ask for documents like the insurance intimation number, the insurance id card number, etc.   

The Claim Process for Reimbursement Treatment for Royal Sundaram Health Insurance Claim Settlement

If for some unforeseen reason you couldn't avail yourself of cashless treatment under the Royal Sundaram health insurance claim settlement process at any network hospital, you can always file for reimbursement after paying the sum required upfront from your own pocket. All you will need to do is file a proper reimbursement claim, with the required documents with the hospital invoice, and you will be reimbursed based on the sum you are insured for under your coverage. When you decide to receive treatment at a non-network hospital, you are required to notify Royal Sundaram health insurance of the admission at least 48 hours in advance for elective care or within 24 hours for emergency care. You will be required to transmit all medical treatment invoices and reports to the Third Party Administrator (TPA) upon hospital release and TPA will investigate the claim and pay the covered person's costs.

List of Documents Required for Royal Sundaram Health Reimbursement Claim

These are the documents required for your Royal Sundaram health claim settlement ratio:

1. Medical test results, consultations with doctors for associated illnesses, and prescriptions from doctors.
2. Hospital receipts, cash memos, and invoices ( in original).
3. All treatment-related reports, including those from the MRI, ECG, Pathology, X-rays, etc.
4. Provide the hospital-issued death summary in the event of a death.
5. Reports of the treatments administered, case histories, discharge and admission summaries,  and medical advice offered by the hospital.

Please note that the Royal Sundaram health insurance may ask for additional documents.

Incurred Claim Ratio (ICR) of Royal Sundaram Health Insurance

The gross claims settled by an insurer in comparison to the net premium generated are known as the ICR or Incurred Claim Ratio. The ratio essentially provides information about an organization's performance, assisting consumers in making knowledgeable decisions. Royal Sundaram's Incurred Claims Ratio (ICR) for FY 2020–21 is 67.82%.

Royal Sundaram Health Insurance Claim Settlement Ratio (CSR)

The Royal Sundaram health claim settlement ratio, or CSR, is the proportion of insured claims that the firm settles compared to the total number of claims received during the course of a fiscal year. It is a crucial component for every health insurance provider. The Insurance Brokers Association of India (IBAI) publishes information in its handbook each year about the claim settlement ratio of health insurance providers. The claim settlement ratio of Royal Sundaram health insurance, for the financial year 2020–2021 was 97.75% for claims settled in less than 3 months and 1.04 % for claims settled in more than 3 months.