Star Health Claim Settlement Ratio (CSR): Claim Process & Required Documents

Star Health Claim Settlement Ratio: Star Health Insurance has over 10,000 network hospitals across India, allowing for convenient cashless claims. Simply inform them before planned procedures or within 24 hours of emergencies, and the hospital will handle all of the paperwork. For out-of-network situations or planned treatments without cashless options, Star Health Insurance offers reimbursement claims. Collect bills, reports, and discharge summaries after treatment, and submit the claim form online or at their office.

What Is A Claim Settlement Ratio?

A claim settlement ratio (CSR) is a metric used in the insurance industry in India to indicate the percentage of claims an insurance company approves and pays out to the total number of claims it receives. 

Calculation: Claim Settlement Ratio (CSR) = (Total number of claims settled in a year / Total number of claims in a year) x 100

For example: If an insurance company receives 10,000 claims in a year and settles 9,500 of them, the CSR would be 95% (9,500/10,000 x 100).

If you are considering to buy a health insurance plan from Star Health, know its claim settlement ratio to understand how effectively it processes claims. This information can also indicate the company's proficiency in settling claims.

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Star Health Claim Settlement Ratio Of Last 5 Years

In the below table, we have mentioned Star Health Insurance Claim Settlement Ratio of last 5 years from 2018 to 2023.

Disclaimer: We have took the data from the internet, so it can vary.

Claim Process For Star Health Insurance Plans

Star Health Insurance offers a simple and efficient claim process for their best health insurance plans. Once a claim is submitted, it goes through a quick verification process and is settled quickly. Their customer service team is available to assist with any queries or concerns regarding the claim process. You can avail cashless & reimbursement claim & the process is mentioned below.

1. Cashless Claim Settlement Process

Here is a detailed step-by-step guide for the cashless claim settlement process for Star Health Insurance Plans.

• Network Hospital: Ensure that you are getting treatment at a hospital that is within Star Health's network of hospitals. The cashless facility is only available at these network hospitals.

• Inform Hospital: Upon arrival at the hospital, inform the staff at the insurance desk that you are covered by Star Health Insurance. Show them your health identity card issued by Star Health Insurance.

• Pre-authorization Form: You can download the pre-authorization form from the official website of Star Health Insurance. Fill out this form with accurate details related to your medical condition, treatment required, and estimated expenses.

• Form Submission: Submit the filled pre-authorization form to the hospital's insurance desk. They will forward it to Star Health Insurance for further processing.

• Verification Process: Star Health Insurance will verify the details provided in the pre-authorization form. This may involve confirmation of coverage, medical necessity of the treatment, and estimated costs.

• Field Doctor Visit (if required): In some cases, Star Health may assign a field doctor to visit you at the hospital to check your medical condition and treatment needs. This step helps in ensuring the accuracy of the claim and the appropriateness of the treatment.

• Claim Approval: Upon successful verification and acceptance of the claim, Star Health Insurance will provide approval for the cashless treatment facility. This means that you can proceed with your treatment without paying upfront for covered expenses.

• Cashless Treatment: With the claim approved, you can avail yourself of cashless treatment at the hospital. All the medical bills incurred during the treatment will be directly settled by Star Health Insurance, subject to the terms and conditions of your policy.

2. Reimbursement Claim Settlement Process

Here is a detailed step-by-step guide for the reimbursement claim settlement process for Star Health Insurance Plans.

• Contact the Company: If you've received treatment at a non-network hospital or if your cashless claim has been rejected, you need to contact Star Health Insurance within 24 hours of hospitalization. This is to initiate the reimbursement claim process.

• Avail Treatment and Settle Bills: Receive the necessary treatment and settle all bills directly with the hospital. Ensure you collect all original bills and documents related to the treatment.

• File a Claim for Reimbursement: After settling the bills, you need to file a claim for reimbursement. Fill out the claim form provided by Star Health Insurance and submit it along with the required documents. These documents include hospital bills, pharmacy bills, and any other relevant treatment documents.

• Submission Deadline: It's important to submit all the required documents, including the claim form and original treatment documents, to Star Health Insurance within 15 days of discharge from the hospital.

• Claim Verification and Processing: Star Health Insurance will verify all the submitted information and documents. They will process the claim accordingly. You may receive confirmation of the claim processing via a phone call or email.

• Receiving Reimbursement: If your claim is approved, Star Health Insurance will reimburse the eligible amount. The reimbursement will be credited to your registered bank account.

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Documents Required For Star Health Insurance Claim

When filing a claim for Star Health Insurance, certain documents are required for smooth processing. These include the claim form, medical bills, discharge summary, doctor's prescriptions, diagnostic reports, policy documents, identity proof, etc. 

• Completed Claim Form: Ensure that all necessary details such as present address, contact number, and email ID are filled out accurately on the claim form.

• Original Bills and Receipts: Collect original bills, receipts, and discharge certificate/card from the hospital where you received treatment. These documents should detail the services rendered and the expenses incurred.

• Prescription and Pharmacy Bills: Include original bills from chemists along with proper original prescriptions for medications prescribed during the treatment.

• Investigation Test Reports: Provide receipts and investigation test reports from a pathologist, supported by a note from the attending medical practitioner or surgeon prescribing the tests.

• Details of Surgery: If surgery was performed, include details regarding the nature of the operation, surgeon's bill, and receipt.

• Accident Cases: In case of accidents, include a self-declaration, Medico-Legal Certificate (MLC), or First Information Report (FIR) as applicable.

• Treating Doctor's Certificate: Get a certificate from the treating doctor detailing the diagnosis, treatment provided, and any other relevant medical information.

• NEFT and KYC Details: Provide details for NEFT (National Electronic Funds Transfer) along with necessary Know Your Customer (KYC) documents for the reimbursement to be transferred to your bank account.

• Other Documents Requested by the Company: Depending on the nature of the claim and specific requirements, Star Health Insurance may request additional documents for claim processing.

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Conclusion

In conclusion, Star Health claim settlement ratio is higher which indicates their commitment to resolving claims efficiently. The claim process is streamlined and customer-friendly, making it easier for policyholders to navigate. The required documents for claim processing are clearly mentioned, ensuring that the necessary information is provided. For any assistance, you can contact “Our Experts”.