Claim Process
Simple, transparent, and hassle-free claim process for your group health insurance policy.
Types of Claims
We offer two types of claim processes to ensure your employees get the medical care they need with minimal financial burden.
Cashless Claims
Get treatment without paying hospital bills upfront at our network hospitals.
Process:
- Show your health insurance card at the network hospital
- Fill out the pre-authorization form
- Hospital coordinates with the TPA/insurer for approval
- Get treatment without paying (except for non-covered expenses)
- Insurer settles the bill directly with the hospital
Advantages:
- No upfront payment required
- Simplified paperwork
- Faster admission process
- Less financial burden on employees
Reimbursement Claims
Pay for the treatment upfront and get reimbursed by the insurance company.
Process:
- Pay for the treatment at any hospital
- Collect all original bills and medical documents
- Fill out the reimbursement claim form
- Submit the claim form along with documents
- Insurer processes and approves the claim
- Amount is transferred to the insured's account
When to use:
- Treatment at non-network hospitals
- Emergency situations
- When pre-authorization isn't possible
- For post-hospitalization expenses
Claim Process Steps
Our streamlined claim process ensures quick and hassle-free settlements.
Submit Claim
Notify us about the claim through our dedicated portal, email, or phone. For cashless claims, present your card at network hospitals.
Processing
Our team verifies the claim details and coordinates with the insurance company for quick processing.
Approval
Once approved, cashless claims are settled directly with the hospital. For reimbursement claims, payment is processed to the insured.
Settlement
Claim settlement is completed, and confirmation is sent to the insured along with settlement details.
Dedicated Claims Support
Our specialized claims team provides end-to-end assistance throughout the claim process, ensuring smooth and quick settlements.
24/7 claims helpline for immediate assistance
Dedicated claims manager for your organization
Regular updates on claim status
Assistance with documentation and submission
Frequently Asked Questions
Find answers to commonly asked questions about the claim process.
What documents are required for claim submission?
For claim submission, you generally need: filled claim form, original hospital bills, discharge summary, investigation reports, doctor's prescription, and any other relevant medical documents. For cashless claims, you also need to present your health card at the network hospital.
How long does the claim process take?
Cashless claims are typically approved within a few hours to 24 hours. For reimbursement claims, the settlement usually takes 7-14 working days after submission of all required documents.
What is the difference between cashless and reimbursement claims?
In cashless claims, the insurance company settles the bill directly with the network hospital. For reimbursement claims, you pay the hospital bills first and then submit the claim to the insurance company for reimbursement.
Are pre-existing conditions covered under group health insurance?
Yes, most group health insurance policies cover pre-existing conditions from day one without any waiting period, which is a significant advantage over individual policies.
What to do if a claim is rejected?
If your claim is rejected, you can appeal the decision by providing additional documentation or clarification. Our team will help you through the appeal process and coordinate with the insurer on your behalf.
Is there a time limit for submitting claims?
Yes, most insurance policies have a time limit for claim submission, typically ranging from 7 to 30 days from the date of discharge for hospitalization claims. It's important to submit claims within this timeframe.