What is restoration benefit in health insurance?
Restoration benefit in health insurance - Importance, types and points to note before claim.
July 11, 2022
Claim settlement ratio (2019-20)
Total GHI lives insured (2020-21)
Total GHI claims incurred (2020-21)
Rs 108 Crores
Royal Sundaram General Insurance Co. Limited was formerly known as Royal Sundaram Alliance Insurance Company Limited. It is the first private sector general insurance company in India licensed in October 2000 by the Insurance Regulatory and Development Authority of India.
Royal Sundaram Insurance provides innovative general insurance solutions to all kinds of groups and individuals. These groups include families as well as businesses. Some of the insurance solutions offered by Royal Sundaram include motor, health, personal accident, home and travel Insurance etc. They also provide specialised insurance products in fire, marine, engineering, liability and business interruption risks to commercial customers.
With Pazcare, your Royal Sundaram group health insurance experience gets even better. We will be able to get the best group health insurance quotes at the best prices for you. We provide an employer dashboard to manage group health insurance that can also be integrated with the HRMS tools.
These simple steps allow you to purchase Royal Sundaram group health insurance online at Pazcare.
For further information, write to us at email@example.com or call our customer care at +91 78291 11300. You can also connect with us on Whatsapp using this number - +91 81973 79596.
The Royal Sundaram group health insurance has 3 plans. They are
The group health policy covers hospitalisation expenses of the insured person incurred at the hospitals for treatment of diseases, illness, medical conditions or injury. However, it is mandatory that the treatment has to be undergone during the policy period up to the sum insured.
To make protection against Corona Virus more comprehensive and protect people from monetary losses, Royal Sundaram has come up with Covid Secure. This product is not a substitute for a baseline indemnity product and has special terms and conditions associated with it.
Arogya Sanjeevani Policy (Royal Sundaram General Insurance Co. Ltd) is a standard health insurance policy that can be purchased individually or on a floater basis for your family. It is a standard health insurance product offered by all insurance companies mandated by the Insurance Regulatory and Development Authority of India (IRDAI). It helps in removing ambiguity in different products by different insurance companies and bringing in uniformity in features and structure of the health insurance product.
A health insurance claim settlement ratio (CSR) is the ratio between the number of claims settled to the number of claims made or requested in a financial year by the health insurance company.
CSR ratio is calculated as
Step 1: Intimate third party administrator (TPA).
Intimate Third party administrator (TPA) in the case of network hospital, on admission for the third-party administrator (TPA), has to be intimated through the Helpline Number before 3 days of admission.
Step 2: Quote your health card membership
Please quote your health card Membership number through the toll-free no. 1860 258 0000.
Step 3: Fill cashless request form
The cashless request form is available at the hospital insurance help desk. The form is to be filled out. Get this form certified by the concerned doctor
Step 4: Fax the cashless request form
The form has to be faxed by the hospital to the TPA's fax number along with the supporting documents. After scrutinizing the documents, the TPA conveys the decision to the hospital. For additional documents, cashless requests or calls are made.
Step 5: Settle any remaining charges due to inadmissible expenses
The hospital bills will be settled directly on the approval of the cashless facility by TPA (subject to policy limits). Some of the inadmissible expenses including telephone charges, food, attendant charges etc, has to be paid by you. In case cashless is not approved by TPA, the bill has to be settled with the hospital and applied accordingly. The Turn around time for approving cashless decisions by the TPA is 24 hours commencing the receipt of all the documents.
Step 1: Know the reimbursement facility
A reimbursement facility is available at network hospitals as well as non-network hospitals.
Step 2: File a claim
After availing of treatment and settling all the bills with the hospital, a claim has to be filed for reimbursement.
Step 3: Intimate Royal Sundaram
On admission not later than 7 days from the date of discharge, intimate Royal Sundaram through toll-free number 1800 345 88 99 (OR) email to firstname.lastname@example.org immediately.
Step 4: Download the claim form
Please quote your Policy certificate number and the claim form can be downloaded from the website directly.
Step 5: Submit claim documents
Submit all the claim documents to the company within 30 days from the date of
Every health insurance company have a list of network hospitals(or cashless hospitals), where cashless treatment can be claimed. Larger the list of network hospitals, the higher the chances of finding a cashless network hospital near your location. Royal Sundaram group health insurance has around 5000+ network hospitals located pan India. This makes sure that you can get high-quality treatment near your location and you will be able to file for a cashless claim.
The Royal Sundaram group health insurance can be renewed easily with Pazcare at end of your policy term. Here are the steps to renew your Royal Sundaram group health insurance plan.
Step 1: Get in touch with Pazcare. Submit a form containing details like name, name of the company, number of employees you wish to insure, work email address and phone number.
Step 2: Once you submit the form, our consultants will contact you. You will have to submit the following documents as this is not a fresh policy.
Step 3: One can select additional add-ons to the existing policy for e.g. maternity insurance riders, dental insurance riders to your existing policy. Furthermore, with Pazcare one can choose additional health and wellness add-ons to your Royal Sundaram group health insurance. These add-ons include unlimited doctor consultations, comprehensive check-ups, therapy and wellness sessions etc.
Step 4: Our consultants will get back to you with the competitive quotes for your Royal Sundaram group health insurance. Based on your claims report and the add-ons you choose, your health insurance premium may vary from the previous financial year.
Step 5: The next step is to agree to the terms and conditions of the policy and pay the premium for your Royal Sundaram group health insurance policy. The policy will be usually valid for a year after the renewal.
Step 6: In case, you are purchasing your Royal Sundaram group health insurance for the first time with Pazcare, the onboarding process will be carried out in 24 hours. During this time, you will be contacted by our associate and will be provided with all the essential information on how to get started with your group health insurance.
We make sure that your Royal Sundaram group health insurance experience will be seamless using our Pazcare dashboard. Using Pazcare’s employee app, your employees can access their policy. Pazcare’s employee app is available on both the play store and the app store.
The Royal Sundaram group health insurance premium is directly proportional to the risks involved. The premium for your group health insurance policy is also calculated based on certain factors, which are -
The average age of the people insured determines the premium calculation. The older the age, the higher the premium. This is because the younger generation poses lesser health risks.
Type of plan opted
Different types of group health insurance policies opted are employee only (E), employee+spouse+children (ESC) and employee+spouse+children+parents (ESCP) plans. The number of people covered under the ESCP plan is higher than the ones covered in the E plan. Hence, the higher the scope of coverage, the higher will be the premium.
Nature of the job
In deciding the annual premium, the nature of the job the person insured performs is also considered a factor. Jobs associated with more risks will have a higher premium compared to the lower-risk jobs. For e.g, the group health insurance premiums will be higher for employees working in a factory than the ones working in the IT sector.
Sum insured is the maximum amount that an insurance company will pay you in case of any hospitalisation in a particular year. In case the hospital expenses cross the sum insured, the policyholder will have to bear the additional expense. So the higher the sum insured, the higher the premiums paid towards the group health insurance policy.
The add-ons opted for say, maternity insurance riders, dental insurance riders along with the existing group health insurance policy will increase your group health insurance premium. With the type of add-ons opted for, the premium varies.
If the number of claims raised exceeds the previous financial year, then during the policy renewal, the premium will increase.
For instance, let a company named ABC wants to renew their Royal Sundaram group health insurance policy for 2022. The premiums paid by them for 2021 were ₹40,000. If the number of claims raised during 2021 is higher than that of 2020, then the premiums for 2022 will be greater than ₹40,000.
Your group health insurance policy is tailor-made to suit your preferences. Here is what your Royal Sundaram group health insurance covers.
All your pre-existing diseases
The Royal Sundaram group health insurance policy covers all your pre-existing diseases from diabetes, cancer, asthma, etc from day 1 of your policy coverage. Hence, there is no waiting period to cover these diseases.
Pre and post-hospitalisation expenses
With Royal Sundaram group health insurance cover your pre and post-hospitalisation expenses. This depends on the terms of your policy usually ranging between a period of 30 to 60 days.
You can cover the maternity-related expenses for normal and c-section delivery, by opting for a maternity insurance rider.
Covid -19 cover
The group health insurance policy covers all hospitalisation expenses related to Covid-19.
Accidental hospitalisations coverage
In case of any hospitalisation expenses due to accidents, your group health insurance policy covers these medical expenses. These hospitalisations must be for more than 24 hours and coverage is limited to India only.
Following are some exclusions that you should be aware of in your Royal Sundaram health insurance -
Certain diseases like hernia, cataract, sinusitis, piles etc are not included during the first year of insurance coverage. Any claim arising out of or traceable to pregnancy is also excluded from the Royal Sundaram group health insurance policy.
Ayurvedic, Homoeopathy, Naturopathy or any other form of local medication are not covered by the Royal Sundaram group health insurance policy.
Treatments for substance abuse
A treatment for alcoholism, drug abuse and AIDS are not covered under the policy.
Dental treatment or surgery, unless requiring hospitalisation are excluded from the policy. The cost of spectacles, contact lenses and hearing aids are also not covered under the group health insurance policy.
Coverage for hospitalisation
In case of accidents or illness, employees are covered for all in-patient hospitalisation expenses covered under the policy. The coverage ranges up to the amount of the sum insured that you choose. However, the stay has to be for more than 48 hours in the hospital.
Expenses on Pre and post hospitalisation
Expenses incurred 30 days before hospitalisation and expenses incurred 60 days after hospitalisation can be claimed.
Outpatient treatment expenses are also covered in some instances such as kidney stone removal, tonsillectomy, eye surgery and D & C etc.
Hospital cash allowance
This plan also provides a daily fixed compensation during the time of hospitalisation.
In case of emergency hospitalisation, intimation is needed within 48 hours to carry out the claims.
Pre-authorization form is to be filled up and submitted to the hospital’s insurance/TPA desk after which the request is initiated.
If the request is approved, the claim is settled immediately. In case the request is not approved, you can claim reimbursement.
Intimate the TPA or insurance company 48 hours prior to hospitalisation in case of planned hospitalisation.
Submit the claim form. The claim form has to be accompanied by relevant documents such as hospital bills, doctor’s reports, diagnostic tests, etc.
Once the request for reimbursement of claims is approved, your expenses will be settled.
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Why buy a group health insurance
policy online from Pazcare?
For any queries or assistance, reach out to us at any time. We provide 24X7 customer assistance.
Royal Sundaram has an alliance with EUROP ASSISTANCE INDIA PRIVATE LIMITED as their Third Party Administrators (TPA) to help you with a speedy and convenient claims process and assist you 24x7 without fail.
You can check the Royal Sundaram claim status through the claim intimation hotline 18005689999.
For further queries, please contact 18604250000 or 18602580000.
Email to email@example.com.
By the Mobile App m-Chatra.
Through the website or visit your nearest branch.
The policyholder can cancel the policy at any time. A notice has to be written and submitted under a certificate of posting or a regd.
Visit https://www.royalsundaram.in/. Select “INSTA RENEW.” After inputting your Policy number and expiry date, view your policy details and Premium amount.
Step 1: Visit The Website. Visit https://www.royalsundaram.in/.
Step 2: Choose the Renewal Option.
Step 3: Enter Required Details.
Step 4: View the policy details and premium.
Step 5: Make Payment.
Step 6: Receive Confirmation.