Aditya Birla Claim Settlement Ratio
  • Explore the CSR process of Aditya Health
  • Know the significance of a good CSR
  • Claim Filing procedure
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Aditya Birla Claim Settlement Ratio

Buying Health Insurance without knowing the company's performance can cause problems during medical emergencies. One such factor that you should always check at the time of buying Health Insurance is its Claim Settlement Ratio (CSR). Why? Because what's the need for a health insurance plan if your health insurance company is unable to settle your claims on time.

Didn't understand? Well, read along to explore more about the Claim Settlement Ratio and its significance.

Health Insurance Claim Settlement Ratio

What is a Claim Settlement Ratio?

The claim settlement ratio or CSR is the percentage of claims that have been paid by an insurance company. In other words, it is the percentage of claims paid out by an insurer during a financial year. The ratio compares the number of claims filed to the number of claims settled.

Health Claim Settlement ratio a number of claims settled/number of claims received * 100

Claim Settlement Ratio of Aditya Birla Health Insurance Company

As per IRDAI, Aditya Birla health insurance Claim Ratio is 94%. Take a look at the below given table that will let you get an insight into the ability of Aditya Birla Claim Settlement.

Status of Aditya Birla Health Insurance Claim Settlement ratio- 2020-21
Age Analysis of Number of Claims Paid (%) < 3 months3 months to 6 months6 months to <1 year1 year to <3 year3 years to <5 years5 years
Claims Settled94 0.210.060.000.000.00

How is a CSR Beneficial to Policyholders?

Before purchasing any new goods, we investigate their dependability as well as the brand's reputation. The same is true when purchasing health insurance. Checking the company's claim settlement ratio might provide insight into how the company is functioning in terms of claiming settlement.

It will also provide you with information about the company's capacity to settle claims. The higher the claim settling ratio, the more capable the firm is of settling claims.

Buying a Health plan from a company that possesses a decent claim settlement ratio helps you and your family at the time of announced medical emergencies.

Let's understand this with a simple example:

Mr Arora bought health insurance, but at the time of his wife's surgery his health insurance company delayed the claim settlement process, which resulted in distress among the family members.

With the above example, it is imperative to check the claim settlement ratio of your chosen company. If you have decided to buy health insurance from Aditya Birla, do not forget to check the claim settlement ratio of aditya birla health insurance and compare it with other top isurers.

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Types of Aditya Birla Health Insurance Claims

There are two types of health insurance claims you can choose from at your own convenience:

  • Cashless Claim
  • Reimbursement Claim

Let us take a look at both types of claim filing processes:

Cashless Claim

  • To avail of the cashless facility, you need to get admitted to any of the network hospitals of Aditya Health Insurance company.
  • At the network hospital, show the cashless card of Aditya Birla Capital Health Insurance and valid ID proof like a Passport, PAN Card, Voting card, etc.
  • Once the identification is done, the network hospital will send the cashless hospitalization request form to the company.**
  • The company will review the form. After completion of the formalities, the decision will be forwarded to you through SMS and E-mail.
  • Once approved, the payment will be made to the network hospital.

** For planned hospitalization, the form needs to be submitted 3 days in advance. For emergency cases, it needs to be submitted within 48 hours after hospitalization.

Reimbursement Claim

If you are admitted to a non-network hospital, you have to pay the hospital directly after the treatment is done.

1. To file a claim, submit the documents to Aditya Birla within 15 days of discharge:

The documents required are:

  • Claim form (Part A & B)
  • Health card
  • KYC documents
  • Original discharge summary
  • Hospital bills
  • The invoice with payment receipt
  • All consultation papers
  • Others

2. After reviewing the documents, Aditya Birla will take the appropriate decision and if approved, the amount will be reimbursed through NEFT to the registered bank account.

**You need to inform the company within 48 hours (in case of emergency hospitalization) and 3 days before your admission (for planned hospitalization).

How can I track my Aditya Birla Claim Status?

To check the claim status of your Aditya Birla Health Insurance policy, follow the below steps:

  • Visit the official website of Aditya Birla Health Insurance Company.
  • Click on the 'Claims' section, and from the drop-down menu select "Check Claim Status", and then click on Track Claims.
  • On the next page, fill in your credentials, and log in.
  • Once done, you can then easily see the status of your claim on the page.

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