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Oriental Health Insurance Claim

The claim process of Oriental Health Insurance is quite smooth and simple. Oriental works with a reputable Third-Party Administrator (TPA) to provide claim settlement services. As a policyholder, you have the choice of having your claims settled via reimbursement or cashless options. We have discussed both methods below.

Cashless Claim Process For Oriental Health Insurance

Cashless claims are available if you receive treatment at a network hospital. The steps to file a cashless claim are as follows:

  1. Find A Network Hospital: Locate a network hospital in the city where you want to receive medical care.
  1. Intimate The Company: Whether it is an emergency hospitalization or planned hospitalization, you need to inform the company about it as soon as possible.
  1. Fill Pre-Authorization Form: Take pre-authorization from the hospital, fill it out, and then submit it to the hospital.
  1. Verify Your Identity: Now show your cashless card and one identity proof to the hospital for the verification process.
  1. Sending Pre-Authorization Form: Once your identity is verified, the network hospital will send your pre-authorization form to the TPA of the insurance company.
  1. Claim Settlement: Based on coverage and various other factors, the insurance company will either approve or disapprove the claim. If the company approves the claim, then your medical expenses will be directly settled by the company.

Reimbursement Claim Process For Oriental Health Insurance

In case you are unable to get cashless treatment, you can follow the below-mentioned steps for a reimbursement claim.

  1. Get Admission To Hospital: The very first step is to get admitted to either a network or a non-network hospital.
  1. Intimate The Company: Inform the insurance company about your hospitalization as soon as possible.
  1. Fill Out The Reimbursement Form: Now you need to fill out the reimbursement claim form of the company and submit it. You can either visit the branch office or you can download the claim form from the company’s official website.
  1. Pay Hospital Bills: After getting discharged from the hospital, pay all the bills.
  1. Submission Of Documents: Send all the necessary documents, including hospital bills and reports, along with the claim form to the TPA of the company.
  1. Investigation: Once you submit all the documents, the company will then investigate and verify each of your documents.
  1. Claim Settlement: When everything is correct, the insurance company will then settle the claim by reimbursing the amount to the registered bank account of the policyholder.

Details Required For Intimation Of Claim

In order to intimate the claim to Oriental Health Insurance company, you will require the following details:

  • Policy number
  • Name of the insured person
  • ID card number
  • Nature of disease/illness/injury
  • Name and address of the hospital, nursing home, etc.

Documents Needed For Oriental Health Insurance Claim

Below are some of the major documents that you need during the claim process of Oriental Health Insurance:

  • Duly filled and signed claim form
  • Medical reports
  • Hospital discharge summary
  • Investigation reports
  • Original copies of receipts and bills
  • Prescription copy
  • Original test reports
  • Valid ID proof
  • Copy of claim intimation

Points To Remember While Raising Oriental Health Insurance Claim

While initiating a claim against Oriental Health Insurance, you need to consider the following points:

  • The cashless facility is only available at network hospitals of the insurance company.
  • Non-medical and unreasonable expenses are not payable to the insurance holder.
  • For easier and faster claim settlement, NEFT and KYC details should be updated with the insurer.
  • Every claim should be informed and filed on time, as failure to do so may cause a delay in claim settlement.
  • Only once all essential and appropriate documents have been submitted will the claim be decided.

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