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Magma HDI Health Insurance Claim Settlement

When you opt for health insurance, you definitely check out how easy or difficult the application process is, the premium amount, the benefits on offer, the sum insured and other benefits. You might even read up a little more about the various riders and add one that you can get with your policy. But aren’t you forgetting something? All of those amazing benefits and that great deal on your premium, amounts to nothing if the insurer is not going to settle your claim. Additionally, if cashless hospitalisation is your goal, how do you plan to achieve it if the insurer does not have a hospital partner in your city or in your locality? 

Claim settlement ratio and hospital network as significant factors in insurer choice 

You must check the network of hospitals in your city before you sign up for health insurance, especially if cashless hospitalisation is your goal. That said, today insurance companies have made reimbursement claims as simple and effortless as cashless claims – the proofs list remains extensive because the insurer needs to evaluate the validity and honesty of your claim, but the process is now quick, easy and hassle free. 

Additionally, you must check the insurer’s claim settlement ratio, which tells you just how many claims they settle as against the number of claims that they receive. Insurers typically will not ever display a 100% claim settlement ratio because opportunistic parties often approach insurance companies with bogus or invalid claims and if the insurance company is not sifting through these, it could run into financial trouble and genuine policy holders could suffer as there is a chance of it running into losses and having to shut shop. 

With over 5000 empaneled hospitals across 16 Indian cities and a claim settlement ratio of over 95%, Magma HDI Health Insurance is definitely and option worth considering. Magma HDI claim settlement ratio of 95% is definitely way above average which means that there is a high chance of your claim being approved, provided of course it is a valid claim. 

Claim settlement process with Magma HDI Health Insurance

Option 1 Cashless hospitalisation claim

Benefits and considerations

Pros – minimal paperwork; you don’t need to pay; stress free hospitalisation without uncertainty 

Cons – need to coordinate with TPA department over and above catering to ill health; need to locate or travel to a network hospital; might not be available when TPA department is off duty 

Procedure 

Get hold of your health card and find a network hospital. Be sure to check the most updated list on the insurer’s website

Visit the network hospital that is closest to you or that has the specialists required for your treatment 

Fill up a form obtained at the TPA department that oversees insurance claims of patients 

The TPA a department will reach out to the insurer to get Magma HDI assurance claim pre authorisation completed 

Documents submission

You need to submit your form, photo ID and your policy number to the TPA department at the hospital 

Option 2 Reimbursement claim 

Benefits and considerations 

Pros – get admitted and begin treatment without waiting on response from insurance company 

Cons – need to pay the hospital upfront; uncertainty/ concerns about claim approval/ rejection; a lot of paperwork; need to gather and secure bills, receipts etc

Procedure 

Get hold of your health card and inform Magma HDI a health insurance of your hospitalisation 

Get your treatment underway and pay all bills but do be sure to maintain copies of bills and receipts and all the other paperwork (including diagnostic tests, prescriptions, diagnosis of doctors along with their certificates, surgery details if any) that comes up during your treatment 

Pay for your hospitalisation, that is settle all your dues and be sure to get a discharge certificate 

TIP – you could also be in touch with the insurance company before you pay your final bill to be certain that you have obtained all documents from the hospital

Fill up the application form to get your claim together

Attach all the documents you have gathered 

Submit your claim to the dedicated Magma HDI claim settlement team 

Documents submission

You need to submit all the below documents to Magma Health Insurance for evaluation: 

  • Diagnostic tests 
  • Prescriptions 
  • Bills and receipts from the hospital itself, the pharmacy, from physical, surgeons, specialists and consulting doctors
  • Doctors diagnosis certificate
  • Surgeons surgery details certificate 

Do note that this is a basic list and that the claim settlement team could request for others during the process of investigation. It is advisable to maintain originals and copies of everything not submitted to the insurer up until the time that your claim is settled. 

Do also keep your policy document and premium receipts handy. 

FAQs

The insurer is saying I should apply for a reimbursement claim after rejecting my cashless claim - why would the reimbursement claim get approved if the cashless claim is rejected? What is the difference?

There is a very small window and very limited information for the insurance company to pursue at the start of your hospitalisation and treatment. It is important to understand that the insurer has SOPs in place to safeguard itself from bogus or invalid claims and thus insufficient information might result in your cashless hospitalisation claim being rejected. However, as your treatment progresses there will be tests, prescriptions and doctor’s certificates to support your claim and prove the validity of it. Therefore the chances of your reimbursement claim being approved are much higher.

What incentive does the insurance company have to approve my claim? Isn’t it better for them if they reject most of the claims?

While it would certainly be very profitable for the insurance company to play that sort of game, it will not work in the long run. Today if the insurance company is to keep attracting customers it has to settle genuine health insurance claims. If not, it will have a very low claim settlement ratio and will start to lose market share.

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