Aditya Birla Claim Settlement Ratio

One of the most reliable insurance providers in the business, Aditya Birla Health Insurance has a claim settlement ratio of a remarkable 94%. Health insurance claim settlement ratio or CSR, refers to the total percentage of insurance claims that an insurance provider settles out of the total number of claims received in a given period. Here is the formula for claim settlement ratio:

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 an health insurance company, the higher the chances that your claim will be approved.

When looking to buy a health insurance plan, one of the most important factors you must consider is the ‘Claim Settlement Ratio’ of the insurance company. You also need to thoroughly understand the claim settlement process of the insurance company you choose. This will make it much easier for you to register claims with your insurance provider and get your claims approved. In this article, we’ll take a look at the Aditya Birla health insurance claim settlement ratio as well as their claim settlement process.

Aditya Birla health insurance claim settlement ratio is 94%. This is one of the reasons why the company has a huge customer base of more than 10 million. Check out the list of some of the popular health insurance plans of Aditya Birla Sun Life Insurance:

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.

Are you wondering how a high claim settlement ratio will benefit a policyholder? Aditya Birla Claim Settlement Ratio is undoubtedly good news for all its health insurance customers. Let's understand why it is beneficial for policyholders:

• A high claim settlement ratio directly states a company's ability to settle claims raised by its customers. Aditya Birla claim settlement ratio of 94% means that out of 100 cases, 94 claims are settled properly

• Claim settlement ratio of a company also impacts its overall market reputation. A company with a high claim settlement ratio is likely to bag a better market image and attract more customer

   

Statistics say a lot about the way a company functions. Aditya Birla health insurance claim settlement ratio of 94% also indicates that the terms of the company are functioning properly which is why it is able to settle the maximum number of claims raised every policy year.

As Aditya Birla health insurance claim settlement ratio is so 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.

1. Inform Your Insurer
   In case of planned hospitalisation, inform your insurer at least 1-2 days in advance and in case of an emergency, notify them within 24 hours.

    

2. Submit Documents
   Submit the required documents like your health card, identity card and medical report.

   
   

3. Insurer’s Assessment
   Your insurance company will verify the details against your health insurance policy coverage and terms.

    

4. Claim Decision
   If your claim request is within the coverage, the insurance company will send the approval to the hospital for the specified amount and the hospital will then start your treatment under the cashless treatment facility.

Keep the following documents handy when filing a cashless claim with Aditya Birla Health Insurance:

• 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 current ailment

• All the 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 centre

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

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

1. Intimate the Insurer
   Inform your insurance provider about the hospitalisation and intent to file a reimbursement claim.

   
   

2. Submit Documents
   After the necessary medical treatment, submit the documents like claim form, discharge summary, medical bills, and OPD expense bills with your insurance company.

    

3. Claim Verification
   After verifying the documents against the claim, your insurance provider will either accept or deny your claim request.

    

4. Claim Decision
   If the claim is approved, the said amount is disbursed and will be deposited in your registered bank account.

You will need the following documents when filing a reimbursement claim with Aditya Birla Health Insurance:

• 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 current ailment

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

• 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 which is signed by the proposer (For claims above ₹1 Lakh)

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

• Misinterpreted Details
  In case any incorrect details and information are provided during the claim, the claim stands rejected as the insurer assesses the claim as per the details provided.

   

• Excluded Incident
  In case you file a claim for an incident that is excluded from your health insurance policy, your claim may get rejected.

   

• Inactive Policy
  In case you file a claim after your policy has lapsed, your claim would be denied.

   

• Delay in Intimation
  In case you fail to inform the insurer regarding the incident, your insurer may not be able to fully assess the scenario, resulting in claim denial.

   

• Waiting Period
  In case you file a claim for the expenses of the treatment of a disease having a certain waiting period which is still not completed, your claim could be denied.

   

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

Raising a claim is one of the most essential parts of any health insurance plan. So, it is important that you understand everything about the process. Once you have raised your claim, you can track its progress. Follow the simple steps below to track your health insurance claim:

• Visit the official website of Aditya Birla Health Insurance Company

• On the home page click on "Claims" 

• Choose "Check claim status" from the drop-down menu

• Fill in the details as asked and log in

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

Health Insurance Plans Available at  Bajaj Markets