Oriental Health Insurance Claim Settlement

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

• Get admitted to any network or non-network hospital
• Intimate Oriental Insurance Company about the hospitalisation as soon as possible
• Get the reimbursement claim form from the insurer or download it from their website
• Provide the required details while filling out the form
• When getting discharged, pay the hospital bills
• Collect all original bills, documents, and reports
• Sign all documents and send them to the TPA service provider along with the claim form
• When the documents are received, the TPA service provider investigates the documents  
• When they find everything correct, the insurer settles the claim as per the terms and conditions of the policy
• The payment will be made in the name of the insured

Listed below are the documents required to file a reimbursement claim:

• Duly filled claim form
• Medical recovery report
• Original investigation reports
• Final hospital discharge summary
• Pharmacy bills along with the prescription
• Original bills, receipts, and discharge report
• Indoor case papers and duly filled claim form
• Original Test Reports (x-rays/sonography/ECG, etc.)
• A valid photo ID proof
• Treating doctor's report, and original consultation notes
• Nature of operation performed and surgeon's bill and receipt
• Copy of claim intimation given to the Company together with xerox of policy & premium receipt

The Incurred Claims Ratio or ICR is the most trusted approach to determine whether or not you should buy health insurance policies from a Health insurance company. It is a way to know the pace of the claim procedure and the productivity of the insurer in terms of revenue. The Oriental Health Insurance Claim Settlement Ratio for FY 2018-19 is 113.86%.