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Royal Sundaram Health Insurance Claim Settlement

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Highlights
Claim Settlement Ratio81.50%
COVID-19 CoverYes
In-House Claim SettlementAvailable
Network Hospitals5,000+
Policies Sold1,85,450
RenewabilityLifelong

Claim Settlement of Royal Sundaram Health Insurance

Health insurance claim procedure at Royal Sundaram is very specific and simple. The company believes that every policyholder likes to have an easy and speedy claim procedure. The claim process for cashless treatment and reimbursement differs though. For the convenience of customers, Royal Sundaram ensures two types of claims can be filed. They are the cashless claim and the reimbursement claim.

  • Claim Process for Cashless Treatment

    Royal Sundaram provides cashless hospitalisation to the members at more than 3,000 network hospitals where you can avail direct healthcare services without any hassle. The processes include:

    • First of all, find a Royal Sundaram network hospital in a city where you want to get cashless treatment
    • Intimate Royal Sundaram within 48 hours in emergency hospitalisation and at least 48 hours before admission in planned hospitalisation
    • While visiting the hospital, carry the health card and one valid photo ID
    • Show the health card and valid photo ID at the insurance desk of the hospital 
    • Fill in the pre-authorization request form correctly available at the hospital and submit it to the hospital
    • Post informing you, the hospital sends the pre-authorisation form to Royal Sundaram health insurance company
    • Your request will be reviewed by the Third Party Administrator (TPA) or insurer
    • You will receive a reply about the decision within 3 hours after the receipt  
    • If the request is approved, your bill will be cleared directly by the insurer
  • Reimbursement Treatment

    If your claim request for cashless hospitalisation is not approved, or if you avail treatment at a non-network hospital, then need not worry. You can later claim for reimbursement for the expenses incurred. Follow these guides:

    • Inform the health insurance company within 72 hours of planned hospitalisation. However, the insurer must be notified within 24 hours of hospitalisation in case of emergency hospitalisation. 
    • Submit the duly filled claim form and relevant documents to Royal Sundaram within 30 days from the discharge date. 
    • The insurer will verify your request and decide to accept or deny it as per the terms and conditions mentioned in the policy.
    • The proposer will be reimbursed with the expenses incurred during hospitalisation through a cheque.
  • Documents Needed

    The documents mentioned below must be sent at the health insurance claim office of Royal Sundaram Health Insurance.  

    • 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
    • Canceled cheque or NEFT details for payment
    • 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

     

  • Incurred Claim Ratio (ICR) of Royal Sundaram Health Insurance

    ICR or Incurred Claim Ratio is the net claims paid by an insurer as against the net premium earned. The ratio basically informs about an organisation’s performance, thereby helping the customers to make an informed choice. The Incurred Claims Ratio (ICR) of Royal Sundaram for FY 2018-19 is 61%.

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Claim Process at Royal Sundaram Health Insurance

  • Network Hospital
  • Non-Network Hospital
  • 1

    Claim Assistance

    For any assistance or query, call InsuranceDekho at the toll-free number 755 1196 989.
  • 2

    Claim Intimation

    Emergency hospitalisation needs intimation within 48 hours and for planned hospitalisation intimate at least 48 hours prior to admission.
  • 3

    Claim Processing

    Fill in the pre-authorisation form and hand it over to hospital's insurance/TPA desk to initiate claim request.
  • 4

    Claim Settlement

    Once your request is approved, claim is settled. If not approved, claim for reimbursement after discharge.
  • 1

    Claim Assistance

    For any assistance or query, call InsuranceDekho at the toll-free number 755 1196 989.
  • 2

    Claim Intimation

    Emergency hospitalisation needs intimation within 48 hours and for planned hospitalisation intimate within 72 hours prior to admission.
  • 3

    Claim Processing

    Submit claim form with original documents such as doctor’s reports, hospital bills, diagnostic tests, etc.
  • 4

    Claim Settlement

    Once your request for reimbursement of expenses is approved, the claim will be settled.

1550 Royal Sundaram Cashless Network Hospitals in India

Insurance Products by Royal Sundaram General Insurance

Royal Sundaram Health Insurance Claim Settlement FAQs

  • How to make a claim for Royal Sundaram health insurance policy?

    To make a claim for Royal Sundaram, you can intimate the company by filing a form online. You can drop an e-mail at customer.services@royalsundaram.in. Royal Sundaram General Insurance Co. Limited guarantees to settle the claims in 2 days, if all the documents are in order and no discrepancy is found.

  • When should I inform Royal Sundaram in case of hospitalisation?

    You must inform Royal Sundaram at least 48 hours before hospitalisation in case of planned hospitalisation whereas within 24 hours at the time of emergency hospitalisation. 

  • What are the documents required by Royal Sundaram at the time of intimation?

    You are required to provide the following documents at the time of intimation:

    • Name of the insured person
    • Name, Address, and Contact Number of the hospital
    • Diagnosis
    • Name and Contact Number of the treating doctor
    • Expected date of discharge 
    • Date of Hospitalisation
  • How can I make a claim for the second opinion for critical illness in Royal Sundaram?

    Claims for the second opinion for Critical Illnesses are serviced through “Europ Assistance India Pvt. Ltd.”

  • How can I make a claim in Royal Sundaram if I have lost my card?

    You should inform Royal Sundaram by contacting them on the toll-free number-18604250000 or drop an e-mail to them. 

  • How many hospitals provide cashless claim settlement in health insurance offered by Royal Sundaram?

    There are 5,000+ hospitals that provide cashless claim settlement in health insurance by Royal Sundaram.

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Network Hospital in Popular Cities

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Cochin21
New Delhi225
Hyderabad225
Ghaziabad70
Lucknow122
Pune225
Gurgaon142
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