When choosing a health insurance provider, it’s important to look beyond just the claim settlement ratio. While figures, like the claim settlement ratio of Go Digit General Insurance, can offer valuable insights, just the CSR alone cannot tell the whole story about the insurer. In moments of unexpected medical emergencies, the last thing anyone wants is the added stress of a denied claim. Healthcare costs can be overwhelming, and that's exactly why selecting an insurer with a solid, dependable track record can make all the difference. It’s not just about the numbers, it’s about peace of mind when you need it most.
In this article, we will examine Go Digit General Insurance Company's claim settlement ratio closely, what it actually means, and the insurance company’s key aspects when choosing the right health insurance policy. Whether you are looking for options for the first time or comparing policies between insurers, knowing this important factor can enable you to make a more informed decision for your health and safeguarding your finances.
What Is The Claim Settlement Ratio And How It Is Calculated?
The claim settlement ratio in health insurance indicates the proportion of claims an insurer settles in a particular financial year against the total number of claims received. It's an easy calculation:
Claim Settlement Ratio = (Total Number of Claims settled) / (Total Number of Claims received + Outstanding claims from the previous year) × 100
Most insurance providers refer to this number as a reflection of reliability. Although it's significant, it does not paint the whole picture. A high claim settlement ratio is good in theory, but other factors, such as the speed of claim settlement or whether they properly pay claims, are just as crucial.
Up next, we’ll take a closer look at Go Digit General Insurance Company’s claim settlement ratio and what sets it apart.
Go Digit General Insurance Company’s Key Features and Benefits
Go Digit General Insurance Company delivers innovative, customer-centric insurance solutions tailored to modern needs. They have various policies to choose from, such as motor, health, travel, home, and shop insurance, allowing individuals to access coverage that suits their requirements more conveniently.
Established in 2016 and based out of Bengaluru, India, the company is run by CEO and MD Jasleen Kohli. The insurance company has earned its reputation over time by aiming to make insurance simpler with lucid policies and smooth claims.
Let us see some of the most important features of Go Digit General Insurance Company -
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% of Complaints Received On Overall Claims
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% of Complaints Received For After-Sales Service
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Claims Settled In Less Than 30 Days
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No. of Cashless Hospitals
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Source: Go Digit General Insurance Company’s official website and public disclosures for the financial year 2023-2024.
Go Digit General Insurance Company’s Benefits:
Health insurance is a financial buffer when there are unforeseen medical bills. The greatest advantage? It pays for a significant portion of healthcare expenses, so you don't have to deplete your savings. From hospitalisation to medical procedures, a comprehensive health insurance policy not only covers a wide range of medical expenses but also offers additional benefits.
- Coverage for Inpatient Hospitalisation
Health insurance takes care of your hospitalisation expenses. A hospital stay of at least 24 hours is required to be regarded as inpatient treatment coverage. The plan takes care of most or all of the costs incurred, such as room fees, nursing service, medical lab tests, operations, and other charges related to the hospital stay.
- Pre- and Post-Hospitalisation Expenses Coverage
Health insurance isn't only for paying hospital bills, it also pays for medical charges prior to and after hospitalisation for some time. Pre-hospitalisation charges, such as diagnostic tests or doctor visits, are paid if they directly relate to the illness that caused hospitalisation and approved as a part of inpatient or daycare treatment. The same is true for post-hospitalisation charges, including follow-up procedures or medication, as long as they're for the same medical condition and fall within approved inpatient or daycare treatment in some cases.
- Coverage of Daycare Treatment
Due to the progress of medical technology, most procedures no longer need overnight hospital stays. Health insurance also covers daycare procedures, which means certain treatments that don’t require hospitalisation, such as gallbladder surgery, hernia repair, and chemotherapy are all covered without further financial burden.
- Coverage for Domiciliary Treatments
At times, medical treatment must be done at home, either because of a serious condition that renders trips to the hospital inadvisable or simply because there are no hospital beds. Under these circumstances, most health insurance policies intervene to fund the cost of domiciliary care so patients can receive essential medical treatment without having to leave their homes.
- Preventive Health Check-Ups
Prevention is better than a cure, and health insurance recognises that. Regular health check-ups are part of most policies, helping in the early detection of potential health problems. Regular screening can identify issues before they turn serious, enabling early treatment and improved long-term health.
- No Claim Bonus (NCB)
Health insurance rewards you for being healthy. If you don't make any claims during a policy year, insurers provide you with a No Claim Bonus (NCB). This may either enhance your sum insured or decrease your renewal premium. It inspires a healthier habit.
- Tax Benefits on Health Insurance
Health insurance can also help you save money with its tax benefits. The premium paid can be claimed as a tax deduction under Section 80D of the Income Tax Act if you qualify. The deduction amount depends on the family members covered under the policy, with additional benefits available if it includes senior citizens or dependent parents.
- Cashless Treatment Facility
One of the key advantages of health insurance is the facility of cashless treatment. In case you get treated at a network hospital, there is no need to worry about organising money in advance, the insurance firm directly settles the bill. This reduces the stress of medical emergencies, and you can concentrate on recovery rather than expenditure. But any additional charges that are not covered under the policy would have to be paid by you from your own pocket.
Health insurance is an essential safety net that helps cover medical bills. From paying for hospitalisation to preventive screenings, not only does it alleviate money worries, but it also has tax advantages and the possibility of additional coverage. It's a safety net against life's unexpected medical hiccups.
With that said, health insurance policies differ from one insurance provider to another. Terms, conditions, and coverages also differ from one to another, and it is always best to thoroughly read the policy documents. Furthermore, tax benefits are subject to prevailing tax regulations, which change over time. Being aware means you can derive the maximum benefits from your health insurance policy.
What Is The Go Digit General Insurance Company’s Claim Settlement Ratio?
As of March 2024, Go Digit General Insurance Company has a claim settlement ratio of 90.69%. (Source: Public Disclosure, FY 2023-24).
What Is The Claim Process Of Go Digit General Insurance Company?
Go Digit General Insurance provides two options for filing a health insurance claim, ensuring the process is easier for the individuals.
Cashless Claim
If you take treatment at network hospitals, then you can prefer a cashless claim. Being associated with those hospitals, Go Digit makes things easier for its customers. You don't need to make a payment in advance for expenses incurred. The payment will be settled by the insurance company directly to the hospital instead. You simply have to take care of non-covered expenses yourself.
Cashless Claim Process
Making a cashless claim through Go Digit General Insurance is very easy, but you need to take the right steps to save time. The following are the things you need to do:
- First, check that the hospital of your choice has a tie-up with Go Digit General Insurance Company and that the hospital accepts cashless facilities.
- Verify that your desired hospital is not among the excluded providers so that you can access cashless treatment without any complications.
- Check the terms and conditions of your health insurance policy to ascertain what will be covered and what out-of-pocket expenses you will have to incur. This will spare you surprises later.
- Collect your documents, such as a copy of your policy, the proposer's PAN and Aadhaar, patient identification, and any other documents needed for a cashless claim.
- Make your request for the claim within the specified timeline. In the case of planned hospitalisation, give the insurance company notice of at least three or four days. In case of an emergency, the request should be made within 24 hours of admission.
- Submit all necessary details and documents for the pre-authorisation process at the hospital's insurance counter. This typically comprises your health card, the proposer's KYC information (PAN, Aadhaar), the patient's identification, policy details, the treating doctor’s name and address information, etc.
- Be ready for potential delays in the pre-authorisation. In case of delay in approval, the hospital can request an advance deposit, which will be reimbursed after the claim is processed.
- Once your discharge date is confirmed, ensure the hospital’s insurance desk submits all necessary documents to your insurer.
- To prevent delays, keep yourself informed about the status of your claim and reply quickly to any requests for additional information or supporting documents from your insurer.
- To find out which expenses are insured and which you may need to pay yourself, read the final invoice and discharge report carefully.
- Before you are discharged from the hospital, make sure you have available funds to take care of any expenses not included in your coverage.
- You may freely call your insurance company or consult your financial advisor directly should you encounter any questions or issues at any time.
Reimbursement Claims
If you are treated by a hospital which is not affiliated with Go Digit General Insurance Company's network, you will be required to bear the cost of treatment yourself while receiving it. You may submit a reimbursement claim within 24 hours of hospitalisation to your insurer, which will pay you back the incurred expenses under your policy terms.
Reimbursement Claim Process
Follow these steps for the reimbursement claim process -
- Make sure that the hospital you select for treatment is not an excluded provider from your insurance policy.
- Inform your insurance company within 24 hours of hospitalisation to process reimbursement smoothly.
- Get all the original documents, such as bills, receipts, discharge summaries, medical reports, MRI/X-ray images, and prescriptions, before you leave the hospital. The claim form (a part of which should be filled by the hospital), so ensure you have that too.
- Ask for a duplicate of the patient's case sheet or indoor case papers, along with a detailed bill that segregates all medical costs in plain terms.
- Cross-check that the patient's name, age, and gender are properly stated in all the records. In case of any mistake, have it rectified prior to submitting your claim.
- Collect all documents in hand, including your health card, policy copy, proposer's KYC (PAN, Aadhaar, passport photograph), and bank details. Patient ID proof, signed claim form, original discharge summary, and certain bills or stickers in case of procedures such as knee replacements or cataract removal will also be required.
- Duplicate all documents in your personal record and keep them properly organised within a file and handy for instant access.
- Completely fill in the claim form and forward the same to your insurer with copies of all mandatory documents.
- Reconfirm with your insurance company if they have indeed received all the originals that you dispatched.
- Remain in contact with your insurer to track the status of your claim and follow up from time to time if needed.
- If your insurer needs further documents, submit them early in order to prevent delays.
- Carefully examine the claim settlement summary and ensure there are no deductions or discrepancies in the final payment.
- In case you have questions or issues, contact your insurer or speak with your financial advisor for guidance.
Documents Required For Go Digit General Insurance Company Claims
Getting a health insurance claim settled with Go Digit General Insurance Company may look like a task, but with the correct documents in hand, the process becomes easier. Whether you're making a cashless claim or a reimbursement claim, you will require the following documents:
For Cashless Claims:
- Health card issued by your insurance company
- KYC documents of the proposer, i.e., PAN card, Aadhaar card, and recent passport-size photographs
- Identity proof of the patient undergoing treatment
- KYC information of the insured person
- Policy number for verification
- Proposer's full name
- Full name and complete address of the person claiming the insurance
- Details of diagnosis, the disease or injury for which the person is undergoing treatment, and the medical procedure needed
- Address and contact of the doctor who is treating
- Date of proposed hospitalisation
- Medical history, such as existing conditions (related or unrelated to the current illness), as any discrepancy with the policy's original disclosures could result in the claim being rejected
For Reimbursement Claims:
- Health card or copy of the policy for reference
- KYC documents of the proposer, which include:
- PAN card
- Aadhaar card
- Current passport-size photo
- Bank details of the proposer, which can be either of the following:
- A bank statement containing the printed name of the bank, account number, and IFSC code
- A passbook containing the latest page of the transaction
- An original cancelled cheque having the name of the insured printed thereupon
- Identity proof of the patient availing of treatment
- A properly signed claim form (a part of which has to be filled by the hospital)
- All documents pertaining to the treatment, such as test reports, medical prescriptions, receipts, and films
- The original discharge summary from the hospital
- An IOL (Intra Ocular Lens) sticker and bill for implantation procedures, such as knee replacement or cataract surgery
Note: It is always best to reach out to Go Digit General Insurance Company to verify any extra document requirements or special formalities prior to lodging your claim.
How To Track Your Go Digit General Insurance Claim Status?
You can monitor your Go Digit General Insurance Company’s claim status by visiting their official website.
Alternatively, you can contact your claim status by dialling 1800-103-4448 and talking to a customer service executive. They will be glad to assist you with the procedure and answer your queries.
Conclusion
Go Digit General Insurance Company has a claim settlement ratio of 90.69% as of March 31, 2024. Whether you make a cashless or reimbursement claim, knowing what documents to present and the procedure involved can go a long way in making it easier. With the constantly changing landscape of health insurance, having a trusted insurer provides you with the assurance that you and your family are safe from financial shocks due to unplanned medical expenses.
FAQs
The Go Digit General Insurance Company claim settlement ratio as of March 2024 is 90.69%. (Source: Public Disclosure FY-2023-24)
The insurance company will process and either settle or reject a claim within 15 to 30 days from the date of intimation, provided all necessary documents are received. However, the exact timeline may vary based on the nature and complexity of the claim. Go Digit General Insurance Company has settled 80.76% of claims in less than 30 days in FY 2023-24. (Source: Public Disclosure FY-2023-24).
While making a claim for health insurance from Go Digit General Insurance Company, the forms you require shall vary based on the nature of the claim. For cashless claims, a health card, KYC documents, policy documents, claim form and medical details would typically be required. In case you are submitting a reimbursement claim, you would mostly require a duly filled claim form, a copy of the policy document, hospital invoices, a discharge summary, medical reports, and cancelled cheques. Remember that there are particular requirements, so it's always wise to inquire with the insurer for precise information.
Go Digit General Insurance Company's health insurance plans do cover pre-existing diseases, but only after a specified waiting period, which may vary depending on the chosen plan. Depending upon the plan, the waiting period can be a maximum of up to 3 years. It is always better to review the policy details thoroughly to learn the precise terms and conditions.
Having an effective policy doesn't guarantee your claim will be approved. Claims may still be rejected if they don't satisfy the terms and conditions of the policy. A few of the most common reasons for claims rejections are treatments covered under exclusions, failure to undergo the waiting period, absence of required documentation, or not adhering to the guidelines of the insurer.
Tracking your health insurance claim with Go Digit is easy. You can check the status through their official website, mobile app, or by contacting their customer care helpline. You may also visit the nearest branch if you prefer in-person assistance. Additionally, insurers often send claim updates via SMS or email to keep you informed.
Some of the determinants of the claim settlement ratio are the overall number of received and settled claims, efficiency and promptness of processing, completeness and correctness of submitted documentation, and admissibility of claims as per the policy's terms and conditions.
A high claim settlement ratio can be a good sign of the trustworthiness of an insurer in settling claims. But it doesn't promise that your claim will be settled. Every claim is settled on an individual basis depending on the terms of the policy, the exclusions, and the correctness of the documents submitted.
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