Claim Process - Oriental Insurance

  1. Intimation
  2. Availing Treatment
  3. Compilation / Submission of Claim File

How to intimate health claim with Oriental Insurance

Planned Treatment - At least 48 Hrs prior to hospitalization
Emergency Treatment - Within 24 Hrs of hospitalization
E-Mail
csd@orientalinsurance.co.in or TPA
Nearest Branch

Details required for Registration/ Intimation of Claim

To Register claim by calling on above contact point, you will need to provide the following information to the customer support executive:-
  • Policy Number
  • ID card no
  • Name of insured person
  • Nature of disease / illness / injury and Name and Address of the attending medical practitioner / Hospital/Nursing Home etc
Once the claim is registered, the customer support executive will provide you with a Claim Reference/Intimation Number.

Points to Remember

  •  Every claim should be intimated & should be submitted within time, as non adherence can lead to delay in claim settlement.
  •  The claim is decisioned only when all required & necessary documents are submitted.
  • NEFT & KYC details should be updated with the Insurer for easier & faster claim settlement.
  • Pre hospitalization expenses may be claimed along with main hospitalization expenses.
  • Unreasonable & Non medical expenses are not payable.
  •  Every claim should be intimated & should be submitted within time, as non adherence can lead to delay in claim settlement.
  •  The claim is decisioned only when all required & necessary documents are submitted.
  • NEFT & KYC details should be updated with the Insurer for easier & faster claim settlement.
  • Pre hospitalization expenses may be claimed along with main hospitalization expenses.
  • Unreasonable & Non medical expenses are not payable.

 

The claim file has to be submitted at the below mentioned addresses within 7 days of discharge

 

The claim file has to be submitted at the below mentioned addresses within 7 days of discharge
Courier Address
TPA mailing address or issuance branch office




List of Documents

  • Original bills, receipts and discharge certificate / card from the hospital.
  • Medical history of the patient recorded by the Hospital.
  • Original Cash-memo from the hospital (s) / chemist (s) supported by proper prescription.Original receipt, pathological and other test reports from a pathologist / radiologist including film etc supported by the note from attending medical practitioner / surgeon demanding such tests.
  • Attending Consultants’ / Anesthetists’ / Specialists’ certificates regarding diagnosis and bill / receipts etc. in original.
  • Surgeons’ original certificate stating diagnosis and nature of operation performed along with bills / receipts etc.
  • Any other information required by TPA / the Company
  • TPA such additional information and assistance as the Company / TPA may require in dealing with the claim.

Process of Claim

01
The treatment is to be intimated within prescribed timelines.
02
Post completion of treatment, documents are to be collected from hospital during discharge.
03
The claim file is to be prepared with reference to check list. (The claim form part B is to be filled by hospital)
06
Post receiving of all required info, the claim will be processed within 30 days.
05
Apollo will inform about any deficiency within 7 days.
04
Duly filled claim forms along with all necessary documents are to be submitted within prescribed timelines.
07
If the claim is approved, amount will be transferred within 30 days.
08
If the claim is rejected, letter with details are to be shared with Insured.
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