Royal Sundaram Health Insurance Claim Settlement
The 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.
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Claim Process for Cashless Treatment
Royal Sundaram provides cashless hospitalisation to members at more than 3,000 network hospitals where you can avail of 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 of emergency hospitalisation and at least 48 hours before admission in planned hospitalisation
- While visiting the hospital, carry a 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 of the receipt
- If the request is approved, your bill will be cleared directly by the insurer
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Reimbursement Treatment
If your claim settlement 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 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 for the expenses incurred during hospitalisation through a cheque.
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Documents Needed
The documents mentioned below must be sent to the health insurance claim office of Royal Sundaram Health Insurance Company:
- Original investigation reports
- Final hospital discharge summary
- FIR or post-mortem report it 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
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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 organization’s performance, thereby helping the customers to make an informed choice. The Royal Sundaram claim settlement ratio for FY 2018-19 is 61%.
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Royal Sundaram Health Insurance Claim Settlement FAQs
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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.
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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.
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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
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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.”
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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.