Oriental Health Insurance Claim Settlement

Oriental Health Insurance

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Highlights

4,300+ Network Hospitals

12,50,812 Policies Issued

Lifelong Renewability

94.28% Claim Settlement Ratio

Dedicated Claim Settlement

Coronavirus (COVID-19) Cover

Claim Settlement of Oriental Health Insurance

The popularity of an insurance company is driven by its claim settlement process. Oriental Insurance Company makes sure easy, smooth and hassle-free claim settlement experience. Oriental strives to provide claim settlement service through a renowned Third Party Administrator (TPA). As a policyholder, you’re able to get your claims settled either with reimbursement facility or cashless option. To register a claim, you need to follow the below instructions to make it smoother and more comfortable. 

  • Claim Process for Cashless Treatment

    If you receive treatment at a network hospital, then cashless claims can be availed. Below are steps to file a cashless claim:

    • Find a network hospital in the city where you want to get treatment
    • Intimate Oriental Insurance Company as soon as possible in emergency and before admission in case of planned hospitalisation
    • Carry your cashless card and one photo ID proof while visiting the hospital
    • Collect the pre-authorization form from the hospital, fill it and submit
    • The hospital checks your identity and sends the pre-authorization form to the TPA of Oriental Insurance Company
    • The TPA checks the coverage, approves or disapproves the claim
    • If the claim is approved, the medical expenses will be borne by the insurer
  • Reimbursement Treatment

    Reimbursement claim 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 the form
    • When getting discharged, pay the hospital bills
    • Collect all original bills, documents, and reports
    • Sign all documents and send 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 terms and conditions of the policy
    • The payment will be made in the name of the insured
  • Documents Needed

    Listed below are 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

    For details about the claim settlement process of the Oriental Insurance Company, dial our toll-free number 1800-120-5698.

  • Incurred Claim Ratio (ICR) of Oriental Health Insurance

    The Incurred Claims Ratio or ICR is the most trusted approach to determine whether or not you should buy health insurance policies from an 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 ICR of Oriental Insurance Company is 113.86%.

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