Star Health Insurance Claim Settlement

A health insurance claim settlement procedure can be a bit time-consuming in some cases. However, with a Star health insurance policy, you are not only getting the benefits of a seamless claim settlement procedure but also get help from highly trained and experienced professional executives. According to recent statistics, the Star health insurance settlement ratio is also reported to be on the higher side. The overall claim process is very straightforward, which requires you to follow a few select steps for its successful completion. Additional details regarding the Star health insurance claim settlement are mentioned below.

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

The cashless claim settlement procedure of Star health insurance is a great feature that you can utilise in order to get professional medical treatment and care across India. They have a large network of partnered hospitals under their policy, which spans more than 12,000 in number, where you can get quality cashless treatment. The Star health insurance claim ratio is admirable, and the procedure is very uncomplicated. In this case, you will have to opt for treatment under a network hospital, follow the simple guidelines for cashless treatment and the majority of your hospitalisation and other medical bills will be taken care of by the insurer. This means you will not have to pay for the medical bills from your side, and you can focus on improving your condition. A vital aspect of this claim is that it can not be availed if you opt for a hospital that is not included within the company’s partnered hospital network range. 

Guide to the Cashless Claim Treatment

The Star health claim ratio is very good, and in order to get cashless claim treatment, you need to follow the explained procedure mentioned down below and the insurer will pay for the medical and hospitalisation cost on your behalf.

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

First, let's go through the two types of cashless Star health insurance claims available, as they have different procedures that you need to follow. The two types of Star health insurance are cashless claims, planned and emergency. Both of them are situation based, and you can find the details of the procedure down below.

Planned Cashless Star Health Insurance Claim Settlement Process

If you have surgery or a medical procedure scheduled in advance, you can get the benefit of the planned cashless claim with the Star health insurance policy. In this case, you will have to contact the insurer first-hand regarding the matter and fill up the pre-authorization form at the selected network hospital. They will forward the duly filled and signed copy, alongside the required documents, to the insurance company. After the verification is made and the confirmation for the cashless treatment procedure is given by the insurer, you will be able to take advantage of Star health insurance's cashless claim.  

Emergency Cashless Star Health Insurance Claim Settlement Process

In the event where you have to opt for emergency hospitalisation due to an accident or sudden medical complication, it calls for the need of immediate treatment and care. In this situation, there is no pre-planning involved, but even so, you can avail cashless treatment features. You would need to opt for a network hospital for the treatment and use the Star health card ID provided by the insurer. Then, you will need to submit the form of intimation and some other required paperwork, and once the approval comes through from the insurer, the benefits of cashless treatment can be availed. 

The Cashless Claim Procedure After Admission

1. After admission, you will need to contact the insurance desk at the network hospital. The intimation in case of emergency hospitalisation is to be made within 24 hours of admission.
2. The insurance desk will send the duly filled pre-authorisation form and the necessary documents needed for the cashless request to Star online through their hospital portal.
3. As soon as the request for cashless treatment is processed and approved, you will be informed, and the treatment will begin.
4. You might need to provide additional documents in case the situation calls for it.
5. The insurer will then settle the hospitalisation and other associated medical expenses and bills directly with the hospital.
6. You will be required to pay for certain non-payable items to the hospital which are not covered under the health insurance plan from your own side.

List of Documents Required for Star Health Cashless Claim

Here are the documents that you would need during Star health insurance cashless claim process: 

1. The health card provided by Star health insurance
2. The consultation papers for the need for hospitalisation by the doctor
3. The summary of the patient release
4. Invoices provided by pharmacies with respect to the prescriptions
5. Medico-Legal Certificate (MLC) and FIR (if available) in case of accidents
6. The investigation tests like blood reports, scans, X-rays, etc.
7. If the claimed amount goes beyond INR 1,00,000 limit, then the KYC documents of the insured.

How to Check the Claim Status of Star Health Insurance Policy?

Star health insurance keeps you posted and updated with your filed insurance claim. This helps you get a precise idea regarding the current state of your claim. The Star health insurance claim ratio is great and you can check your claim status via both online and offline methods. 

Here are the steps to check the status of Star health insurance claim settlement:

The Online Process for Star Health Insurance Claim Settlement

1. Visit the official Star health insurance website, find and select the “Claim” tab.
2. In this section, you will need to go with the “Claim Status” option to move forward.
3. There, you will have to pick the “Health Policies” option and provide the details of your Star health insurance policy. You can use the intimation number, registered mobile number, health ID card or policy number and then click on “Get Claim Status” to acquire the details.

The Offline Process for Star Health Insurance Claim Settlement

You can also check the current status of your health insurance claim settlement through the offline process, where you will have to visit any of the local Star health insurance branch offices and talk with their executives. You can also contact them for your claim-related queries by calling their customer care numbers, which are 044-6900-6900 and 1800-425-2255.

The Claim Process for Reimbursement Under Star Health Insurance Claim Settlement

The second type of insurance claim under the Star health insurance policy is called a reimbursement. Just like its literal meaning, if you opt for the reimbursement claim, you have to initially pay for the entire hospitalisation and medical bills. After the payment has been made to your account, you can file for a reimbursement claim with the Star health insurance policy and provide the requested paperwork and documents for it. The insurer will verify the reimbursement claim, and you will get the money transferred to your registered account once the claim is authorised.

Here is the Procedure for Submitting a Reimbursement Claim

1. After you avail of treatment and pay for the entire medical expenses first-hand, you can apply for the reimbursement claim.
2. You will have to download the form of Star health insurance claim settlement for the reimbursement procedure and collect every single original invoice and bill involved in the treatment.
3. You can then submit the claim form, attached with the required documents and bills of the undergone treatment procedure, to the nearby company office within 15 days from the date of patient discharge.
4. The submitted insurance claim will then be checked and processed. Upon its approval, the reimbursement amount will be deposited into the enlisted bank account.

List of Documents Required for Star Health Reimbursement Claim

At the time of the Star health insurance claim settlement reimbursement procedure, you might have to provide the general information;

1. The patient’s full name
2. Valid proof of identity
3. The Star health insurance policy number
4. Name of the visiting physician
5. Name and address of the hospital
6. Date of hospital admission
7. Details regarding the injury or illness
8. Further details (if required)

The documents that you would need to submit for the Star health insurance reimbursement claim are:

1. The duly filled and properly signed claim form
2. A copy of the Star health insurance health card
3. Investigations reports that are done prior to the admission
4. The doctor’s consultation paperwork
5. The original summary of patient discharge provided by the hospital
6. X-ray, blood reports, scans and other investigation reports
7. The invoices provided by pharmacies in accordance with the prescriptions
8. Receipts that are obtained from the hospital, chemists, etc.
9. The Medico Legal Certificate (MLC) and FIR (if available) would be required in cases involving accidents
10. A full copy of KYC documents
11. The NEFT details for the refund procedure, along with e-mail ID and contact number

Star Health Insurance Incurred Claim Ratio (ICR)

If we take a look at the ICR, which stands for Incurred Claim Ratio, of Star health insurance, we will see very impressive numbers on the chart. The ICR of Star health insurance is the value obtained from the ratio of the total amount of insurance claims paid and the total amount of premiums gathered in a specific time frame. According to the IRDAI reports, the ICR of Star health insurance was 94.44% for the fiscal year 2020-21.

Star Health Insurance Claim Settlement Ratio (CSR)

Along with its respectable Star health claim settlement ratio value, the company is very efficient in settling claims. The CSR, which stands for the Claim Settlement Ratio, of a company helps you to get a solid idea of how likely your claims are going to be resolved. The CSR is obtained by dividing the total number of claims that have been resolved and the total number of claims that have been submitted within a given time period. However, the IRDAI doesn’t release this data, and it depends on the insurer’s individual reports. The claim settlement ratio of Star health insurance in 2019-20 was very praiseworthy, and the company affirms to have resolved 99.9% of the claims in a period of fewer than 3 months, while 0.1% of claims took more than 3 months to get resolved.