Aditya Birla Health Insurance Online Claim - Cashless & Reimbursement

Aditya Birla Health Insurance Claims

When looking to buy a health insurance plan, one of the most important factors you need to look into 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

Before we look at Aditya Birla health insurance claim settlement ratio, let’s take a minute to understand what claim settlement ratio is:

What is a Claim Settlement Ratio?

The claim settlement ratio refers to the total percentage of insurance claims that an insurance provider settles relative to the total number of claims received in a given period. The higher the claim settlement ratio of an insurance company, the higher are the chances that your claim will be approved. Here is the formula for claim settlement ratio:

Claim Settlement Ratio = (No of claims settled/No. of claims received)x100

Aditya Birla Claim Settlement Ratio:

With an impressive claim settlement ratio of 94%, Aditya Birla Health Insurance is one of the most reliable insurance providers in the business.

Types of Aditya Birla Health Insurance Claims

There are two types of health insurance claims you can choose from:

1. Cashless Claim

2. Reimbursement Claim

Let’s take a deeper look into these two Aditya Birla Health Insurance claim processes. 

What are Cashless Claims

Ever stuck in a medical emergency and were low on cash? Such an uncertain health emergency can drill a hole in your pocket, where you are required to spend your savings on hospital bills! Here's when a health insurance plan with cashless claim settlement acts as a saviour. Under a cashless facility, your insurer directly settles the medical bill with the hospital without you having to pay the bills first. Aditya Birla Health Insurance plans are no different. With a cashless treatment facility available at its wide network of 6500+ hospitals, you need not worry about those hefty hospital bills!

Aditya Birla Health Insurance has simple procedures that enable a hassle-free claim process. All you need to do is:

• Inform your insurer

In case of planned hospitalization, inform your insurer at least 1-2 days in advance and in case of an emergency, notify within 24 hours

• Submit documents

Submit the required documents like health card, identity card and medical report

• Insurer’s assessment

Your insurance company verifies the details against your health insurance policy coverage and terms

• Claim decision

If your claim request is within the coverage, approval is sent to the hospital for the specified amount.

Documents Required for Filing Cashless Claim

Take care of the following documents when filing a cashless claim with Aditya Birla Health Insurance:

• Duly filled Claim Form
• Photo ID & Age Proof
• Original Discharge Card of the Hospital / Day Care Summary / Transfer Summary
• Previous consultation papers mentioning history & treatment details for current ailment
• All the original final Hospital Bill with all original Deposit & Final Payment Receipt
• All original diagnostic reports, Medical Practitioner’s prescription & invoice / bill with receipt from diagnostic centre
• If claims are above Rs. 1 Lakh, CKYC form duly filled and signed by proposer with residential proof copy & photo ID
• All Original Pharmacy and medicine bills along with doctor’s prescription

What are Reimbursement Claims

Under reimbursement claims, you must pay all the hospital bills and expenses out of your pocket initially. You also need to carefully record and store all the hospital and pharmacy bills. Once the treatment is complete and the patient is discharged, the insurance company reimburses the policyholder/insured of their medical expenses. The reimbursement is done on the basis of providing accurate medical bills and expenses to the insurance company.

As a result, reimbursement claims are a bit more time-consuming when compared to cashless claims. However, reimbursement claims can be filed for treatments done in non-network hospitals as well, a feature not available when opting for cashless claims settlement. 

When making a reimbursement claim, follow the steps below –

• Intimate the insurer

Inform your insurance provider about the hospitalisation of the insured and intent to file a reimbursement claim. 

• 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.

• Claim verification

After verification documents against the claim, your insurance provider will either accept or deny your claim request

• Claim decision

If the claim is approved, the said amount is disbursed

Document Required for Filing Reimbursement Claim

Take care of the following documents when filing a cashless claim with Aditya Birla Health Insurance:

• Duly completed Claim Form
• Photo ID & Age Proof
• Original Discharge Card / Day Care Summary / Transfer Summary
• Original final Hospital Bill with all original Deposit & Final Payment Receipt
• All previous consultation papers indicating history & treatment details for current ailment
• All original diagnostic reports along with doctor’s prescription & invoice / bill with receipt from diagnostic centre
• All Original Medicine / Pharmacy Bills along with doctor’s prescription
• Cancelled cheque copy for proposer with pre-printed name. In case name is not pre-printed, please provide copy of bank passbook/bank statement
• If claims are above Rs. 1 Lakh, CKYC form duly filled and signed by proposer with photo ID and residential proof copy 

Why Your Aditya Birla Health Insurance Claims May Get Rejected

Here are some reasons why your 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

• In-active policy

In case you file a claim after your policy is 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 policy wordings to check complete list of policy exclusions.

We are Here to Help You

Best Health Insurance Plans Available at Finserv MARKETS