How to File a Claim with Apollo Munich Health Insurance?

Apollo Munich- One of the top most health insurance companies of India, which is not only providing a wide range of healthcare products for customer but also serve a hassle free claim process to get the competitive edge in the market. Apollo Munich deals in two types of claims- Cashless claims for either planned or emergency visits, and reimbursement claims where policyholders can ask for refund of cash already spent for hospitalization and other charges.

Apollo Munich carries a wide list of network hospitals where a person can get the cashless hospitalization benefits. Whenever a policyholder is going to file a claim, it is always advisable that they should keep a copy of the documents that they have submitted towards the claim.

Incurred Claim ratio of Apollo Munich Health Insurance:

ICR or Incurred claim ratio is basically the amount or the value of claims paid by the company and divided by the total sum of premiums collected by that company for a specific period of time.

Claim Procedure:

Policyholders can go for cashless claims. At Apollo Munich, the claim process is really easily and same for almost all policies along with slight differences.

The following claim procedure highlights the necessary steps required to file the claim.

Cashless Claim:

The best thing about the cashless claim settlement procedure is that under the same, a person need not settle the bill themselves. Under the same, a TPA will take care of all the payments related to the hospital bills and treatment charges. However, the procedure related to cashless emergency claims and cashless planned claims vary.

Cashless Claims Procedure for Emergency Admission:

There is no doubt in saying that the emergency hospitals visits are a matter of concern and stress related to associated funds, insurance claims will only add to it. At the time of admission a person should make sure that it is a network hospital or not, otherwise cashless claim would not take place. Lfit is a network hospital, and then the following procedure needs to be followed.

Inform the Apollo Munich about the hospitalization within 24 hours. You must reach out to the desk of hospital and fill the forms related to cashless claim and share the same with the Apollo Munich for a cashless claim. It is important for the claim to be certified by the attending doctor.

The hospital authority will send the insurance claim themselves or can fax it to Apollo Munich.

After that, the TPA will check the documents submitted. If additional documents are required, the TPA will ask for it. If the claim got approval from TPA, then the hospital bills and all expenses will get cover under the effective health insurance plan(Why Health Insurance Is Must For You?). If the claim got rejected, then the bills need to be settled by policyholder and later he/she can ask for reimbursement.

Cashless Claims Procedure for Planned Admission:

If the policyholder is going to take a treatment in a network hospital and wants to avail the cashless benefit then he/she requires following the planned cashless claim procedure which is as follows:

Choose the hospital from the wide list of network hospitals. Inform the company about the same at least 48 hours before the hospitalization. For the same, the policyholder have to submit a few details such as policy number. You can inform the company by dialing toll free number 1800-102-0333.

The policyholder have to fill the cashless request form and can faxed the same to the company. Attached the form along with a certification from the doctor and medical records. Apollo Munich will check the submitted documents and send their decision to the hospital.

In a few cases, the company can also ask for a few additional documents. If the claim got approve then the Apollo Munich will take care of the same. In case of rejection, the bills have to be cleared by the policyholder and later on he/she can ask for reimbursement.

Reimbursement of Treatment Expenses:

In case where the cashless claims face rejection, the bills will get clear by the policyholder and Later on he/she can file for the reimbursement of expenses. Cashless claims get rejected because of less supporting documents or because the hospital is not the in the network list of Apollo Munich. The following procedure needs to be followed to make reimbursement claims:

You will have to inform Apollo Munich about the hospitalization in a specific time period.

You will have to intimate Apollo Munich on admission or treatment within a stipulated time frame. More often than not the sooner one intimates the insurance provider, the better the chances of getting approved.

Claims Process:

The team of claim process will review all documents and ask for additional if required. For the additional documents you will get the time of 7 days for submission

If the claim is acceptable, the cheque will be dispatched within 30 days

If the claim is not acceptable you will get a rejection letter along with the reasons for rejection.