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Claim Procedure for Royal Sundaram Alliance General Insurance Company Ltd.

Procedure for Cashless Claims
Cashless claims facility is available only with the network hospitals. The list of network hospitals is also available in the policy kit. Under this facility you will have to sign the bills at the time of your discharge and the company shall settle the amount directly with the hospital. You can contact the Third Party Administrator through the helpline numbers given below, immediately on admission by quoting your Membership number shown on your health card. A. 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 TPA is 24 HOURS AFTER RECEIPT OF ALL DOCUMENTS B. Planned Admission: - Select a hospital from the list of network hospitals for treatment - Intimate 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 Claims: 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 [email protected] 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 dispatched 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
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