Oriental Health Insurance Claim Settlement Ratio

The claim settlement ratio (CSR) indicates the percentage of claims an insurance company settles out of the total claims received. A higher CSR suggests better chances of your claim being settled, providing insight into the health insurance company's reliability when you need to make a claim.

Every year, the Insurance Regulatory and Development Authority (IRDAI) releases the claim settlement ratios for all insurers. Oriental Health Insurance's claim settlement ratio is 95.49%.

Why Is Claim Settlement Ratio Important?

When buying an insurance policy, it's crucial to consider various aspects, including policy features, coverage, and customer reviews. However, many people overlook the claim settlement ratio, which is a significant mistake. Here are two key reasons why checking the CSR is important:

1. Measure the insurer’s reliability

Buying a policy is a significant investment. You pay premiums over a long duration to avail of its benefits. If your claim is rejected in the future, it can seriously impact your financial planning. The claim settlement ratio is a reliable indicator of an insurer's trustworthiness. A favorable ratio suggests a reliable insurer.

2. Ensures your dependent’s financial future

Checking the claim settlement ratio is important for ensuring your family's financial security. The last thing any family needs after losing a family member is the rejection of an insurance claim. As a policyholder, it is your responsibility to ensure your family does not face such difficulties. The settlement ratio helps you make an informed decision when buying a policy.

Types Of Oriental Health Insurance Claims

There are two types of health insurance claims you can choose:

• Cashless Claim
• Reimbursement Claim

Cashless Claims

Cashless claims in health insurance allow the policyholder to receive treatment without upfront payment, as the bills are settled directly between the hospital and the insurance company. Oriental Health Insurance's cashless claim settlement helps pay hospital bills instantly and upfront. Cashless claims are gaining popularity due to the convenience they offer.

Oriental Health Insurance Cashless Claim Procedure

If you are undergoing treatment at a network hospital, you can avail cashless claims. The steps to file cashless claims are given below:

1. Find a network hospital in the city where you can avail medical treatment.
2. Inform Oriental Insurance Company in case of an emergency or before hospital admission for planned hospitalization.
3. Show your cashless health card and a photo ID at the network hospital.
4. Get the pre-authorization form from the hospital, fill it, and submit it to the hospital authority.
5. The hospital then cross-checks the customer’s identity and sends a pre-authorization form to Oriental Health Insurance Company or its TPA.
6. The insurer or the third-party administrator checks and approves the coverage. If the health insurance claim is approved, Oriental Health Insurance Company will cover the medical expenses.

Reimbursement Claims

With reimbursement claims, you can visit any hospital, not just those in your insurer's cashless network. Here, you pay for your treatment upfront and then apply for reimbursement from your insurer. To make a claim, the customer needs to submit all hospital bills, prescriptions, and medical documents. These documents will need to be approved by Oriental Health Insurance Company before the claim is processed, which may take slightly more time.

Oriental Health Insurance Reimbursement Claim Procedure

Reimbursement claims can be filed in both network and non-network hospitals. You can follow the reimbursement claim process as given below:

1. Upon admission to any network or non-network hospital, inform Oriental Insurance Company about the hospitalization as soon as possible.
2. You can get a reimbursement claim form from the insurer or download it from the Oriental Insurance Company website.
3. Provide the required details when filling out the form.
4. Upon discharge, pay the hospital bills and collect all original bills, documents, and reports.
5. Sign all documents and send them to Oriental Health Insurance Company along with the claim form. If all information is correct, Oriental Health Insurance Company will settle the claim as per the policy terms and conditions. The payment will be made to the policyholder’s bank account.