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Occasional Contributor
Niraj
Posts: 5
Registered: ‎13-10-2021

Claim Settlement Amount

We have registered a claim under Health Suraksha policy and amount received is less then claim amount, why has co-pay deducted?

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Accepted Solutions
Occasional Contributor
Dr Shilpa
Posts: 6
Registered: ‎04-10-2021
Solution

Re: Claim Settlement Amount

There could be 2 reasons for co-pay deduction in your policy:

1. If you have opted for co-payment at the time of issuance / renewal of the policy. This information is available on the policy Schedule or

2. The city where you were hospitalized maybe different from your city of residence.

If you belong to Tier 1b ,then copay is applicable if treatment is availed in Tier 1a

If your city of residence falls under Tier 2 and treatment was undergone in Tier 1a or Tier 1b, then copay is deducted.

The Tier type is as per your city of residence, details of which should be available in the policy Schedule.

You may refer policy terms and conditions for Tier distribution of regions.

View solution in original post

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Occasional Contributor
Dr Shilpa
Posts: 6
Registered: ‎04-10-2021
Solution

Re: Claim Settlement Amount

There could be 2 reasons for co-pay deduction in your policy:

1. If you have opted for co-payment at the time of issuance / renewal of the policy. This information is available on the policy Schedule or

2. The city where you were hospitalized maybe different from your city of residence.

If you belong to Tier 1b ,then copay is applicable if treatment is availed in Tier 1a

If your city of residence falls under Tier 2 and treatment was undergone in Tier 1a or Tier 1b, then copay is deducted.

The Tier type is as per your city of residence, details of which should be available in the policy Schedule.

You may refer policy terms and conditions for Tier distribution of regions.

View solution in original post