The health insurance claims settlement ratio in the world of the medical insurance sector will always allow the individuals to understand how the insurer will handle the claim process whenever it will be required on the behalf of the insured. Having a very consistent health claim settlement ratio is considered to be a very good idea and indicator of the ability of the company to settle out the claims received and the best part is that this is one of the most important features which every company should possess in the world of insurance. On the behalf of individuals, it is very much important to check out the health insurance claim settlement ratio of the company before finalizing the deal with any of the companies about insurance policy so that they never have to face any kind of hassle at the time of filing the claims. The companies which come with more than 90% of this particular ratio is a very good point and when the claims and element pattern will be consistent it will make sure that the company will be highly trusted in the whole world among the Indian Insurance customers.
The ideal settlement of this particular ratio will help in making sure that healthcare insurance providers will be very much successful in terms of fulfilling the overall purposes and the people should go with that particular company which comes with more than 80% of this ratio so that overall goals are efficiently achieved. The health claim ratio will help in reflecting the reliability, financial health, efficiency and great value products and this particular ratio has been determined with a specific formula which has been explained as follows:
The health claim settlement ratio is equal to total claims settled/total number of reported claims minus pending claims at the start of the year and minus pending claims at the end of the year which is the fiscal year.
There are various companies like Care health insurance that come with the best possible smooth claim settlement procedures for all the individuals so that every plan has been perfectly available for them. Some of the common will be plans from the house of this company include senior citizen plans, Corona virus healthcare plan, Arogya Sanjeevani plan, critical illness plan, family floater plan and several kinds of things and the best part is that every plan comes with best possible claim settlement ratio. In all such cases, the policyholders can even avail the cashless hospitalisation in more than 700 hospitals across more than 500 cities in India and the easy online mode of payment premium is also very easily possible so that people can enjoy the best possible procedures. These kinds of cashless claims can even be submitted and settled out without any kind of hassle of submitting the medical bills and the discharge summary but the only requirement to be taken care of is that individuals have to get the treatment done from a network Hospital of the policy only so that they can file the cashless claim request with the insurer with the steps mentioned as follows:
- At the very beginning of the process, it is important to intimate about the claim and for this purpose the customers can call the customer care team within 48 hours of a planned hospitalisation and 24 hours of emergency hospitalisation.
- After this, the pre-authorisation process has to be initiated and for this purpose, the customers need to submit the form of the pre-authorisation at the insurance desk of the hospital so that things can be initiated.
- After this, they need to process a request for the pre-authorisation because the in-house medical insurance team will help in reviewing the whole process and documents so that claim can be accepted or rejected depending upon the situation.
On the other hand in the traditional process of reimbursement treatment the steps are mentioned as follows:
- The basic steps will be the same and for the very basic purpose, the individuals need to inform the support within 24 hours of the emergency and 48 hours in the cases of planned hospitalisation.
- Then people need to initiate the claim procedure along with several kinds of documents that need to be submitted.
- After this claim Processing will be undertaken that will help in coming up with the final result of rejection or acceptance.
There are several kinds of documents to be taken into consideration in the whole process which included usually find and signed claim form copy, original ID proof of the people, description of the doctors, recipient and bill, letter of Dr about mentioning of consultation, medication and test, Indore case papers, medical test and reports, police FIR if applicable, medical test, original post mortem report if applicable and several other kinds of things depending upon the scenario. Hence, depending upon Care insurance in this particular industry the Care insurance is a very good idea to avail several kinds of advantages in the long run.