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We all know the importance of having an active health insurance in place. With a health insurance policy, you and your family members are safe from the financial burden of hefty medical expenses.
Regardless of the caution taken, health issues can arise anytime. Hence, you cannot wholly rely on a life insurance policy alone. Security of your financial future is way beyond that. Therefore, not only do you require health insurance plans, but you also need to know the claim process.
This article explains everything you need to know about the health insurance claim process.
What is a Health Insurance Claim?
Due to the rise in the healthcare cover, more and more people are looking for appropriate health insurance plans. But if you do not have any understanding of the health insurance claim, the most suitable policy becomes useless.
A health insurance claim is nothing but a request you raise for reimbursement or direct payment of medical services obtained. In simple words, when you make a claim, your insurance provider will either reimburse the medical expenses incurred or pay directly for the said costs.
Types of Health Insurance Claims
Following are the type of health insurance claims in India-
Cashless Claims
Many up and coming insurance companies offer you cashless benefits in their respective network hospitals. To avail cashless claims, you will have to contact a network hospital and follow the claim procedures as mentioned in your policy paperwork.
Reimbursement Claims
Instead of cashless claims, many insurance providers provide reimbursement claims. This claim can be utilised when you are not seeking treatment in one of the network hospitals.
In such a situation, you have to submit all the relevant documents and bills of the hospital and treatment availed by you. After this, the reimbursement claim process is initiated. Your policy document will give you a detailed understanding of the claim process and materials required to be submitted for process initiation.
Personal Accident Claims
This claim covers you for mishaps like accidental deaths, permanent total disability, and permanent partial disability. It will cover the ambulance and hospital expenses up to a specified limit.
Global Personal Guard
The global personal guard, much like personal accident claims, will financially cover you against death, permanent total disability, and permanent partial disability. However, a claim for the underlying expenses has to be made by submitting certain documents to your insurance provider.
Non-Medical Expenses List
Every insurance provider has a specific list of expenses that it does not cover under the policy terms. Some of these include baby food, cosmetics, band-aids, and health drinks.
How to Make a Health Insurance Claim?
Every insurance provider follows a necessary procedure that enables a hassle-free claim process. Refer the following for raising successful claims.
For Cashless Settlement
In case you are making a cashless claim, follow these pointers –
In case of planned hospitalization, inform your insurance provider at least 1-2 days in advance
In case of emergency, your insurance provider should be notified within 24 hours
The network hospitals have a dedicated TPA (Third Party Administrator) assistance. They will help you with all the necessary documentation and formalities.
Submit the required documents like health card, doctor’s report, and so on with the TPA
Once your insurance company received these documents, they are verified against your health insurance policy coverage and terms
If the raised request is well within the coverage, approval is sent to the hospital for the specified amount. In case the treatment amount exceeds the approved amount, then the hospital can request for re-approval
If the raised request is denied, you will be asked to pay from your pocket and later raise another request for reimbursement
For Reimbursement
When making a reimbursement claim, follow the steps below –
Much like cashless settlement, informing your insurance provider is necessary even during the reimbursement claim process.
After the necessary medical treatment, you will have to submit the documents with your insurance company. The documents to be submitted include –
Duly filled claim form
Discharge summary signed by the concerned doctor/hospital
Medical bills along with the related prescriptions
Depending on the pre-hospitalization cover clause in your policy, you will have to submit the OPD expense bills
Copy of canceled cheque
Any other related document
After verification of the filed documents, your insurance provider will either accept/deny your claim request based on your policy terms and coverage
If the claim is accepted, the said amount will be disbursed along with the Claim Settlement Letter
If the claim is denied for valid reasons, the Claim Rejection Letter will be sent with the stated reasons
Documents Required for Health Insurance Claim Submission
Health insurance card or health card issued by the insurer
Consultation documents certified by the doctor
Duly filled claim application form
Investigation and diagnosis reports
Medico Legal Certificate and/or FIR (in case of accident)
Pharmacy bills along with the prescriptions
Discharge papers
Any other relevant document
Tips To Remember When Filing Health Insurance Claims
When making a claim, make sure that you are informing your insurance provided within 24 hours of hospitalization
Upon receiving the policy paperwork, carefully go through the terms and conditions related to your chosen plan including the claim settlement process
Every insurance provider follows specific time frames. Make sure you are well-versed with it to avoid any further issues
Understand what is covered and excluded in your health insurance.
Share a copy of the policy document, health card, and contact details of the insurance provider with your family members and friends. Also, keep them updated on the process to follow in case of emergencies
Check the waiting period for claiming on your insurance plan
Lastly, make sure you maintain a file of your policy paperwork, medical bills, incurred treatments, and prescriptions for easy availability
To Conclude
Being knowledgeable regarding the health insurance claim process is essential. It is highly advisable to choose an insurance provider that enables an easy claim process and helps you through the entire procedure.
Are you looking for health insurance?
Head over to our website or download our insurance app to get touch with us at Finserv MARKETS. With our Health Insurance plans, you can benefit from features like easy claim settlement, reinstatement benefit, bespoke insurance coverage, and more.
So, apply for Health Insurance with us today!
“Finserv MARKETS, a subsidiary of Bajaj Finserv, is a one-stop digital marketplace that has been created for consumers on the go. It offers 500+ financial and lifestyle products, all at one place. At Finserv MARKETS, we understand that every individual is different. And that’s why we have invested in creating a proposition – Offers You Value. A value proposition that ensures you get offers which are tailor made for you. We also offer an amazing product range and unique set of online offers across Loans, Insurance, Investment, Payments and an exclusive EMI store. Be it in helping you achieve your financial life goals or offering you the latest gadgets, we strive to offer what you are looking for. From simple and fast loan application processes to seamless and hassle-free claim-settlements, from no cost EMIs to 4 hours product delivery, we work towards fulfilling all your personal and financial needs. What’s more! Now enjoy the same benefits in just one click with our Finserv MARKETS App”.
