How to File a Claim with Religare Health Insurance?

How to File a Claim with Religare Health Insurance?

Religare Health Insurance Company is a standalone health insurance company which was established in July 2012. Religare Health is a part of the Religare Enterprises Limited which enjoys a good market reputation. Ever since the company was formed, Religare Health has been offering innovative and cutting edge health insurance products which are not only comprehensive in terms of their coverage, they also have affordable premiums. The company has also won various awards which include the Best Health Insurance Company presented by the ABP News-BFSI Awards and also the Best Medical Insurance Product Award presented at The FICCI Healthcare Awards among others.

When it comes to health insurance claims, Religare has an in-house claim settlement department which eliminates any third-party administrator and ensures speedy claim settlements. The company boasts of a high claim settlement ratio which stands at 92%. The Incurred Claims Ratio for the financial year 2017-18 is also good at 51.97% (Source: https://www.bankbazaar.com/health-insurance/incurred-claim-ratio-irda-data.html)

Health insurance claims can be of two types which are as follows –

• Cashless claims
• Reimbursement claims

Let’s understand what these claims are and the process of filing each.

What is a cashless claim?

A cashless health insurance claim is where Religare settles your medical bills directly with the hospital. You don’t have to face the burden of the bills yourself. Cashless claims are available if you seek treatment at any of the networked hospitals in India. Currently, Religare has a tie-up with more than 5420 hospitals across India that allows cashless claim settlements.

What is a reimbursement claim?

A reimbursement claim, on the other hand, is when you are not admitted at a networked hospital. In that case, you are required to pay your medical bills yourself. Thereafter, once you are discharged, you can submit your medical bills and get them reimbursed from Religare.

Claim settlement process for Religare health insurance plans

Now that you know the different types of health insurance claims, let’s understand the process through which you can file each claim.

Process for cashless claims

The cashless claim settlement process is divided into three parts which are described below –

1. Informing the company of the claim
   This is the first step in raising a health insurance claim. You have to inform Religare about your claim. Information can be given through a toll-free helpline number which is 1800 102 4488 or by sending an email at customerfirst@religarehealthinsurance.com. If you are hospitalised due to an emergency, the company should be intimated within 24 hours of hospitalisation. However, in the case of planned hospitalisation, intimation should be given at least 48 hours before you are hospitalised.
2. Starting the process for pre-authorization of your claim
   Once the claim has been intimated, you have to complete the pre-authorization process so that your claim is settled on a cashless basis. For pre-authorization, the following steps should be followed –
   • Avail a pre-authorization form from the hospital’s insurance desk. The form is also available online on the company’s website at https://www.religarehealthinsurance.com/health-insurance-claim-forms.html?categoryId=1
   • The first part of the form contains your personal details which you should fill up. Sign the form and submit it to the hospital’s insurance desk. The remaining form would, then, be filled up by the insurance desk of the hospital
   • Once the form is completely filled, the hospital’s insurance desk would fax the same form to Religare at 1800 200 6677
3. Processing of pre-authorization request
   After the pre-authorization process has been initiated by the submission of the pre-authorization form, Religare would process the form and approve cashless claim settlements. The steps involved in this processing are as follows –
   • The company’s medical team would assess the pre-authorization form and the documents which the hospital submitted
   • If the pre-authorization request is approved, you and the hospital would be informed by Religare
   • If there is any lack of information or if any important document is missing, Religare would inform you as well as the hospital so that the missing information or document can be furnished
   • If the pre-authorization request is not accepted by Religare, you would be informed. You would then have to bear your medical expenses yourself and later get them reimbursed from the company after you are discharged from the hospital

Process for reimbursement claims

If you are admitted in a non-networked hospital or if your cashless pre-authorization is not accepted, you have to file for a reimbursement claim. The process is again divided into three heads which are as follows:

1. Informing the company of the claim
   After you are hospitalised, you are required to inform Religare of the same. This information should be given within 24 hours of hospitalisation if you are hospitalised in an emergency. For planned hospitalisation, however, the information should be given at least 48 hours in advance.
   When informing Religare, the following details would also have to be furnished –
   • Name of the policyholder
   • Customer ID
   • Name of the claimant
   • Details of the hospital where you are availing treatments
   • Details of diagnosis and treatments
   • The approximate amount of claim
   • Date of admission into the hospital

When the company is informed it would give you a claim reference ID for future correspondence. You can check your Religare claim status using the reference ID.

2. Commencement of the claim process

You should avail the claim form which is available online with Religare at https://www.religarehealthinsurance.com/health-insurance-claim-forms.html. Fill up the form, sign it and send it to the company along with the relevant documents pertaining to the claim. The address at which the claim form and the documents should be sent is as follows –

Religare Health Insurance Company Limited,
Unit No. 604 – 607, 6th Floor, Tower C, Unitech Cyber Park,
Sector-39, Gurugram-122001 (Haryana)

3. Processing of the claim and reimbursement of expenses
   Once the claim documents are received by Religare, its in-house claim settlement team would look into the claim documents. If the reimbursement claim is approved, you would be informed by the company. If any information or document is missing, the same would be communicated to you and you should provide the missing detail.

If the claim is rejected the company would inform you of such rejection and also the reason.
Remember that reimbursement of the expenses is done directly to your bank account. You should, therefore, submit a copy of your bank account’s cancelled cheque for getting the reimbursement directly credited to your account.

Documents required for claim settlement

Whether you are making a cashless claim or a reimbursement one, you would have to submit some documents to the insurance company for settlement of your claims.
These documents include the following –

• Original claim form which should be filled in and signed
• A valid photo identification proof
• Discharge Summary received after being discharged from the hospital
• Referral letter issued by a medical practitioner which recommends hospitalisation
• Prescription issued by a medical practitioner which lists the medicines, diagnostic tests or consultation given
• All the medical bills and receipts in original received from the hospital or medical practitioner
• All the original bills received from the pharmacy
• All the original reports of the diagnostic or investigative tests done, radiology reports and the receipts of payments made for the same
• Indoor case papers which is made by the hospital on a daily basis and contains the notes of doctors and nurses as well as the patient’s progress and condition
• Police FIR in case of accidental hospitalisation or for any other case, if applicable
• Post mortem report if post mortem has been done
• Any other additional document which Religare requires to assess and verify the claim

Reasons for rejection of health insurance claims

Though Religare offers speedy claim settlements, there are situations when your health insurance claim can be rejected. These situations include the following –

• If the policy has expired
• If the sum insured has been exhausted
• If the claim is made for a medical expense which is excluded under the plan
• If a fraudulent claim is made
• If the claim related documents are not submitted

So, if your health insurance claim is rejected, understand why the rejection occurred.

Religare’s in-house claim settlement department makes all the difference in the claim settlement process. Your claims are handled directly by the company and are settled effectively and efficiently. So, the next time you face a health insurance claim in your Religare health insurance policy, know the steps to file the claim and also submit the important documents so that the claim is settled smoothly.

Alternatively, you can also contact Turtlemint for your Religare health insurance claims. Turtlemint would help you get your claims settled quickly. You wouldn’t have to remember the detailed steps of the claim process. All you would have to do is intimate Turtlemint of your claim. Intimation can be given by calling up the toll-free number 1800 266 0101 or by sending an email to claims@turtlemint.com. Thereafter, Turtlemint would coordinate with Religare and get your claims settled at the earliest. You can also track your Religare health insurance claim status online and keep informed about the settlement of your claim. Simple, isn’t it?

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Courtesy Article: Supramind / October 20, 2019 mintpro.in