Tata AIG Health Insurance Claim Settlement

Do not worry if your request for the cashless claim has been rejected, or if you have availed of treatment at a non-network hospital. You still have an option to make a claim for the reimbursement of expenses incurred. Follow the below guidelines for the reimbursement claim settlement:

• After the treatment, settle the medical bills at the non-network hospital.
• Contact the TPA and keep the policy information ready with you.
• Collect all the required documents and submit them to the TPA.
• Your documents will be reviewed.
• You may be asked for additional documents if required.
• The claim will be settled in accordance with the terms and conditions mentioned in the policy.
• Once approved, the amount will be reimbursed to you.

​Here is a list of documents required for filing a reimbursement claim.

• Original investigation reports
• Final hospital discharge summary
• FIR or post-mortem report (if happened)
• Pharmacy bills along with the prescription
• Canceled cheque or NEFT details for payment
• Original bills, receipts, and discharge report
• Indoor case papers and duly filled claim form
• 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 Claims Ratio (ICR) is the net claims incurred divided by net earned premium. It is an important factor to consider while shortlisting a health insurance policy. The reason is, that it indicates if the company is successfully making claims on it. The TATA AIG Health Insurance claim settlement ratio for FY 2018-19 is 78%.