Aditya Birla Health Insurance Claim Settlement Ratio

Medical costs in any health emergency can cause a huge dent in your overall financials. The reason being the ever-increasing hospital bills. To be ready with any medical contingency, people have started to accept health insurance policies as an important part of their financial portfolios. Aditya Birla Health Insurance Policy is one of the most popular insurance policies among customers due to its comprehensive coverage benefits. With a wide network of over 7000 hospitals and a presence in more than 2,100 Indian cities, Aditya Birla garners massive customer trust and loyalty. But before choosing any health insurance scheme, it is important to know the Claim Settlement Ratio of Aditya Birla Health Insurance.

You must be thinking why? Well, the Claim Settlement ratio helps you decide whether a company is suitable for you or not. Still, have some doubt left? Don’t worry, we will discuss this extensively in this article so that you can understand better. Also, we will tell you about the claim process and the documents you will require to get the claim. Keep reading to know more!

What is the Claim Settlement Ratio?

In the financial year 2017- 2018, the Claim Settlement Ratio of Aditya Birla Health Insurance was 96%. What does this mean? Well, this number implies that Aditya Birla managed to approve 96 health insurance claims out of every 100 claims it received. So, you can guess that Claim Settlement Ratio is the number of total claims approved by a company out of the total number of claims received by the company in a financial year. With this ratio, a customer can assess the ability of an insurance company to settle the claim.

You can consider this ratio as a tool to check the reliability of any insurance company when you are going for a Health Insurance scheme. The Insurance Regulatory and Development Authority of India (IRDAI) publishes the Claim Settlement Ratio of different Health Insurance Companies every year on its official website. You can check it there.

How to Get Claims for Aditya Birla Health Insurance Policy?

One of the most important aspects of Aditya Birla Health Insurance Policy is the process by which you can get claims. There are two methods by which you can get the same – Cashless and Reimbursement. The insurance company directly settles the claims in the Cashless process. This means you don’t need to pay a single penny. However, in the reimbursement process, you will need to pay all the expenses first and the company will reimburse the amount later.

To get the Claims for Aditya Birla Health Insurance Policy, you will need to follow a few simple steps for both Cashless and Reimbursement claims. We are showing them below. Please have a look!

How to Raise Aditya Birla Cashless Health Insurance Claims?

We are showing the steps that you need to follow if you want to opt for the Cashless Claim. Do check!

Step 1: Check Network Hospitals

If you want to enjoy the Cashless Claim for your Aditya Birla Health Insurance Policy, the first thing you should do is to approach one of the Network Hospitals associated with the company. To know the Network Hospitals, you can visit the official website of Aditya Birla Health Insurance company and go to the ‘Claim’ section where you will see the option of ‘Our Network’.

Step 2: Patient Identification

In the second step, you will need to show your (if you are a patient) Aditya Birla Health Insurance Cashless Card at the Network Hospital. You will get this card on opening the policy with the company. Other than this, you can also provide your Policy Number (if you don’t have a Cashless Card). This will help in the identification process. For further processing, you will also need to show a valid ID Proof like Passport, PAN Card, Voter’s ID Card, Aadhar Card, etc.

Step 3: Cashless Hospitalization Request Form

After the process of Identification, the network hospital will submit the Cashless Hospitalization Form to the Aditya Birla Health Insurance. You can consider this form as the pre-authorization form. If you want to speed up the process of Cashless pre-hospitalization, you can submit this form by yourself.

Remember to submit the Cashless Hospitalization Request Form within 48 hours from the time of Hospitalization in case of Emergency Hospitalization. In case it is planned, you can submit this form 3 days before hospitalization if you want to enjoy the high Claim Settlement ratio of Aditya Birla Health Insurance Company.

Step 4: Hospitalization Request Review

In this step, Aditya Birla will review your Claim and intimate to the Network Hospital about your claim approval. On receiving the request within usual business hours, Aditya Birla will communicate the decision to you within 2 hours via SMS and Email. Other than this, you can also check the status of your claim on the official website of Aditya Birla.

Step 5: Claim Settlement

In the final step, Aditya Birla will process the claim with the network hospital as per the terms and conditions of your Aditya Birla Health Insurance Policy. But before this, all the formalities should be completed.

How to Raise Reimbursement Claims with Aditya Birla Health Insurance?

Have a look at the steps that you need to follow if you want a Reimbursement Claim

Step 1: Intimate Aditya Birla Health Insurance Company

The first thing you need to do is to Notify or Intimate the company via any method. There are 3 methods – Logging in to your account, sending an email, or dialing the official customer care number to do so. As we told earlier, you need to notify the company within 48 hours in case of emergency hospitalization and 3 days before you are admitted to a network or non-network hospital. Once you get admission to the hospital, you will need to manage all your expenses by yourself unless your company issues a pre-authorization.

Step 2: Collection and Submission of Claim Documents

After getting discharged from the hospital, you will need to submit a few documents to get Reimbursement from Aditya Birla Health Insurance. Since the claim settlement ratio of the company is pretty good, you don’t need to worry about getting the amount back. However, there is one important thing to remember here – You will need to submit the required documents within 15 days of discharge from the hospital. You can see the list of documents in the next section.

The address to submit the claim documents for reimbursement is mentioned below.

Aditya Birla Health Insurance Co. Limited

5th Floor, Modi Business Centre

Kasarvadavali,

Mumbai, Thane West 400615.

Step 3: Claim Processing and Reimbursement

After completing all the above steps, Aditya Birla will review your claim request and approve or reject the claim accordingly. All the communication will be done via registered email and contact number. In case your request gets approved, Aditya Birla will disburse the claim amount to your registered bank account via NEFT. If your request gets declined, the company will communicate the same with a valid reason(s) for rejection.

What Documents are Required for Aditya Birla Health Insurance Claim?

As we promised in the last section, you can see the required documents for making your Aditya Birla Health Insurance claims. It is important to know these documents if you don’t want to face any difficulty in getting the claim. We are providing them below. Please have a look!

1. Claim Form Part A – This form needs to be filled by the Insured Person
2. Claim Form Part B – This form needs to be filled by the Hospital
3. Policy Copy or Health Card
4. KYC Documents ( Photo ID, Address Proof and Age Proof)
5. Copy of Hospital Registration Certificate
6. Original Certificate of Discharge/ Day Care Summary/ Transfer Summary or Death Summary
7. Original Copy of Final Hospital bill with a proper break-up along with all the original deposits and final payment receipts
8. Original invoice with the payment receipt for those payment charges that are billed outside the main hospital bill
9. Implant Stickers & Invoice for all implants used during the surgery
10. Letter from the Treating Doctor stating Complaints, Duration, history, and Details of Treatment
11. All previous consultation papers for the current ailment
12. All the Original diagnostic reports along with prescription and bills
13. Pharmacy/ Medical Bills along with the prescription

In the case of an accident, you will need to submit a few additional documents. Do check them below!

1. Medico-Legal Certificate MLC or FIR Copy
2. Letter of the Treating from a medical practitioner stating the details of accident/ Trauma and influence of Alcohol/Intoxication
3. Pre and post-operative imaging reports