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.
Royal Sundaram 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
Contact details for Claim intimation
The contact details for successful, quick and hassle-frees claim settlement are mentioned below:
- 24 x 7 Toll Free: 1800-425-6645
- Email: customer.services@royalsundaram.in
- Health Claims Department , Royal Sundaram General Insurance Co Ltd, Vishranthi Melaram Towers, No.2/319, Rajiv Gandhi Salai (OMR) Karapakkam, Chennai – 600097
- Contact details of Service Provider: Europ Assistance India Pvt Ltd, 301, C Wing, Business Square, Andheri Kurla Road, Chakala, Andheri (East), Mumbai – 400093, Contact No: +91-22-67872035 Email: rsalifeline@europ-assistance.in
Claim Process - Cashless Service (For Domestic Claims)
- In case of a planned hospitalization, kindly intimate the TPA. It is important to seek cashless authorization at least 72 hours prior to hospitalization.
- In case of any emergency hospitalization, it is important to inform TPA within 24 hours of the hospitalization.
- Fill in the cashless authorization form within 3 hours given by the TPA post checking your coverage. Your eligibility for the claim too would be verified. Attach your documents and send the form within 3 hours back to the TPA. The TPA would get in touch with you within 4 hours of your receipt of the documents in case of a deficiency
- Immediately make the payment of the non-medical charges and expenses which are not covered to the hospital prior to the discharge
- You would receive a rejection letter within 2 hours in case your ailment or treatment is not covered under the health insurance plan
Claim Procedure for Cashless facility (for Worldwide Emergency Hospitalization)
- Inform the service provider within 24 hours of hospitalization.
- Your eligibility as per the request made would be verified by the Service Provider and you will receive a call for more information or details, if required.
- The Service Provider will get in touch with the hospital immediately in case the pre-authorization request has been approved or denied.
- In case of approval of the pre-authorization request, your bill will be settled directly with the hospital by the service provider.
- Any additional charges approved by the service provider would be paid by the insured
Claim Procedure for Reimbursement
- The claim form duly filled and signed needs to be sent to the Royal Sundaram Health Insurance within 30 days from the date of discharge
- In case of any discrepancy in the documents/information submitted by you, you will receive a deficiency letter within 7 days from the date of receipt of the documents from Royal Sundaram Health Insurance
- If there is no deficiency of the received documents, Royal Sundaram Health Insurance would make the payment of your admissible amount within 30 days as per the policy terms and conditions
- The payment will be made in the name of the proposer.
- You need to send across the Claim documents to:
Health Claims Department , Royal Sundaram General Insurance Co Ltd, Vishranthi Melaram Towers, No.2/319, Rajiv Gandhi Salai (OMR) Karapakkam, Chennai – 600097
Claim Procedure for International Treatment for 11 specified Critical Illnesses
- The insured should immediately inform the service provider post diagnosis of a Specified Critical Illness. The same needs to be informed also before travelling overseas for the treatment. You may call on the helpline number specified in the Schedule of Insurance Certificate requesting for a pre-authorization for the treatment.
- Your eligibility as per the request made would be verified by the Service Provider and you will receive a call for more information or details, if required.
- The Service Provider will get in touch with the hospital immediately in case the pre-authorization request has been approved or denied.
- In case of approval of the pre-authorization request, your bill will be settled directly with the hospital by the service provider.
- Any additional charges approved by the service provider would be paid by the insured
In case of any emergencies, you need to inform Royal Sundaram 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.
Note: If you are a Coverfox customer, you can directly reach out to us for all your claim-related issues and queries.
