Cholamandalam Health Insurance Claim Settlement
Cashless Approval TAT | 70 mins Cashless Claim Processing |
Claim Settlement Ratio | 94% |
Network Hospitals | 11,000+ |
Pre-existing Disease Waiting Period | 3 years |
Special Benefits | High Coverage |
Starting Premium of Rs. 5 lakhs SI | Rs. 407/month |
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Claim Settlement of Cholamandalam Health Insurance
Cholamandalam MS General Insurance Company Limited is a reliable name in the general insurance sector. It is widely appreciated for providing easy and smooth claim settlement procedure to its customers. Under Cholamandalam MS plans, the policyholders can get their expenses back with two types of claim procedures such as Cashless and Reimbursement. The cashless treatment option can only be availed at the network hospitals, empanelled with the insurer. Here, Cholamandalam MS attains 7,000+ network hospitals across the country, where claims are directly settled as per the policy terms and conditions. Whereas, as per the reimbursement option, the policyholders are required to submit the bills of the expenses covered under their health insurance plan. Then after the analysis, the claim is approved and policyholders are provided with their money.
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Claim Process for Cashless Treatment
To settle a cashless claim with Cholamandalam MS General Insurance Company, one needs to visit its network hospital and get treated only there. If the insured individual is required to seek a claim under the policy, he/she will have to follow the following steps:
- Look for a network hospital equipped with the best possible facilities nearest to your place
- Visit the hospital with the health card and show it to the concerned official present there
- With the help of your card, the hospital will verify your identity
- The hospital will send a claim request to Cholamandalam MS or the TPA
- After this, your application will be thoroughly processed, and then the decision for approval or denial is made accordingly
- If the claim request gets approved, then insurance providing company, CholamandalamMS, in this case, will settle the bills directly with the network hospital
- If rejection comes for a claim request, then the insured individual can get treated at the network hospital by making a payment on his/her own and request for reimbursement claim later
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Reimbursement Treatment
If the insured is treated in a non-network hospital, he or she can file a reimbursement claim. Also, the policyholder can request for a reimbursement claim on getting his or her cashless claim request rejected. Here are the steps to request the claim successfully:
- Inform the insurer about the hospitalisation immediately with policy certificate number
- Choose the medical procedure, avail it and pay the bill for the same
- Collect all the original bills and documents at the time of discharge from the hospital
- Duly fill the claim form and get it signed from the authority. After that, submit it with all the original documents to the insurer
- Approval or denial will come as per the terms and conditions of the health insurance plan
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Documents Needed
Here are some essential documents which are needed to be submitted to successfully make a reimbursement claim:
- Bill, certificate of discharge, receipts, card of the insurance policy
- Cash memos from the hospital, chemist, and labs along with proper prescriptions
- Lab test reports and any essential receipt received from pathologist
- Detailed certificate from doctor or surgeon, where nature of the operation is elaborated
- Bills and receipts of attending physician, medical specialist, etc. and certificate of diagnosis
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Incurred Claim Ratio (ICR) of Cholamandalam Health Insurance
The Incurred Claim Ratio (ICR) is a perfect measure to understand the potential of an insurance firm. It is a ratio of claim settled by the insurer to the actual premium collected by the insurance company during that period. It unveils the productivity of a health insurance firm in terms of revenue. The Incurred Claim Ratio (ICR) of Cholamandalam MS General Insurance Company Limited for FY 2018-19 is 35%.

*Tax benefits are subject to changes in Income Tax Act.
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Cholamandalam Health Insurance Claim Settlement FAQs
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In how much time I need to contact network hospitals of the Cholamandalam MS about the hospitalisation?
To seek cashless facility in the network hospital of Cholamandalam MS, you need to inform them within 72 hours in advance in planned admission case, while within 48 hours in the case of emergency hospitalisation.
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Where to approach for claim-related assistance with a Cholamandalam MS plan?
If you need any claim-related help, you can call Cholamandalam MS at their 24x7 customer helpline number 1800-208-5544 or email them at customercare@cholams.murugappa.com. You can also call InsuranceDekho's customer care executives at toll-free number 7551-196-989.
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Is it mandatory to stay for 24 hours in the hospital to be eligible for a claim?
Yes, any policyholder needs to be hospitalised for at least 24 hours in a hospital to be eligible for a claim. Only in the case of daycare treatments or procedures, the admission for less than 24 hours is considered for a claim.
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What are the basic documents I need to present to get the claims settled?
The documents that you need to present for the settlement of your claim are :
- Duly filled claim form
- Certificate from the doctor
- Medicine prescriptions and bills
- Diagnosis and test reports like CBC, ECG, x-ray etc.
- Discharge details and reports
- Final receipts from the hospital
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What is the Claim Settlement Ratio of Cholamandalam MS General Insurance Company?
The Claim Settlement Ratio of Cholamandalam MS General Insurance Company for FY 2021-22 is 95%.