HDFC ERGO Health Insurance Claim Settlement

The claim settlement ratio for HDFC Ergo Health Insurance is calculated by dividing the total claims paid within 30 days by the total number of claims paid. The following are the Claim Settlement Ratios for the preceding five years:

When choosing a health insurance company, it is critical to analyze the company's claim settlement ratio (CSR), which is a solid insurance indicator. CSR enables you to assess the company's ability to pay claims, which is critical for you and your loved ones. There are two primary reasons why CSR is important:

1. Assists in evaluating insurance companies: When purchasing an insurance policy, consider the insurer's Claim Settlement Ratio (CSR). CSR is a statistic that can help you decide if an insurer is right for you or not. Before making a purchase, examine the CSR of various firms to determine which one has the highest ratio. An insurer's claim settlement ratio increases the likelihood that you will get a claim if you need to file one.

If you need to file a claim from HDFC Ergo Health Insurance, please follow the process mentioned below:-

How To File a Claim

Step 1:- Initiation

When you schedule a medical appointment or have an emergency, contact InsuranceDekho or HDFC Ergo Health Insurance customer service right away.

• You can contact HDFC Ergo Customer Support at care@hdfcergo.com or phone the HDFC Ergo Health Insurance customer support team at their toll-free number, 022 6234 6234.[2]

• To contact an InsuranceDekho representative, please call 7551196989 or send an email to support@insurancedekho.com.[3]

Step 2:- Verification

When you submit your documents to HDFC Ergo Health Insurance, the claims team will review them thoroughly. If all of your information is correct, your claim will be processed.

Step 3:- Tracking

You can contact HDFC Ergo Health Insurance customer support to follow up on your claim. To receive frequent updates, you can also contact a customer service specialist at InsuranceDekho

To submit a claim for HDFC Ergo Health Insurance, you must fill out two areas of information. The separated information is listed below:

Furthermore, the following information is also necessary:

1. Duly filled claim form

2. Discharge or daycare summary

3. Final hospital bill

4. Payment receipts

5. Investigation report

6. Pharmacy bills

7. Implant invoice

8. Doctor Prescriptions

9. Consultation Papers

10. Age Proof

11. Indoor Case Paper

12. Copy of canceled cheque

13. KYC Form

HDFC Ergo Insurance has partnered with over 13,000 healthcare establishments and helps the insured get cashless services there. Notification of scheduled procedures at non-network hospitals must be sent to HDFC Ergo Insurance 48 hours in advance, or within 48 hours of the patient's admission to the hospital in the event of an emergency. Notably, authorization for cashless care at non-network hospitals is subject to completing the requirements mentioned in your HDFC Ergo Insurance policy and the hospital's agreements.

Furthermore, the steps to take in the event of cashless or reimbursement claims are mentioned below:

Cashless Claims

• Go to the nearest HDFC Ergo network hospital.

• Contact the front desk to talk with the TPA, or third-party administrator.

• TPA will fill up and submit your application to HDFC Ergo Insurance on your behalf.

• If everything is permitted, the claim executive will review the reports and handle the claim.

• You can start receiving therapy at the hospital as soon as you have approval.

• Your insurer and the hospital will settle the bill immediately following treatment.

Reimbursement Claims

• Notify HDFC Ergo Insurance of your hospital stay (within 48 hours of an emergency, or 48 hours in advance if planned).

• Pay your hospital bills in full and submit all relevant documents.

• Fill out and send in a claim form.

• Await the insurer's approval and status report.

Keep in mind that you must:

• Submit all documents, including your claim form, within 15 days following release.

• Save all fully signed papers for submission to guarantee a smooth claim process.

Follow the steps outlined below to check the status of your HDFC Ergo Health claim both online and offline:

Online

• Visit HDFC Ergo Insurance’s official website.

• Select the “Claim” option.

According to the Insurance Regulatory and Development Authority of India (IRDAI), an insurer normally settles a claim 30 days after receiving money or filing claim documentation.

Tips to Get Your Claim Settlement Faster

To speed up the settlement of your claims, keep the following in mind:

• Develop a deeper grasp of your policy.

• Send only full documents.

• Keep a note of any correspondence with your insurance provider.

• Maintain an active policy.

• Examine each document carefully.

• Consult an attorney if necessary.

To seek claim assistance and support from HDFC Ergo Health Insurance:[2]

• Call toll-free at 022 6234 6234

[1]https://www.hdfcergo.com/

[2]https://www.hdfcergo.com/customer-care-new