Health Insurance Claims

Procedure to Apply for Health Insurance In India

Under Health Insurance, you may apply for a claim as follows:

    - Claiming through Cashless facility
    - Claiming through Reimbursement of claims

Procedure for Cashless Claims: Cashless claims facility is available only with our network hospitals. The list of network hospitals is also available in the policy kit. Also available under the link “cashless hospitals” in claims section of the website. Under this facility you will have to sign the bills at the time of your discharge and we shall settle the amount directly with the hospital.
You can contact our Third Party Administrator through the helpline numbers given below, immediately on admission by quoting your Membership number shown on your health card.

Cashless Claims procedure for Emergency Admission:

- In case of network hospital, on admission, Intimate Third party administrator (TPA)
  through Toll free no. Please quote your health card Membership number
- Fill in the cashless request form which is available with the Hospital Insurance Help
  Desk and get it certified by your treating doctor
- This form, with supporting medical records has to be faxed by the hospital to the TPA's
  fax number
- TPA scrutinizes the documents, conveys the decision to the hospital -sanction of
  cashless request or calls for additional documents, if required.
- On approval of cashless facility by TPA, the hospital bills will be settled directly
  (subject to policy limits). Inadmissible amounts like telephone charges, food, attendant
  charges etc would have to be settled by you
- If cashless is not approved by TPA, please settle the bill with the hospital and apply
  for reimbursement. The claim will be processed as per policy terms and conditions
- The Turn around time for approving Cashless decision by our TPA is 24 HOURS AFTER
  RECEIPT OF ALL DOCUMENTS

Cashless Claims procedure for Planned Admission:

- Select a hospital from our list of network hospitals for treatment
- Intimate our Third party administrator (TPA) through the Helpline Number before 3 days
  of admission, quoting your Health card Membership number
- Fill in the cashless request form which is available with the Hospital Insurance Help Desk and get it certified by your treating doctor
- This form, with supporting medical records has to be faxed by the hospital to the TPA's
  fax number
- TPA scrutinizes the documents, conveys the decision to the hospital -sanction of
  cashless request or calls for additional documents, if required
- On approval of cashless facility by TPA, the hospital bills will be settled directly
  (subject to policy limits). Inadmissible amounts like telephone charges, food for
  attendants etc would have to be settled by you
- If cashless is not approved by TPA, please settle the bill with the hospital and apply
  for reimbursement. The claim will be processed as per policy terms and conditions
- The Turn around time for approving Cashless decision by our TPA is 24 HOURS AFTER
  RECEIPT OF ALL DOCUMENTS

Procedure for Reimbursement of Claim: Reimbursement facility is available at network hospitals as well as non-network hospitals
- You have to avail treatment and settle all the bills with the hospital and file a claim for
  reimbursement
- Intimate Royal Sundaram through toll free number 1800 345 88 99 (OR) Mobile
  Number: 9444448899 (OR) email to customer.services@royalsundaram.in- immediately on
  admission not later than 7 days from the date of discharge. Please quote your Policy
  certificate number
- Claim form can be downloaded from the website directly. 
- Submit the following Claim Documents to the Company within 30 days from the date of
  discharge

Document checklist: (All  ORIGINAL documents, to be submitted within 30 days from date of discharge)
- Duly filled claim form along with Doctor's certificate
- Discharge summary
- Bills
- Prescriptions
- Advance and final receipts
- Diagnostic Test Reports, X Ray, Scan and ECG and other films
- Claims would be processed on receipt of all required documents  and additional
  documents/information if any required will be called for after scrutiny of the claim
- Cheque will be despatched to you if the claim is admissible. If not, a repudiation
  letter would be sent to you
- The turn around time for Reimbursement claims is 20 working days from the date of
  receipt of all documents