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All About HDFC Ergo (formerly known as Apollo Munich) Claim Form

Updated On Apr 27, 2021

HDFC Ergo General Insurance (previously known as Apollo Munich Health Insurance) provides customers several benefits. It is one of India’s reliable health insurance providers and is known to have the fastest claim settlement process. Ninety percent of the cashless claims get approved in an hour. The firm’s customer-friendly claim settlement team guarantees that each insured member and his/her family experience a stress-free claim process.

How to File a Claim With HDFC Ergo (formerly known as Apollo Munich) Health Insurance?

Insurance’s claims procedure is the same for almost all policies with minor differences for every policy. Policyholders can get cashless claims or claim for expenses incurred already. The below-mentioned claim process emphasizes the necessary steps needed to file the claim.

1. Cashless Claim:

In a cashless claim, one should not settle the bill themselves. The insurance company will be represented by a TPA who will settle the bill with the hospital directly. The procedure for cashless planned claims and cashless emergency claims differ.

Emergency Admission Cashless Claims Procedure:

On admission to the hospital, HDFC Ergo (formerly known as Apollo Munich) will have to check if cashless claims can be made. If the hospital of admission falls in the cashless hospitals network supported by HDFC Ergo (formerly known as Apollo Munich) the following process needs to be followed.

  • Inform HDFC Ergo (formerly known as Apollo Munich) of the emergency hospital admission within 24 hours. Contact the hospital insurance help desk and fill in the cashless claim details and send it to the company for a cashless claim. This claim should be approved by the attending doctor.
  • The TPA will review the documents submitted. If the TPA grants the claim, then the hospital expenses covered under the policy will be settled and the patient/policy owner will settle other expenses not covered by the policy.
  • If the claim is not supported, then the bills are settled by the patient or policy owner and a request for reimbursement can be made. Rejection of a cashless claim does not indicate rejection of the reimbursement.

Cashless Claims Procedure For Planned Admission:

If the policyholder plans to get a treatment at a hospital on the network panel and get the cashless claim, the following steps are followed:

  • Select the hospital from the network hospital list.
  • Intimate HDFC Ergo (formerly known as Apollo Munich) 48 hours prior to admission.
  • The cashless request form should be filled by the policyholder or patient and sent to HDFC Ergo (formerly known as Apollo Munich) along with a certification from the attending doctor and the required medical records.
  • HDFC Ergo (formerly known as Apollo Munich) will review the submitted documents and convey their decision to the hospital. If approved, the hospital bill will be settled by HDFC Ergo (formerly known as Apollo Munich) directly. If rejected, the patient pays the bill and a claim for reimbursement can be made.

2. Reimbursement of Treatment Expenses:

If a cashless claim is rejected, the policyholder’s bills can be repaid by claiming for recompense of expenses. Follow the below-mentioned procedure to make reimbursement claims:

  • Contact HDFC Ergo (formerly known as Apollo Munich) on treatment within a stipulated time frame.
  • Patients or policy owners should provide policy numbers when making intimations
  • Download the claim form from the website or get it from the agents at the office locations.
  • Submit the form to the HDFC Ergo (formerly known as Apollo Munich) office address.

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HDFC Ergo (formerly known as Apollo Munich) Health Insurance follows a simple and straightforward claim process. You can follow the points mentioned in the post mentioned to file your claims.

Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.

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