How To Claim Health Insurance?
Updated On May 01, 2021
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In the case of health insurance, a claim is made at the time of medical emergency or admission of a policyholder in hospital or any other health care institution. It covers all the hospital expenses, bills paid and post and pre-hospitalisation expenses to the extent of the sum assured and the plan’s coverage.
There are two ways to claim health insurance. Either you can make a cashless claim or go for a reimbursement claim depending upon the type of hospital opted for the required medical treatment.
If the hospital you are getting treatment in is not the member of the network of hospitals of the insurance company then, they would not provide a cashless facility and you would have to pay the hospital expenses from your pocket. But after discharge you can claim the insurance from the company and the company would send the compensation amount to you.
The insurance companies have a network of hospitals in which they provide cashless facilities. That means at the time of hospitalisation you need not to pay anything from your pocket and the hospital expenses will directly be covered by the insurance company. It may cover the hospitalisation and treatment expenses but no post or pre hospitalisation expenses would be covered.
A claim is settled in a reimbursement manner when the insured gets the treatment at a non-network hospital of the insurance provider.
A claim is settled in a cashless manner when the policyholder gets the treatment at a network hospital of the insurance provider.
Steps To Claim Insurance Through Cashless Mode
You can claim insurance through Cashless mode within 24 hours easily by just providing required details to the hospital. These are the steps involved in cashless insurance claim.
Step 1: Contact Your Insurance Provider
Hospitals have separate mediclaim departments,you have to contact them and provide your policy related details.
Step 2: Share Your Policy Details
You need to provide your policy card which has details such as policy number, policy holder name etc.
Step 3: Complete TPA Formalities
After that the hospital will contact the company through TPA (third party administrator) and will share the details.
Step 4: Claim Settlement
Then within 24 hours the company will analyse details regarding the claim and will approve it.
Steps To Claim Insurance Through Reimbursement Mode
You need to contact the insurance company directly or TPA to claim reimbursement insurance and then follow the steps mentioned below.
Step 1: Contact insurance company after admission
You need to contact the insurance company within 24 hours after the admission in the hospital, and provide them with the details regarding policy such as policy holder name,policy number, hospital details etc.
Step 2:Fill the Reimbursement Form
The company will provide you with the reimbursement form and you have to fill it and submit it to the company.
Step 3: Collect Original Reports and Bills
You also need to submit the original reports and bills, and the file made by the hospital to the company with the form. Also,do keep a Xerox copy of the documents submitted as a proof with yourself. Do check that the bills and reports should be stamped by the hospitals and diagnostic centre then only it would be considered original.
Step 4: Get a Discharge card
It is given to you by the doctor at the time of discharge, it ensures that you are medically fit now and the date of admission and discharge is also mentioned on it, you need to submit this to the insurance company.
Step 5: Submit Doctor’s Prescription
You will be asked to submit the follow-up Prescription of the doctor to the company along with the other documents, so that this cost may also be covered under the claim.
Step 6: Post hospitalisation bills
You are also required to submit post hospitalisation bills, bills after 30 days of discharge, that cost would also be covered under the claim.
Step 7: Take a Follow-up
After submitting all the required documents and registering for the claim, keep a follow-up with the company to check the status of a claim.
Step 8: Claim settlement
Within two to three weeks the claim would be settled by the company and the amount would be transferred to your provided account.
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.