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Coverage Up to ₹5 Crores*
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What is Health Insurance Claim?
Health insurance is indispensable as it offers much-needed protection against unforeseen medical expenses.It is like a financial backup that makes quality healthcare accessible without worrying about the hefty costs. During an emergency, you can claim your policy to receive the necessary financial assistance.
At IndusInd General Insurance, we offer a smooth and swift health insurance claim process to ensure a satisfactory resolution of your medical claims. Whether you are filing a cashless claim or looking for reimbursement, our claims experts ensure an effective and timely resolution. Health insurance claim settlement is a process in which your insurance company pays for the medical expenses covered under your health policy.
During a medical emergency, you can either opt for cashless settlement or request reimbursement if you have already paid your bills. Note that the final settlement takes place after you submit all the necessary documents
IndusInd Health Claim Process
Here is how the IndusInd health claim process works
Step
Claim Intimation
Report your medical emergency immediately to our claims department.
Step
Select Cashless or Reimbursement Claims
Choose between cashless and reimbursement settlement.
Step
Documentation
Fill out a claims form. Submit it with the necessary claims documents.
Step
Final Settlement
Once the documents are verified, we settle the claims cashlessly or offer reimbursement as per your policy terms.
Types of Health Insurance Claims
Cashless Health Insurance Claims
The cashless claim process allows you to receive treatment at a medical facility without making any upfront payments. Earlier, cashless claim settlement was only available at the insurance company's network hospitals. This means you must get your treatment at the insurer's network hospital if you want a cashless settlement. However, after the launch of the "Cashless Everywhere" initiative in 2024, cashless treatment is now available at any hospital across India.The cashless hospitalisation process enables you to focus on your health and get treatment without worrying about the mediclaim reimbursement process.
Reimbursement Health Insurance Claims
The reimbursement medical claims process is based on the traditional settlement approach. In this process, you can get the desired treatment and settle all the bills from your pocket.
Once you have all the medical invoices and bills, you can submit them along with other documents to the insurer to receive compensation.
How to Claim Health Insurance: Step-by-Step Process
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IndusInd Health Insurance Claim Process
Claim intimation is a process of informing the health insurance company about your upcoming hospitalisation or treatment. This is the first and critical step in the claims settlement process. Note that any delay in claim intimation can lead to the rejection of your claim.
For Planned Hospitalisation:
You must intimate your claim at least 48 hours (two days) before your planned admission date.
For example, If you are supposed to be admitted to the hospital on 22 September, register your claim before 20 September according to the admission time.
For Emergencies Hospitalisation:
You must intimate or register your claim immediately or within 24 hours of emergency hospitalisation.
3 Simple Ways to Claim Health Insurance
Claims Helpline: You can call +91-4890-3009 and provide all the specified claim details.
IndusInd Self-i App: You can download the Reliance Self-i app and register your claims instantly by following simple instructions.
Drop an Email: You can also register your claim by emailing our claims department at rgicil.rcarehealth@relianceada.com
Details Required for Health Insurance Claim
Policy number
Name of policyholder
Name of insured (in case of family and group health insurance)
Nature of illness or accident
Name and address of attending doctor
Date of emergency or planned admission to the hospital
Any other information requested by our claims department
IndusInd Health Insurance Claims Process
Cashless
Step 1: Register your claim using the steps mentioned above.
Step 2: Once your claim has been authorised, get cashless treatment at any hospital.
Step 3: After the treatment, our TPA (Third Party Administrator) at the select hospital will review and settle your hospitalisation expenses.
Reimbursement
Step 1: Register your claim using the steps mentioned in the above section.
Step 2: Get the desired treatment at any hospital and settle your bills.
Step 3: Once you have all the bills and required documents, submit them to our claims department for reimbursement.
For any query/complaint/assistance, reach out to RCare Health (our in-house health claims department).
List of Health Insurance Claim Documents
Duly filled and signed health claim form. (Original)
Reference letter from the doctor advising hospitalisation.
Prescriptions for drugs, diagnostic tests or consultations attested by the doctor.
Original pharmacy bills.
Original pathology/diagnostic test reports.
Ambulance bill
Death certificate (if applicable)
Post-mortem report (if applicable)
FIR (if applicable)
Any case-specific medical insurance claim documents requested by our claims department.
Types of Hospitalisations Covered by Reliance Health Insurance Claims
Emergency Hospitalisation
Emergency hospitalisation is when you require immediate medical attention due to sudden illness, accident or injury. For this, you need to inform the insurance company within 24 hours of admission to the hospital.
Planned Hospitalisation
Planned hospitalisation is when you already know about the medical procedure or treatment you are going to go ahead with. It is usually advisable for specific treatment or pre-planned surgery.
If you plan to be hospitalised, you must inform the insurance company at least 48 hours before the planned date of admission.
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Things to Consider While Applying for Health Insurance Claims
Timely Claim Intimation
Timely claim intimation is important for a successful health insurance claim settlement. Hence, register your claim within the specified timelines.
Submit Complete Documents
A successful claims settlement requires accurate documentation. Hence, make sure to submit all the required documents in a correct and authentic form.
Use Correct Claims Form
You may need to use a different claim form depending on the type of insurance plan you have. Make sure to download and submit correct and complete claims forms.
Learn About Exclusions
Before filing your claim request, make sure to check the exclusions of your medical claim insurance policy. This will help you prevent claim rejection for events that are not covered by your policy.
Avoid Duplicate/Fake Claims
Raising fake and duplicate claims can lead to several consequences. These include policy cancellation, legal actions, penalties and whatnot. Hence, raise only genuine claims by providing correct information.
Common Medical Claim Rejection Reasons in India
Reason Behind Claim Rejection | Explanation | How to Avoid? |
|---|---|---|
Incomplete/Incorrect Documents | You have submitted incomplete or incorrect documents. | Make sure that the documents you submitted are complete and as per the requirement. |
Fake Claim | You have raised a fraudulent claim using forged documents. | Be responsible and avoid raising fake claims. Otherwise, it may lead to serious consequences. |
Expired Policy | You have filed a claim after the expiry of your health insurance policy. | Make sure to renew your health insurance policy on time for an obstacle-free settlement. |
Non-disclosure of Pre-existing Disease | You have filed a claim for an undeclared pre-existing disease. | Make sure to disclose your pre-existing conditions at the time of buying your policy. |
Incomplete Waiting Period | You have filed a claim before completing the specified waiting period. | Read your policy wordings to make sure your waiting period is complete. |
Claim for Excluded Treatment | You have filed a claim for a treatment that is not covered under your policy. | Read policy documents to ensure that the event you are raising claim for is covered under your policy. |
How to Appeal a Rejected Health Insurance Claim?
1
Call us at +91-22-4890-3009 or drop us an email on: rgicl.services@relianceada.com
2
If you are not satisfied with stage 1, contact our Nodal Officer.
3
For further objections, get in touch with our Head of Grievances.
4
If your issue remains unresolved, seek assistance from the Insurance Ombudsman.
Steps to Check Health Insurance Claim Status
Step
Visit our Health Claims
Step
Enter your policy or claim reference number on the top-right of your screen.
Step
Click on "Show My Claim Status & Upload Pending Documents" to view your medical claim status.
Health Insurance Claims: Cashless Vs Reimbursement
Parameters | Cashless Health Insurance Claim | Reimbursement Medical Claim |
|---|---|---|
Choice of Hospital | Any hospital across the country. | Any hospital across the country. |
Out-of-Pocket Expenses | Minimal (only a small amount towards chosen deductibles or co-payment) | You need to pay all the hospitalisation charges and collect the bills for reimbursement. |
Payment Process | Claims are settled directly with the hospital. | You need to submit bills and other documents to receive the compensation. |
Approval Requirement | Pre-authorisation is required. | Pre-authorisation is not required. |
Health Insurance Claim Settlement Time | Within 3 hours of receiving the discharge request from the hospital. | Within 15 days of receiving the last “necessary” document. |
Convenience | Highly convenient due to minimal expenses. | Less convenient due to initial out-of-pocket expenses. |
Ideal For | Both emergency and planned hospitalisation. | Situations when cashless hospitalisation is not applicable. For example, overseas hospitalisation, alternate treatments (such as Ayurveda, Unani), etc. |
Can You Claim Health Insurance from Multiple Insurance Companies?
Yes. If you have multiple health insurance plans from different providers, you can distribute the claim expenses between them. Here is how:
Claim with the first insurance policy up to the given claim limit.
Once you have reached the maximum limit with your first policy, you can pass the remaining amount to the next insurer.
To do this, you need to submit the complete summary of the first settlement to the next insurer. In addition, you also need to share all the original bills and documents with both insurers to keep them informed.
For health insurance plans that offer a single lump sum payout (for example, critical illness insurance), you can claim up to your full sum insured with each provider.
Important Things to Remember When Filing Claims with Multiple Insurers
Make sure that all the insurance providers involved in the process are well-informed and aware.
Avoid making duplicate claims, as they can lead to the termination of your policy.
Read the specific terms and conditions of your policy before raising the claims.
IndusInd General Insurance
Aapke Protection ka All-rounder
Get health insurance starting at ₹243/month*!
10,000+ Hospitals Within Reach!
Get cashless care at leading hospitals without payment hassles. With IndusInd General Insurance, enjoy instant access to quality healthcare across the state.*
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Disclaimer:
*T&C Apply. For more details on risk factors, terms conditions, brochure, and exclusions, please read the policy wording and CIS carefully before concluding a sale.
The total no. of customers insured data is for FY24 and has been picked up from the number of lives insured for Health, Personal Accident, Overseas Travel, Domestic Travel, Workmen Compensation and Crop Insurance, Weather LOB & Fire LOB provided by IRDAI count that is master policy count. Other than these LOBs, we have also provided data for the number of certificates issued.
Claim Settlement: This is the overall claim settlement ratio for FY 2023-24 without claim outstanding at the start of the financial year as per public disclosure of Reliance General Insurance Co. Ltd.
Premium: The premium mentioned is excluding taxes for single person aged between 5 years to 20 years with individual health policy for Sum Insured of ₹3 lakhs considering no adverse health conditions/pre-existing disease/medical conditions with waiting period of 3 years. For more details, please refer to the policy wordings. Premium used is 2,919/year converted into a month which gives us Rs.243/month (2,919/12).
Health Infinity UIN: The details mentioned above are for Reliance Health Infinity Insurance UIN: RELHLIP23120V042223
Health Gain UIN: The details mentioned above are for Reliance Health Gain Policy. Reliance Health Gain UIN: RELHLIP22229V032122
Health Super Top-Up UIN: The details mentioned above are for Reliance Health Super Top Up. UIN- RELHLIP21617V012021.
Heath Global UIN: Details mentioned above are for Reliance Health Global UIN: IRDAN103RP0001V01202324
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