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Documents Required for Making a Health Insurance Claim

Published On Feb 19, 2021 5:30 AM By Sakshi Aggarwal

Today, health insurance plans have become a must-have in order to keep oneself shielded against financial crisis at the time of medical emergencies. As important it is to have a health insurance plan, as important it is to know what documents are required while making a health insurance claim.

Sound knowledge of the right documents required at the time of a health insurance claim helps you complete the process in a hassle-free and peaceful manner.

Documents Required for Making a Health Insurance Claim

Health Insurance can be claimed through two modes, either it is a cashless mode or reimbursement mode, basis the hospital chosen by you for the treatment.

If you are admitted to a network hospital of the insurance company then you would get a cashless facility and if you are getting treatment from a non-network hospital of the insurance company then you have to fill a reimbursement form and submit the required documents with it to get the medical expenses reimbursed by the insurer later.

List of Documents Required For A Cashless Health Insurance Claim

1. Mediclaim Card: If you are opting for cashless mode then there are not many documentation requirements from your side, you would only require to submit your mediclaim card which has your policy related details on it such as policy number, policyholder name, etc and then the further process and documentation would be completed by hospital authority itself.

List of Documents Required For A Reimbursement Health Insurance Claim

Following documents are required if you are making a claim for the medical treatment availed at a hospital outside the partner network of your insurance provider -

1. Reimbursement Form: In order to claim health insurance, you need to fill a reimbursement form in the company's name and submit it with the other required documents.

2. Health Card: Health Card is provided to you by the company you are buying an Insurance policy from, it includes all the policy-related details such as policy number, policyholder name, etc. You would be asked to show your health Card and submit a copy of it along with other required documents while filing a claim for health insurance.

3. ID Proof: You can submit a copy of your Voter ID Card, Driving License, Aadhar Card, or Passport as your identification proof.

4. Pre-admission Medical test Reports and Doctors Consultation Papers: You are also required to submit Pre-admission medical tests and Doctors Consultation Papers, it acts as proof that the required treatment was consulted by the doctor and that expenses incurred are justified.

5. Discharge Summary from Hospital: Hospital provides you with a discharge summary document that includes information regarding admission and discharge of the patient. You are required to attach this document along with the Reimbursement form and other documents.

6. Hospitalisation Bills: It includes all the bills and expenses incurred while you were hospitalized, you are required to submit bills to evaluate the number of expenses incurred.

7. Diagnostics Tests and Reports: You are required to submit diagnostic tests and reports which justify the medical expenses.

8. Pharmacy Invoices: Medication expenses are also covered under Health Insurance, you are required to submit pharmacy invoices so that the company could evaluate expenses incurred on medication.

9. Medical-Legal Certificate: A MLC is a case of injury/illness where the attending doctor, after eliciting history and examining the patient, thinks that some investigation by law enforcement agencies is essential to establish and fix responsibility for the case in accordance with the law of the land. In case of accidents, you are required to submit MLC or FIR copy.&

10. Copy of KYC Documents: You are also required to fill and submit KYC documents to claim health Insurance through reimbursement mode.

Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.

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