Aditya Birla Health Insurance Claim Settlement Ratio 2025

Choosing the right health insurance provider does not just include analysing the claim settlement ratio. While metrics like the Aditya Birla Health Insurance Company’s Claim Settlement Ratio matter, it is much more than numbers. If unforeseen medical complications occur, the last thing one would want is claim rejections. Medical emergencies are often unforeseen and do cost a fortune. This is why having a provider with a proven track record may provide peace of mind in such circumstances.

In this article, we will analyse Aditya Birla Health Insurance Company’s Claim Settlement Ratio and discuss its key aspects. Even if you are looking for coverage options or comparing plans among insurers, understanding the claim experience of Aditya Birla can impact your decision-making. This helps you to opt for the ideal plan to serve your financial well-being.

What Is The Claim Settlement Ratio And How It Is Calculated?

The health insurance claim settlement ratio indicates the percentage of claims that an insurer successfully processes against the total number of claims received within a particular year. This attribute may seem trivial, but it offers a glimpse into an insurer’s efficiency. You can determine it by the following formula:

Claim Settlement Ratio = (Total claims settled) / (Total claims received + Outstanding claims from the previous year) × 100

This, and many other metrics of claim settlement and customer experience, are what make sure that an insurer can be referred to as reliable. While this ratio is often touted as an indicator of an insurer’s credibility, it should not be regarded as the final determinant.

Further, we will examine in detail the derivation of the claim-settlement ratio, followed by an analysis of Aditya Birla Health Insurance Company's performance and other aspects you need to consider for making an informed choice.

Aditya Birla Health Insurance Company’s Key Features and Benefits

Aditya Birla Group, along with the South African MMI Holdings, has launched Aditya Birla Health Insurance Company Limited (ABHICL) as a joint venture that focuses on health insurance plans. The organisation was founded in 2015 and is headquartered in Mumbai, Maharashtra. Chronic Care and Incentivized Wellness are among the most notable innovative offerings in their catalogue. Mr. Mayank Bathwal serves as the Managing Director and Chief Executive Officer of the company.

Highlights of Aditya Birla Health Insurance Company include the following -

Source: Aditya Birla Health Insurance Company’s official website and public disclosures for the financial year 2023-24.

Aditya Birla Health Insurance Company’s Benefits:

A health insurance plan serves as a financial protection when unforeseen medical expenses crop up. It helps in taking care of huge healthcare bills, keeping you from exhausting your savings. From hospitalisation to treatments, it provides comprehensive coverage together with other benefits, including:

1. Coverage for Inpatient Hospitalisation
   Health insurance covers your hospitalisation costs. For inpatient coverage, a hospital stay for a minimum of 24 hours is required. The coverage includes room rent, nursing charges, medical investigations, the cost of surgery, and other hospital-related expenses.
    
2. Coverage of Pre- and Post-Hospitalisation Expenses
   Health insurance doesn't only pay for hospitalisation, it also covers medical charges made prior to and subsequent to hospitalisation for a certain time. Pre-hospitalisation charges are covered if they have a direct association with the illness for which hospitalisation is sought and are eligible under inpatient coverage. To be eligible for coverage, post-hospitalisation charges also need to be associated with the same illness and fall under the same approved inpatient category.
    
3. Coverage for Daycare Treatments
   With advances in medical technology, most procedures no longer need overnight hospital stays. Daycare treatments are covered by health insurance policies, providing financial assistance for prompt medical interventions such as gallbladder surgery, hernia repairs, and chemotherapy.
    
4. Health Insurance Coverage for Home-Based Treatments
   Domiciliary treatment is clinical care delivered within the home in cases where there is no space for hospital admission because of the condition of the patient or insufficiency in hospital beds. Most health policies cover these interventions, thus affording medical access in the homes of individuals requiring it.
    
5. Insurance coverage for Preventive Health Check-Ups
   Most health insurance policies have free health check-ups, encouraging preventive care. Routine tests and screenings detect possible health problems early, and this encourages proactive management of overall health.
    
6. Rewards for No-Claim History
   Health insurance policies provide a no claim bonus to insureds who do not make any claims in the policy year. The no claim bonus is provided as an extra sum insured amount or reduced renewal premium for the following year, inspiring a healthier habit.
    
7. Tax Benefits on Premium Payments
   Health insurance offers financial benefits over and above medical bills. Premiums you pay are eligible for income tax deduction under Section 80D of the Income Tax Act, but under certain conditions. The amount of deduction depends upon the insured individuals, with added benefits to senior citizens and dependent parents.
    
8. Hassle-Free Cashless Treatment
   One of the most important advantages of health insurance is access to cashless hospitalisation. The medical bills are paid directly by the insurer, without any need for upfront payments. This aspect is particularly useful in times of emergencies, reducing financial burdens while leaving the insured person with only non-covered expenses to pay.

Health insurance is very important in covering healthcare costs. It includes hospitalisation to routine check-ups, provides tax relief, and permits further coverage. It serves as a financial protector in dealing with unexpected medical expenses.

Note:  Health insurance plans differ from one provider to another in terms of coverage, conditions, and terms. One needs to go through the policy documents carefully to comprehend the inclusions and exclusions. Tax benefits are also subject to existing tax legislation and may fluctuate from time to time.

What Is The Aditya Birla Health Insurance Company’s Claim Settlement Ratio?

The claim settlement ratio of Aditya Birla Health Insurance Company as of March 2024 is 94.51%. (Source: Public Disclosure, FY-2023-24).

What Is The Claim Process Of Aditya Birla Health Insurance?

Cashless Claim

This option is used when treatment is obtained at a network hospital that is associated with the insurer. The insurance company pays the medical bills directly to the hospital, covering qualified expenses. The insured only pays for costs not covered under the health insurance.

Cashless Claim Process

Prior to making a cashless claim, it's vital to comply with the following steps:

• Find out whether the hospital you have selected for treatment accepts cashless services from your insurance company, and also check if they're not on the exclusion list.
• Check the policy document of health insurance to discover terms and conditions that may translate into out-of-pocket payments.
• Collect necessary documents like your policy document, PAN, proposer's Aadhaar, patient identification, medical reports, etc.
• Verify if the hospital needs any extra documents prior to starting the cashless claim process.
• Make your claim request at least 3–4 days prior to planned hospitalisation and within 24 hours in case of emergency hospitalisation.
• Share the pre-authorisation documents with the hospital, such as your health card, KYC details (PAN, Aadhaar), patient ID, policy details, etc.
• Follow up with the hospital or insurer if pre-authorisation approval is delayed and be ready to pay an advance deposit if necessary.
• Ensure that all documents required are obtained from the insurance desk of the hospital prior to finalising the discharge date.
• Remain available to answer any questions from the insurer and provide additional documents in a timely manner if asked.
• Check the status of your claim on a regular basis to prevent delays.
• Carefully check the final bill and discharge summary to determine uncovered charges and any remaining charges.
• Contact your insurer or financial advisor if you are unsure or have any problems along the way.
• Ensure that all payments for uncovered charges are planned for prior to discharge.
• Save copies of all claim-related documents for future reference in case of discrepancies.

Reimbursement Claims

If you are treated in a non-network hospital, you have to pay the hospital bills and medical charges yourself. Subsequently, you can make a claim for reimbursement with your insurance company, which will reimburse the amount that is eligible according to the terms and conditions of your policy.

Reimbursement Claim Process

In order to file a claim for reimbursement successfully, take the following steps:

• Make sure the hospital you go to is not on the list of excluded or blacklisted healthcare providers.
• Report your hospitalisation to your insurance company within 24 hours of checking in.
• Collect all original documents prior to discharge, such as receipts, invoices, discharge summaries, medical reports, MRI/X-ray images, prescriptions from your doctors, and the hospital-filled claim form.
• Take a photocopy of the patient's case sheet or indoor case papers and a breakdown of the hospital bill indicating all the costs incurred.
• Check if the name, gender, and age of the patient are appropriately stated in all the documents and correct them, if necessary.
• Keep handy critical documents like health card, policy document, proposer's KYC (PAN, Aadhaar, passport photo), bank account details, patient ID proof, signed claim form, original discharge summary, and IOL sticker/invoice for implant claims (for example, knee replacement, cataract, etc).
• Keep duplicate copies of all documents for your reference and arrange them in a folder.
• Complete the claim form and send it to your insurer, accompanied by the necessary documents.
• Your insurer should acknowledge the receipt of all original documents.
• Regularly contact your insurer to monitor the status of your claim after submission.
• Send any further documents promptly if the insurer asks for them.
• Gently check the settlement summary of the claim, carefully observing any deductions taken.
• Consult your insurer or financial advisor in case of any queries or questions regarding the claim.

Documents Required For Aditya Birla Health Insurance Claims

Making a health insurance claim with Aditya Birla General Insurance Company can feel like a chore, but having documents on hand makes the process much easier. The following documents will usually be required:

For Cashless Claims:

• Health card issued by the insurance company
• KYC documents of the proposer, such as PAN card, Aadhaar card, and passport-size photographs taken recently
• Identity proof of the patient undergoing treatment
• KYC information of the insured person
• Policy number for verification purposes
• Full name and address of the person making the claim
• Information about the illness or injury, along with the details of treatment or surgery
• Address and contact details of the treating doctor
• Date of hospitalisation
• Medical history, both related and unrelated to the current condition, because discrepancies with primary policy disclosures will result in the rejection of the claim

For Reimbursement Claims:

• Health card or insurance policy copy
• The proposer's KYC documents, such as:
  • PAN card
  • Aadhaar card
  • Recent passport photograph
• Bank details proof, such as:
  • The printed name of the bank, account number, and IFSC code on the bank statement
  • Passbook with the recent transaction page
  • Original cancelled cheque with printed name of the insured
• Patient's identity proof
• Signed claim form (a part of which has to be filled by the hospital)
• All medical documents relevant to the case, including test reports, prescriptions, imaging films, and treatment-related receipts
• Original discharge summary from the hospital
• IOL (Intra Ocular Lens) sticker and bill for implant-related claims, like cataract or knee replacement

Note: One should verify with Aditya Birla Health Insurance Company for any additional documents or requirements.

How To Track Your Aditya Birla Health Insurance Claim Status?

To track the status of your Aditya Birla Health Insurance claim, use this link. Just input your claim number, complete the captcha, and press 'Submit' to access real-time status of your claim. Otherwise, dial 1800-270-7000 to contact a customer service representative. Tell them you wish to track your claim, and they will assist you accordingly.

To Conclude

Aditya Birla Health Insurance Company's claim settlement ratio as of March 31, 2024, is 94.51%. A cashless or reimbursement claim will proceed more quickly if you understand how it operates and have the necessary paperwork available. You and your loved ones will be financially secure and worry-free during unforeseen medical events if you choose a reputable provider in the ever-evolving world of health insurance.

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