Edelweiss Health Insurance Claim Settlement

Cashless facility is applicable only if the treatment is availed at network hospitals of Edelweiss General Insurance. The insurance company has a tie-up with thousands of top hospitals in India. Here are step-by-step guides to file a cashless claim:

• First, look for a network hospital in your city for cashless treatment. The list of network hospitals is available on the insurer’s official website
• Inform the insurer within 48 hours in emergency hospitalisation and 72 hours before getting admitted in case of planned hospitalisation
• Carry your health card issued by the insurer and a photo ID while visiting the hospital
• Fill the pre-authorisation request form given to you by the hospital and submit it at the hospital help desk
• After checking your identity, the hospital sends the form to the Edelweiss General Insurance
• If the claim is approved by the insurance company, then it pays the hospital bills directly

The reimbursement claim is filed in both network and non-network hospitals. The process includes the following steps:

• Inform Edelweiss General Insurance as soon as possible - both in planned and emergency hospitalisation. It is normally 48 hours in emergency hospitalisation and 72 hours in case of planned hospitalisation
• Collect discharge summary, hospital bill, invoices, medical reports, etc. from the hospital. Make sure the documents are hospital sealed
• Download the ‘Claim Form’ from the insurer’s website and fill it properly and sign it
• Annex a valid photo ID and the cashless card
• Send all the documents to the address of Edelweiss General Insurance
• After reviewing the claim form and documents, the insurer approves the claim. However, the approval is subject to the policy terms and conditions

Find a list of documents you should submit in case of the reimbursement claim:

• Investigation reports (original)
• The discharge summary from the hospital
• Pharmacy bills along with the prescription
• FIR or post-mortem report if any
• Original bills, receipts, and discharge report
• Duly-filled claim form and indoor case papers
• Original hospital bills and a valid photo ID
• Doctor's report and original consultation notes
• Surgeon's bill and nature of operation performed
• Test reports along with attending doctor’s report
• A canceled cheque with your name on it or bank account details

Incurred Claims Ratio is an important approach to find the best insurance company. It enables you to know whether or not the company is able to pay the claims. Every year IRDAI (Insurance Regulatory and Development Authority) reveals the data of the ICR in its annual report. The ICR of Edelweiss General Insurance for FY 2018-19 is 115%.