Reliance Health Insurance: understanding the Claim Process

Claims process – Reliance Health Insurance

There are two ways to make claim under a Health Insurance Policy:

a.) Cashless basis

b.) Reimbursement basis.

In simple terms, for making a claim on cashless basis, the treatment must be done only at a network hospital of the insurance company servicing your policy. For availing the treatment, you would have to first seek an authorization as per the procedures laid down and in the prescribed form.

In case of claims on reimbursement basis, the insurance company has to be informed as per their prescribed procedures. The policyholder has to ensure that documents such as claim form, discharge summary, prescriptions and bills to be submitted for the claim on reimbursement are obtained after hospitalization.

Reliance Health Insurance has a well-defined claim processing system.

Important details required for claim intimation

• Health Insurance Policy number
• Phone no., email id, address, landmark etc. of the insured/claimant
• Name of Insured/claimant who is admitted in the hospital
• Relationship of insured with the person who is hospitalized.
• Name of the hospital
• Nature of ailment (For health claims)
• Nature of  accident, date, time and location of the incident (For accident cases)
• Commencement date of the symptom of ailment

Claim Process – Cashless Service

• Once the doctor advises hospitalization or a treatment, intimate your claim
• Intimation can be done by calling on the toll-free number of the Reliance Health Insurance Company 1800 3009 or email on rcarehealth@relianceada.com
• Get hospitalized in any of the network hospitals
• Show your Reliance Health Card to the representative at the TPA desk

• Complete the ‘Cashless Request Form’ available at the hospital’s insurance/TPA Desk.
• Submit your authorization form along with your health card copy and your photo identity copy
• You will have to wait for an approval from the hospital.
• Send the completed form via email or fax to the RCare Health/ TPA along with any important medical details
• Verify and sign the details along with all the bills
• You may leave the investigation and original discharge letter with the hospital and retain a photocopy of these for your reference

Claim process if ‘cashless hospitalization’ is denied by RCare Health/TPA:

• Settlement of the hospital bill to be done as required
• During discharge, ensure to collect all the original bill documents and reports
• Make a complaint with RCare Health /TPA for processing and reimbursement

Claim process for emergency hospitalization with ‘cashless facility’:

• Get hospitalized and then obtain the pre-authorization form from the hospital
• Immediately fill the form and get it signed by the attending doctor
• Send the completed form via email or fax to the RCare Health/ TPA along with any important medical details
• Verify and sign the details along with all the bills
• You may leave the investigation and original discharge letter with the hospital and retain a photocopy of these for your reference

Claim process for emergency hospitalisation with ‘reimbursement facility’:

• Get hospitalized
• Immediately intimate or register the claim at RCare Health call centre/E-mail  as soon as possible
• Make the hospital bill payments in full as required
• Collect all the original bills, documents and reports at the time of discharge
• Register a claim with RCare Health /TPA for processing and reimbursement, by filling in the claim form and attaching required documents as mentioned in the claim form

Claim process for planned hospitalisation with ‘reimbursement facility’:

• Intimate RCare Health /TPA of the planned hospitalisation
• Get hospitalized
• Make the hospital bill payments in full as required
• Collect all the original bills, documents and reports at the time of discharge
• Register a claim with RCare Health /TPA for processing and reimbursement, by filling in the claim form and attaching required documents as mentioned in the claim form

Documentation for smooth Claim Settlement

The below documentation is required as per the type of claims registered:

Hospitalisation / Day-Care Treatment

• Claim form duly signed and filled completely
• Doctor’s first prescription with the beginning of the symptoms or illness mentioning the date
• Doctor’s prescription & medical treatment papers
• X-ray/Scan/ECG, Laboratory etc. which are the investigation reports
• Original medical bills, receipts, hospital discharge card
• In case of an accident the Copy of FIR
• CTS formatted Cancelled Cheque mentioning the printed account number, IFSC code and name of insured). In case, insured’s name is not printed on the canceled cheque, provide scanned copy of 1st page of passbook or bank statement.
• Patients pan card details (photo copy) and identification card
• Copy of Health card

Critical Illness Claims

• Claim form duly signed and filled completely
• Doctor’s certificate mentioning the diagnosis with the date of the symptoms when first occurred
• Relevant Investigation reports (Radiology, Pathology etc) confirming the diagnosis
• Original medical bills, receipts, hospital discharge card
• Hospital admission & discharge card/ certificate
• CTS formatted Cancelled Cheque mentioning the printed account number, IFSC code and name of insured). In case, insured’s name is not printed on the canceled cheque, provide scanned copy of 1st page of passbook or bank statement.
• Patients pan card details (photo copy) and identification card
• Copy of Health card

Domiciliary Hospitalisation

• Claim form duly signed and filled completely
• Doctor’s first prescription with the beginning of the symptoms or illness mentioning the date
• Doctor’s prescription & medical treatment papers
• X-ray/Scan/ECG, Laboratory etc. which are the investigation reports
• Original medical bills, receipts, hospital discharge card
• In case of an accident the Copy of FIR
• Documentary proof showing lack of accommodation in hospital/nursing home (if this is the case)
• CTS formatted Cancelled Cheque mentioning the printed account number, IFSC code and name of insured). In case, insured’s name is not printed on the canceled cheque, provide scanned copy of 1st page of passbook or bank statement.
• Photocopy of identification card of patient & PAN card of insured

In case of any emergencies, you need to inform Reliance Health Insurance within 24 hours of the admission. In case of planned emergencies, the notification has to reach the company 48 hours prior to the hospitalization. The claim intimation can be done via Reliance toll free number 1800-3009 the same could also be emailed to rgicl.rcarehealth@relianceada.com

Review

With a robust base of faithful customers clubbed with sturdy Pan India branch setup, Reliance Health Insurance Plans are reasonably priced and cost-optimized. Also the premiums are viable, pocket friendly and accounted for. The cover gives you cashless hospitalization benefit in over 4000 hospitals across nation. If a worthy health cover with strict budget is what’s on your mind, Reliance Health Insurance is a sure contender.