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Aditya Birla Health Insurance stands out as one of the most reliable insurance providers in the industry, boasting an impressive claim settlement ratio of 98.12%. The Claim Settlement Ratio (CSR) is a crucial metric that reflects the percentage of insurance claims settled by an insurer out of the total number of claims received within a specific timeframe. The formula for calculating the claim settlement ratio is:

 

Claim Settlement Ratio = (No. of claims settled in the year/No. of claims received in the year) x 100

 

The higher the claim settlement ratio of a health insurance company, the higher the chances that your claim will be approved.

Aditya Birla Health Insurance Claims

When considering the purchase of a health insurance plan, it's essential to prioritize the "Claim Settlement Ratio" of the insurance company. Understanding the claim settlement process of your chosen insurer is equally vital, as it streamlines the claims registration process and increases the likelihood of claim approval. In this article, you can learn about the Aditya Birla health insurance claim settlement ratio and their claim settlement procedures. The firm boasts an impressive claim settlement ratio of 98.12%, contributing to its extensive customer base exceeding 10 million individuals. Discover some of the popular health insurance plans offered by Aditya Birla Sun Life Insurance:

Health Insurance Plans

Premium Rate

Features 

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Activ Assure Diamond Health Insurance Plan

 

 

 

 

₹6,371/ annum

  • Enjoy annual health-check ups and no claim bonus benefits

  • Worldwide emergency assistance service feature available. It helps in the safe transportation of patients to any hospital in the world and back to home

  • Day care treatments available

  • In-patient hospitalisation expenses and organ donor expenses covered

  • Pre and post-hospitalisation expenses covered

 

 

 

 

 

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Activ Fit Health Insurance Plan

 

 

 

₹6,863/ annum

  • Applicants below the age of 35 years enjoys a better premium rate and discount

  • Covers maternity benefits

  • Applicants below the age of 18 years enjoy 10% discount on passing the health risk assessment

  • Daily cash benefit offered

  • Dar care treatments and in-patient hospitalisation expenses available 

 

 

 

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Activ Care Classic Health Insurance Plan

 

 

 

₹28,373/ annum

  • Enjoy comprehensive health check-up every year at any network hospital

  • No claim bonus benefits

  • AYUSH expenses covered

  • Enjoy the benefits of a personal health coach

  • Cashless claims can be raised for home treatments like that for dengue, hepatitis, chemotherapy, etc. 

  • Pre and post-hospitalisation expenses covered

 

 

 

 

 

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Activ Health Platinum Essential Health Insurance Plan

 

 

 

₹5,390/ annum

  • Enjoy 30 days pre-hospitalisation and 60 days of Post-hospitalisation medical expenses cover

  • Avail the benefits of an expert health coach for health, fitness, etc. 

  • Day care treatment expenses covered

  • In-patient hospitalisation and domiciliary hospitalisation expenses covered

  • Pre and post-hospitalisation expenses covered

 

 

 

 

 

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How to File Aditya Birla Health Insurance Claim Online Through Bajaj Markets

Filing health insurance claims was never so simple. Just follow these steps and you’re done!

  1. Register your claim through Bajaj Markets online

  2. Upload the necessary documents

  3. Your insurer will assess the claim

  4. Check claim status online

How does Aditya Birla Claim Settlement Ratio Benefit Policyholders?

Aditya Birla's Claim Settlement Ratio of 98.12% is undoubtedly good news for all its health insurance customers. Here's why a high claim settlement ratio like Aditya Birla's 98.12% is beneficial for policyholders:

  • Efficient Claims Settlement

A high claim settlement ratio reflects the insurer's capability to efficiently settle claims raised by policyholders. With Aditya Birla's ratio, out of 100 cases, over 98 claims are settled properly, ensuring timely financial assistance in times of need.

  • Enhanced Market Reputation

The claim settlement ratio significantly influences an insurer's market reputation. A company with a high ratio, like Aditya Birla, is perceived positively in the market, fostering trust among customers and attracting more clientele.

  • Operational Integrity 

A robust claim settlement ratio indicates that the insurer's operational processes are functioning effectively. Aditya Birla's 98.12% claim settlement ratio reflects the company's adherence to sound policies, ensuring maximum claim settlements every policy year.

Types of Aditya Birla Health Insurance Claims

SInce the Aditya Birla health insurance claim settlement ratio is high, there are two types of health insurance claims you can choose from:

  • Cashless Claim

  • Reimbursement Claim
     

Let’s take a deeper look into these two Aditya Birla health insurance claim processes.

Here's a detailed overview of the two types of health insurance claims offered by Aditya Birla:

1. Cashless Claims

  • Inform Your Insurer: For planned hospitalization, notify your insurer at least 1-2 days beforehand. In case of emergencies, inform them within 24 hours

  • Submit Documents: Provide the necessary documents such as your health card, identity card, and medical reports

  • Insurer’s Assessment: The insurance company will assess your claim against the coverage and terms of your health insurance policy

  • Claim Decision: If your claim is approved, the insurer will send authorization to the hospital for the specified amount. The hospital will then initiate your treatment under the cashless facility

2. Reimbursement Claims

  • Intimate the Insurer: Notify your insurance provider about hospitalization and your intention to file a reimbursement claim

  • Submit Documents: After receiving medical treatment, submit necessary documents such as the claim form, discharge summary, medical bills, and OPD expense bills to your insurance company

  • Claim Verification: Your insurance provider will verify the submitted documents against the claim

  • Claim Decision: If the claim is approved, the specified amount will be disbursed and deposited into your registered bank account

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Documents Required for Filing Cashless and Reimbursement Claims

When filing a cashless claim with Aditya Birla Health Insurance, ensure you have the following documents ready:

  • Duly filled Aditya Birla health insurance claim form

  • Photo ID and age proof

  • Original discharge card of the hospital/day care summary/transfer summary

  • Previous consultation papers mentioning medical history and treatment details for the current ailment

  • All original final hospital bills with all original payment receipts

  • All original diagnostic reports, medical practitioner’s prescription, and invoice/bill with payment receipt from the diagnostic center

  • Duly filled CKYC form signed by the proposer (For claims above ₹1 Lakh)

  • All Original Pharmacy and medicine bills along with doctor’s prescription
     

For reimbursement claims with Aditya Birla Health Insurance, you'll need these documents:

  • Duly completed claim form

  • Photo ID and age proof

  • Original discharge card/day care summary/transfer summary

  • Original final hospital bills with all original payment receipts

  • All previous consultation papers indicating medical history and treatment details for the current ailment

  • All original diagnostic reports along with doctor’s prescription and invoice/bill with receipt from the diagnostic center

  • All original medicine/pharmacy bills along with doctor’s prescription

  • Cancelled cheque copy for proposer with pre-printed name. In case the name is not pre-printed, please provide a copy of the bank passbook/bank statement

  • Duly filled CKYC form signed by the proposer (For claims above ₹1 Lakh)

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Why Your Aditya Birla Health Insurance Claims May Get Rejected

Here are some reasons why the claims on your health insurance policy may get rejected:

  • Misinterpreted Details: Providing incorrect information during the claim process can lead to rejection as insurers assess claims based on the provided details

  • Excluded Incidents: Claims for incidents excluded from your policy will likely be rejected

  • Inactive Policy: Filing a claim after your policy has lapsed can result in denial

  • Delay in Intimation: Failing to inform the insurer promptly about an incident may hinder a full assessment, leading to rejection

  • Waiting Period: Claims for treatment of diseases within a waiting period may be denied if the waiting period hasn't elapsed
     

Note: Kindly refer to the policy wordings to check the complete list of policy exclusions.

How Can I Track my Aditya Birla Health Insurance Claim Status?

Raising a claim is one of the most essential parts of any health insurance plan. So, you must understand everything about the process. Once you have raised your claim, you can track its progress. To track your health insurance claim with Aditya Birla Health Insurance, follow these steps:

  • Visit the official website of Aditya Birla Health Insurance Company.

  • Click on "Claims" on the home page.

  • Select "Check claim status" from the drop-down menu.

  • Fill in the required details and log in.

  • Upon successful login, you can easily track the details of your claim.

Conclusion

Understanding the claim settlement ratio of your health insurance provider, such as Aditya Birla Health Insurance, is crucial for ensuring a seamless claims experience. With a remarkable claim settlement ratio of 98.12%, Aditya Birla Health Insurance stands out as a reliable choice for policyholders. By leveraging platforms like Bajaj Markets, where you can explore different insurance plans,  make informed decisions and secure the best health insurance coverage tailored to your needs.

Health Insurance Plans Available at  Bajaj Markets

FAQs on Aditya Birla Health Insurance Claim Settlement Ratio

Can I get a cashless claim facility with Aditya Birla health insurance?

Yes, you get the cashless treatment facility with Aditya Birla health insurance, where you can get your treatment done at the nearest network hospital, without having to shell out money from your pocket.

How long does it take for claims to be settled?

Each insurance company has their own claim settlement process and timelines. You should contact your insurance provider to know the exact time for claim settlement.

How can I check my Aditya Birla health insurance claim status?

You can contact the Aditya Birla Health Insurance customer support team at 1800-270-7000 to know your claim status.

How can I contact the Aditya Birla Health Insurance support team by email?

You can reach out to Aditya Birla Health Insurance representatives at care.healthinsurance@adityabirlacapital.com.

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