Claim Settlement of DHFL Health Insurance
The claim settlement process of DHFL General Insurance is as smooth as you would want it to be. Also, the company does not put any limit on the number of claims that can be made during a policy period. However, the sum insured is the maximum limit under the policy. You can file claims with DHFL General Insurance in two ways, either cashless or reimbursement. You will be happy to know that the company settles a claim or communicate rejections within 30 days of submission of the relevant documents required for the process.
Claim Process for Cashless Treatment
You can avail cashless treatment at any of the network hospitals of DHFL General Insurance. Given below are the steps that must be followed to make a claim:
- Approach the network hospital for hospitalisation (intimate at least 24 hours prior in case of emergency and 48 hours in case of planned hospitalisation) to avail medical treatment
- Provide your health insurance details at the hospital admission counter
- Fill up correctly the pre-authorisation form which is available at the hospital
- Your request will be forwarded by the network hospital within 24 hours of the hospitalisation
- In the meantime, the network hospital will either treat the insured person by taking a token deposit or as per the rules in a situation requiring emergency medical attention
- The hospital will refund the deposited amount to you barring a token amount to cover the non-covered expenses after the issuance of the authorisation in emergency hospitalisation
- In case of approval in planned hospitalisation, the company will directly bear the medical expenses
- Whereas, if the request for claim gets rejected, then the policyholder is required to pay off the bills from own pocket
There can be instances where the TPA or the company may reject cashless treatment due to some reason. And if you couldn't avail the cashless treatment, don’t worry. You can submit your claim to the TPA office for reimbursement not later than 15 days after your discharge from the hospital. Given below are the steps to avail the reimbursement facility-
- Inform the company as soon as possible in case of emergency or planned hospitalisation
- Submit the relevant documents as required according to the terms and conditions of the policy
- The company will investigate the details on the claim form and other documents
- The approval letter will be sent to you by the claim management team of DHFL General Insurance confirming the approval
- Within 15 days after this, you will get the amount reimbursed
- If the claim request gets rejected, then the insured person can raise a query for the rejection
The company requires the following documents for the purpose of reimbursement-
- Duly filled and signed claim form
- OT notes if available
- Original discharge or death summary
- Original bills from the pharmacy
- Original main bill from the hospital along with break up bill and original receipts
- Reports of X-ray, CT films, MRI, HPE etc.
- Reference slips from the doctors
- KYC Documents
- FIR Report/MLC/Post Mortem Report (if applicable)
- Cancelled cheque for NEFT payment
You will be called for any additional documents or information required based on the circumstances of the claim.
Incurred Claim Ratio (ICR) of DHFL Health Insurance
Incurred Claim Ratio or ICR, simply indicates how much you can believe in an insurance company as far as claims are concerned. Every year, IRDAI (Insurance Regulatory and Development Authority of India) releases the data of ICR for all the companies, according to which the ICR of DHFL General Insurance is 7.89%. ICR is the ratio of the claim incurred by the insurance company to the actual premium collected for that period. ICR of DHFL General Insurance is sure to change over time.