Royal Sundaram Health Insurance Claim Settlement

Royal Sundaram Health Insurance

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Highlights

5,000+ Network Hospitals

1,85,450 Policies Issued

Lifelong Renewability

77.32% Claim Settlement Ratio

In-House Claim Settlement

Coronavirus (COVID-19) Cover

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

    In case of any query, call InsuranceDekho at 1800-1205-698.

  • 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 Incurred Claims Ratio (ICR) of Royal Sundaram is 61%.

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