IRDA encourages Insurance companies to be involved directly with
Hospitals in Settling Claims than solely depend on TPAs

...
Religare Health Insurance – Seamless Claim Process
Claim process in case of Cashless
Treatment at Network Hospitals
Step 1 : Claim Intimation
• For Emergency hospitalization...
Reimbursement of Treatment Expenses
Step 1 : Claim Intimation
For Emergency: Call and inform us within 24 hours of your
ad...
Step 2 : Initiating the Claim process (Also applicable for Pre/Post Hospitalization claims)
You can downloaded claim forms...
Step 3 : Claim Processing and Reimbursement
 An In-house medical team reviews the case and documents
submitted by you.
 ...
To help us serve you better, please ensure:
 Pre-Authorization/Claim form is filled
completely, sincerely and truly.
 Al...
Claim Search
You can search the status of your claim at
http://www.religarehealthinsurance.com/religare/claim_search.php
What’s more… Get No-Claim Bonus
In a particular year, if you did not find any occasion to
make a claim for your health ins...
Excerpts taken from:
• http://www.religarehealthinsurance.com
• http://www.livemint.com/Money/buNwYJXEx
EqYeYzXNcTD0M/Rais...
Religare Health Insurance Leadership Talk   Mr. Anuj Gulati - Claim Process
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Religare Health Insurance Leadership Talk Mr. Anuj Gulati - Claim Process

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At Religare Health Insurance, our guiding principal is to ensure that our customers enjoy quick and hassle free access to best-in-class healthcare delivery facilities and their claim process is easy!

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Religare Health Insurance Leadership Talk Mr. Anuj Gulati - Claim Process

  1. 1. IRDA encourages Insurance companies to be involved directly with Hospitals in Settling Claims than solely depend on TPAs Mr. Anuj Gulati MD & CEO Religare Health Insurance Ltd “These regulations have also worked towards better coordination between the hospital and insurers. By standardizing the claim form and other claim procedures, the effect of having multiple parties will get minimized. Earlier a customer had to deal with multiple TPAs and each came with their pre-defined claims process” says Anuj Gulati
  2. 2. Religare Health Insurance – Seamless Claim Process
  3. 3. Claim process in case of Cashless Treatment at Network Hospitals Step 1 : Claim Intimation • For Emergency hospitalization: Call and inform us at 1800-200-4488 within 24 hours of your admission. • For Planned Hospitalization: Call and inform us 48 hours prior to your admission by calling on the same number or writing to us at customerfirst@religarehealthinsurance.com Step 2 : Initiating the process for Pre-Authorization • A Pre-Authorization form can be taken at the hospital's Insurance/TPA desk, or you can alternatively download the same from here. • Please fill the first section of the form by giving your personal details and hand over signed PreAuthorization form to hospital's Insurance/TPA desk for them to fill up the balance details. • Hospital will fax the completed Pre-Authorization form to us at 1800-200-6677. • • • • Step 3 : Processing a request for Pre-Authorization An In-house medical team reviews the case and documents submitted by you If Approved: You are intimated instantly Any missing/insufficient information: We immediately get in touch with the hospital/you. If Declined: it only indicates that we are not able to process your request basis the requisite information available with us at this point of time. In such cases, you may claim for reimbursement of your expenses after discharge from the hospital.
  4. 4. Reimbursement of Treatment Expenses Step 1 : Claim Intimation For Emergency: Call and inform us within 24 hours of your admission. For Planned Hospitalization: Call and inform us 48 hours prior to your admission. The following information is to be provided during the claim intimation• Policy Holder's Name. • Claimant's Name & Customer ID. • Hospital details. • Diagnosis and Treatment details. • Approximate claim amount. • Date of admission We will provide a reference ID for all future communication pertaining to the claim request.
  5. 5. Step 2 : Initiating the Claim process (Also applicable for Pre/Post Hospitalization claims) You can downloaded claim forms here. Please complete and duly sign the claim form and send it to us with the following documents • Duly completed and signed Claim form, in original; • Valid photo-id proof; • Medical practitioner's referral letter advising Hospitalization; • Medical practitioner's prescription advising drugs/diagnostic tests/consultation; • Original bills, receipts and Discharge card from the Hospital/Medical Practitioner; • Original bills from pharmacy/Chemists; • Original pathological/diagnostic tests reports/radiology reports and payment receipts; • Indoor case papers • First information Report, final police report, if applicable; • Post mortem report, if conducted; • Any other document as required by the company to assess the claim The claim form and additional documents should be sent to us at the following address: Religare Health Insurance Company Limited Claims Department, GYS Global, A-3, 4, 5, Sector-125, Noida, Uttar Pradesh - 201 301
  6. 6. Step 3 : Claim Processing and Reimbursement  An In-house medical team reviews the case and documents submitted by you.  If Approved: You are intimated instantly  Any missing/insufficient information: We immediately get in touch with you.  If Declined: You are communicated the valid reason(s) for rejection.  Review: If you have further documents to enhance/substantiate your case, the same can also be sent to us; and if found rational, the case will be reopened for review of the documents and response, if any. Most importantly, You are updated at all important stages of the claim process.
  7. 7. To help us serve you better, please ensure:  Pre-Authorization/Claim form is filled completely, sincerely and truly.  All required documents are submitted alongwith the form and in original, wherever specified.  Retain a copy of the duly filled forms. You are provided a reference id for all communication pertaining to your claim request. Please state your reference number in every communication during your Claim process.
  8. 8. Claim Search You can search the status of your claim at http://www.religarehealthinsurance.com/religare/claim_search.php
  9. 9. What’s more… Get No-Claim Bonus In a particular year, if you did not find any occasion to make a claim for your health insurance, you get an increase of 10% in your sum insured during the next year. For every year that you enjoy un-interrupted good health, your bonus keeps building up, Yes, it keeps building up year on year, upto 50% of your sum insured! It’s just our way to tell you that we’re there with you not just in bad time but in your good healthy times too!
  10. 10. Excerpts taken from: • http://www.religarehealthinsurance.com • http://www.livemint.com/Money/buNwYJXEx EqYeYzXNcTD0M/Raising-a-genuine-toast-toyour-health-and-wealth.html

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