How Can I Claim my Royal Sundaram Health Insurance?

Posted by kiran singh on December 18th, 2018

Royal Sundaram Health Insurance is one of the leading players in the insurance industry in India. It was the first company in the insurance segment to offer benefits like cashless claims, cash allowances for hospitalization and partnerships with value-added benefits with key institutions, etc. From basic individual health insurance cover to specialist medical insurance plans, Royal Sundaram health insurance gives you the opportunity to choose from a wide range of health insurance plans that also include a host of benefits.

Royal Sundaram Health Insurance offers two policies to choose from:

• Lifeline Health Insurance Plans
• Family Plus Insurance Plus

Some of the key features and benefits of availing one of Royal Sundaram’s Health Insurance Policies include:

• Anyone above 18 years of age can purchase a Mediclaim policy. However, the policy only covers a maximum of 5 family members
• Royal Sundaram health insurance policy can be availed either for a duration of 1, 2 or 3 years respectively
• If you wish to include dependent children in your policy, then they should be between 91 days - less than 25 years of age.
• You get the opportunity to reload 100% of the Sum Insured at no extra cost
• The Incurred Claims Ratio of Royal Sundaram is 78.13%
• You can avail the Cashless hospitalization facility at any of the 3000+ network hospitals
• There is no cap on the room rent or any limitation on specific diseases
• If you have 5 claim-free years with have not received any claim bonus, then you can opt to double the insured sum
• You also receive coverage for Ayush treatment ( Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy ), as well as vaccination in case of Animal Bite
• The policy covers medical costs that are incurred 30 days before your hospitalization and 60 days
• This health insurance policy offers the option of Lifetime Renewability
• There is no condition of Co-pay in this policy. ( If there is a condition to Co-pay in the policy, then a part of the expenses have to be shared by the policyholder )
• Here, cumulative bonus is offered up to 100% of the base sum insured for years that you don’t make a claim
• Offers reload of up to 100% of the sum insured amount
• Around 100 daycare procedures are also covered in the policy
• Maternity expenses are also covered in the policy
• Get Tax Benefits under section 80(D) under all health insurance plans
• The sum insured can be extended further by about 50% in case of accidents

What is the procedure to claim reimbursement of Royal Health Insurance Policy?

There are two ways of making a health insurance claim under a Royal Health Insurance Policy:-

➔     Cashless treatment

➔     Reimbursement of expenses after treatment

In Case of Cashless Treatment:

In the cashless treatment method, the insurance company pays for all the expenses incurred during the treatment. However, this is possible only when you get treated at one of the network hospitals that the insurance company is tied-up with.

1. Procedure to File a Claim (Planned/Emergency Hospitalization):

➔     If the hospitalization is planned, then Royal Sundaram Health Insurance Company must be intimated at least 48 hours before the hospitalization through the helpline number 1860 425 0000 (Toll free), along with the Unique Health Card membership number.

➔     The health card along with a Photo ID must be mandatorily submitted as a part of the verification process too

➔     Collect, Fill and Submit the “Cashless Request Form”, that can be availed from the hospital’s insurance help desk. This needs to be duly stamped, signed and faxed to the TPA, along with all relevant medical records

➔     After receiving the details, the same will be verified and a decision will be taken within 24 hours. The same will also be conveyed to the hospital. If more documents are not required, then the cashless decision will be approved by the third party administrators (TPA).

➔     Post this, the bills will directly be cleared by Royal Sundaram or the TPA. This is subject to the limitations of the policy, and all other expenses that are not covered, will have to be taken care by the policyholder.

➔     Lastly, please ensure that all the original bills and reports are duly signed by the claimant, and the photocopies of the same are saved for future verification.

In Case of Reimbursement of Treatment Expenses:

Some policies do not have a cashless claim option. In fact in some cashless claims, the insurance company also rejects the policyholder’s claims for reimbursement too. In such cases, the expenses can be recovered by way of reimbursement.

1. Procedure to File a Claim:

In many situations, it so happens that the insurance company rejects the cashless claim settlement application of the policyholder. This could also happen when the policyholder is admitted in a hospital that is not tied up with Royal Sundaram Health Insurance Company. In such a scenario, the concerned can file for a reimbursement while at the hospital.

Here’s is the process to file a claim:

➔     Notify Royal Sundaram immediately about the admission

➔     You can do this either by calling the toll free number, landline number or email ( Toll free: 1860 425 0000; Landline: 91-44-7117 7117 )

➔     Let the treatment get completed and clear all the dues at the hospital. Post which, you can claim for reimbursement along with all the original bills

➔     Please make sure that you attach the following documents when you apply for reimbursement

◆      Discharge summary

◆      Treatment and investigation bills

◆      Prescriptions

◆      Advance and final receipts

◆      Diagnostic Test Reports, X Ray, Scan and ECG and other investigation reports

➔     You will find the relevant claim form on company’s official website (royalsundaram.in/ )

➔     Download that form, duly fill the requested details and submit the same to RCare for processing the reimbursement.

➔     If all the details match the regulations of the insurance company, your reimbursement claim will be processed.

➔     You will receive a cheque or repudiation letter, within 20 days of receiving and processing the documents

NOTE

• The insurance company has to be informed within a week of discharge
• In some cases, pre-authorization from the insurance company has to be requested

To ensure that you receive the reimbursement, it is important that all the original bills, documents and any other relevant reports, are submitted within 10 days post discharge, and are send to the following address:

Royal Sundaram General Insurance Co. Ltd
Vishranthi Melaram Towers
No.2/319 , Rajiv Gandhi Salai (OMR)
Karapakkam, Chennai - 600097