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Aditya Birla Health Insurance Claim

Aditya Birla Capital Health Insurance Company is very popular among the customers as the company has come up with a wide range of customer-friendly and transparent health insurance products with various variants to cater to the varied needs of the individuals. Once you opt for a health insurance plan, your responsibility does not end there, rather it is the beginning, as we buy health plans so that it can stay beside us by providing us financial security whenever we need that. For that, it is very important to know the claim procedure of that particular insurer as the process may differ from one insurer to another. So, for your better understanding, here, all the required details related to the Aditya Birla Health Insurance Claim procedure have been discussed so that you can find all the information in one go.

Claim Process of Aditya Birla Health Insurance

The company has offered its consumers both types of health insurance claim procedures, namely Cashless and Reimbursement Process so that the customers can choose any of these according to their convenience. The details of both the procedures are given below.

Cashless Procedure:

If you prefer to avail of the cashless claim process, you need to get admitted to one of the network hospitals of the company and follow the below steps as stated here.

  • As soon as the incident happens, you need to inform the insurer about the same. This is the first and crucial step. For planned hospitalization, you need to intimate the company 3 days before the hospitalization and for emergency hospitalization, intimate the insurer within 48 hours of the occurrence. You can intimate the insurer by visiting the official website of Aditya Birla Capital Health Insurance and logging in to your portal or you can download the Active Health App. You can contact them via WhatsApp or can call the company using the toll-free number 1800-270-7000. Else, you can also directly write to them at care.healthinsurance@adityabirlacapital.com to raise your claim.
  • Once you reach the hospital, you need to show and submit your Aditya Birla Health Insurance Policy Cashless Card. Or, you can also show your policy number at the hospital desk. Along with that, you also need to submit any valid photo identity proof such as voter card, pan card, password, etc.
  • After that, from the insurance desk of the chosen network hospital, get the pre-authorization request form. You can also download it from the official website of the company. Then, submit the duly filled and signed form to the hospital and they will send the form to Aditya Birla Health Insurance.
  •  Once the company received all the required documents, it will evaluate and assess the documents in accordance with the terms and conditions of the policy. If any extra document is required, the company will communicate the same.
  • Once the evaluation and review process is done, and it is fair and transparent, your claim amount will be settled directly to the hospital by the insurer.
  • If any discrepancy is found, your claim will be rejected and the same will be communicated to you stating the reason(s).

Reimbursement Procedure:

If you prefer to avail of reimbursement claim procedure, you can choose any hospital of your convenience. In that case, it is not mandatory to get admitted to a network hospital of the insurer. Follow the below easy steps to enjoy a smooth reimbursement claim process.

  • You need to inform the insurer 3 days prior to the hospitalization for planned hospitalization and within 48 hours for emergency hospitalization. You can choose any of the methods for raising a claim as stated in the Cashless Procedure section.
  • Once admitted to the hospital, receive the required treatments and pay all the bills directly to the hospital. At the tie of discharge, get the discharge certificate too, and preserve all the documents for future reference.
  • Within 15 days of the discharge from the hospital, send all the necessary documents to the headquarter of Aditya Birla Health Insurance or any of the nearest branches of the company in its original form. The list of required documents is available on their official website.
  • Once the company receives all the required documents, your claim will be initiated and your documents will be reviewed and evaluated by the company according to the terms and conditions of the policy.
  • If your claim is fair and justified, the claim amount will be sent to your registered bank account. But if any discrepancy is found, your claim will be rejected, and the same will be communicated to you stating the reason(s).

What Is Cashless OPD in Aditya Birla Health Insurance?

The Cashless OPD is a unique feature offered by Aditya Birla Capital Health Insurance and it is a part of the Chronic Management Programme of the company. This benefit is only available for the Activ Health Platinum Enhance Plan and Activ Health Platinum Essential Plan. This benefit helps the customers to avail of the opportunity of cashless payments for outpatient expenses such as lab tests, medicines, and doctor consultations. One can avail of the facility in the healthcare network of the company such as diagnostic centres, pharmacies, and outpatient clinics.

How Can You Check Cashless Hospitals For Aditya Birla Health Insurance?

As stated before, for availing of the cashless facility, it is important to receive the medical treatments from any of the network hospitals of the insurer, your next responsibility is to find out a cashless hospital or healthcare center within your vicinity. For your better understanding, here is the detailed process of how you can find the same easily.

  • Go to the official website of the Aditya Birla Capital Health Insurance and click on the Claim tab available at the top of the homepage.
  • Then, select the Cashless Hospital Network option from the options available on the left-hand side.
  • Choose the city name according to your preference. After that, select any of the options of your choice such as Hospitals, Pharmacy, Gym Centers, and Diagnostic Centers.
  • Then, click on the Search option. Your job is done. All the network hospitals or healthcare centers will appear on the screen within your vicinity.

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