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Zuno Health Insurance Claim Settlement

Edelweiss General Insurance ensures an easy and hassle-free claim process. With more than 2,500 network hospitals spread across the country, the company is committed to settling claims as per the policy terms and conditions. Whether it is planned or emergency hospitalisation, claims are approved in both cases. In addition, this health insurance company entertains all health insurance claims, be it cashless or reimbursement. It directly pays the hospital in case of cashless hospitalisation and transfers the money to the policyholder’s account in case of a reimbursement claim.

  • Claim Process for Cashless Treatment

    A cashless facility is applicable only if the treatment is availed at network hospitals of Edelweiss General Insurance. The health insurance company has a tie-up with thousands of top hospitals in India. Here are step-by-step guides to filing a cashless claim:

    • First, look for a network hospital in your city for cashless treatment. The list of network hospitals is available on the insurer’s official website
    • Inform the insurer within 48 hours of emergency hospitalisation and 72 hours before getting admitted in case of planned hospitalisation
    • Carry your health card issued by the insurer and a photo ID while visiting the hospital
    • Fill out the pre-authorisation request form given to you by the hospital and submit it at the hospital help desk
    • After checking your identity, the hospital sends the form to the Edelweiss General Insurance
    • If the claim is approved by the insurance company, then it pays the hospital bills directly
  • Reimbursement Treatment

    The reimbursement claim is filed in both network hospitals and non-network hospitals. The process includes the following steps:

    • Inform Edelweiss General Insurance as soon as possible - both in planned and emergency hospitalisation. It is normally 48 hours in emergency hospitalisation and 72 hours in case of planned hospitalisation
    • Collect discharge summaries, hospital bills, invoices, medical reports, etc. from the hospital. Make sure the documents are hospital-sealed
    • Download the ‘Claim Form’ from the insurer’s website then, fill it out properly and sign it
    • Annex a valid photo ID and a cashless card
    • Send all the documents to the address of Edelweiss General Insurance
    • After reviewing the claim form and documents, the insurer approves the claim. However, the approval is subject to the policy terms and conditions
  • Documents Needed

    Find a list of documents you should submit in case of the reimbursement claim settlement:

    • Investigation reports (original)
    • The discharge summary from the hospital
    • Pharmacy bills along with the prescription
    • FIR or post-mortem report if any
    • Original bills, receipts, and discharge report
    • Duly filled claim form and indoor case papers
    • Original hospital bills and a valid photo ID
    • Doctor's report and original consultation notes
    • The surgeon's bill and the nature of the operation performed
    • Test reports along with attending doctor’s report
    • A canceled cheque with your name on it or bank account details
  • Incurred Claim Ratio (ICR) of Zuno Health Insurance

    Incurred Claims Ratio (ICR) is an important approach to finding the best insurance company. It enables you to know whether or not the company is able to pay the claims. Every year IRDAI (Insurance Regulatory and Development Authority) reveals the data of the ICR in its annual report. The Edelweiss General Insurance claim settlement ratio for FY 2018-19 is 115%.

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Zuno Health Insurance Claim Settlement FAQs

  • How many claims does Edelweiss health insurance allow to make in a year?

    There is no rule that sets the number of claims you can make in a policy year. However, the number of claims should not exceed the limit of the sum insured. 

  • Does Edelweiss General Insurance accept the reimbursement claim?

    Yes, the company accepts the reimbursement claim. It reimburses by paying the entire amount that you have already paid from your pocket. In case of cashless treatment, the payment is made directly to the hospital. 

  • When do I need to inform the insurer for proper claim settlement?

    You must convey about your admission in the hospital within 48 hours for emergency hospitalisation and 72 hours prior to admission in the case of planned hospitalisation.

  • How much time do I need to spend in the hospital for requesting a claim?

    You have to stay for at least 24 hours in the hospital to ask for a successful claim settlement. In the case of daycare procedures, the hospitalisation can be less than 24 hours.

  • Where can I seek assistance for claim settlement related to Edelweiss Gneral Insurance plans?

    To seek assistance for claim settlement related to the plans of Edelweiss Tokio you can call on the toll-free number of Edelweiss General Insurance at 1800-120-00. You can also connect with the team of InsuranceDekho at 7551-196-989.

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