HDFC ERGO Health Insurance Claim Settlement

HDFC ERGO Health Insurance

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10,000+ Network Hospitals

10,63,052 Policies Issued

63% Incurred Claim Ratio

Lifelong Renewability

84.08% Claim Settlement Ratio

100% In-House Claim Settlement

Coronavirus (COVID-19) Cover

Claim Settlement of HDFC ERGO Health Insurance

HDFC ERGO Health Insurance (Previously known as Apollo Munich Health Insurance Company) provides a hassle-free and straightforward claim settlement process. Offering a number of benefits, the company is known to have the fastest claim settlement process. At HDFC ERGO Health Insurance, 90% of the cashless claims get approved within 60 minutes. It has a customer-friendly claim settlement team in place to make sure every insured member and his/her family experience hassle-free claim process. You can file a claim for both cashless treatment and the reimbursement of the treatment expenses.

  • Claim Process for Cashless Treatment

    If treatment is received in an empanelled hospital, the cashless claim can be availed. The steps for cashless claim process are as follows:

    • First of all, find an HDFC ERGO Health network hospital in a city where you want to get cashless treatment
    • Intimate Bharti within 24 hours in emergency hospitalisation and 48 hours before admission in case of planned hospitalisation.
    • While visiting the hospital, carry your cashless card and one photo ID proof.
    • Fill in the pre-authorization request form correctly available at the hospital and submit it to the hospital.
    • After your identity is checked, the network hospital sends the pre-authorization request form to HDFC ERGO Health Insurance.
    • The insurance company checks the coverage and sends an authorization letter to the hospital for claim settlement.
    • In case of approval, the medical expenses will be borne by the HDFC ERGO Health Insurance directly. For any non-medical and expenses not provided under the coverage, you will need to pay.
  • Reimbursement Treatment

    Reimbursement claim can be filed in both network and non-network hospitals. The steps for the reimbursement process are as follows:

    • Get admitted to any network or non-network hospital.
    • Intimate HDFC ERGO Health Insurance (formerly known as Apollo Munich) about the hospitalisation as soon as possible.
    • At the time of discharge, settle the hospital bills and collect all original bills, documents, and reports
    • Send the duly signed and filled claim form along with all original documents to HDFC ERGO Health Insurance.
    • On receipt of the documents,  HDFC ERGO Health Insurance investigates the documents and claim form details, 
    • After the investigation is done, the insurer settles the claim within 30 days if terms and conditions are met.
    • The payment will be made in the name of the proposer.
  • Documents Needed

    Here is a list of documents required for filing a reimbursement claim.

    • Original investigation reports
    • Final hospital discharge summary
    • FIR or post-mortem report if happened
    • Pharmacy bills along with the prescription
    • Original bills, receipts, and discharge report
    • Indoor case papers and duly-filled claim form
    • Original hospital bills and a valid photo ID proof
    • Treating doctor's report, and original consultation notes
    • Nature of operation performed and surgeon's bill and receipt
    • Test reports along with attending doctor’s or surgeon’s report

    For details about HDFC ERGO Health Insurance claim settlement, get in touch with InsuranceDekho.

  • Incurred Claim Ratio (ICR) of HDFC ERGO Health Insurance

    The Incurred Claims Ratio (ICR) indicates the strong footing of insurance companies in the insurance market. The ICR of HDFC ERGO Health Insurance (previously known as Apollo Munich) is 63%. It shows that HDFC ERGO Health Insurance is in good condition to approve and clear claims without having to overburden their finances.

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