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How To Claim Women Health Insurance?

Updated On May 03, 2021

In today's time, changing lifestyles has led to stress related disorders and lifestyle diseases among women. Women have become more vulnerable to health problems especially after the age of 40 and the freads of maternity related disorders come solely in women's share.

Considering these facts, it becomes obvious that women need health insurance as much as anyone else to ensure a financial backup in case a medical emergency arises. That's why insurers have become serious about catering to the health insurance needs of women. The market now offers women-specific health insurance plans designed specifically as per the medical needs and requirements of women.

How To Claim Women Health Insurance?

Types of health insurance claims

A health insurance policy can be claimed through two ways.These are as follows:

  • Cashless
  • Reimbursement

Let’s understand the meaning and the steps involved in both these types of claims.

Cashless Claims

Cashless settlement of health insurance claims occurs when the policyholder seeks treatment in a network hospital of the insurance company. A network hospital is one such hospital which is tied-up with the insurance company. Since treatments are taken at a network hospital, the insurer himself settles the hospital bills directly with the hospital. You, therefore, do not have to pay the medical expenses yourself.

Here are the steps involved in filing a cashless claim:

Step 1: Inform the Insurer

If you are taking a planned treatment, inform the insurance company beforehand. Intimation should be given to the company at least 3 to 4 days prior to being hospitalised. You will need to fill a pre-authorisation form and submit it with the insurance company. In case of a planned hospitalisation, the form should be filled in and submitted in 3 to 4 days in advance.

Step 2: Pre Authorisation form in case of medical emergency

If there is a medical emergency and the policyholder is being hospitalised under an emergency situation, the insurer should be informed and the pre-authorisation form should be submitted within 24 hours of hospitalisation.

Step 3: Assessment of the Claim

After the submission of the pre-authorization form, the insurance company assesses the claim based on the form and documents and if satisfied then allows cashless claim settlements.

Step 4: Cashless Treatment

The policyholder can avail of the required treatments without paying the medical bills . 

Step 5: Submission of Bills

You would need to submit all the medical bills, medical reports and other medical documents to the insurance company.

Step 6: Other Documents

If there are other expenses which are to be covered, original document proofs of such expenses will be submitted to the insurance company.

Reimbursement Claims

Reimbursement claim occurs when the policyholder pays for the medical bills himself and then gets the expenses reimbursed from the insurance company. Reimbursement claims happen if the policyholder gets treatments at a non-network hospital of the insurance company or if the insurance company does not allow cashless claim settlements.

Here are the steps involved in filing a claim through reimbursement mode:

Step 1: Admission in a Non Network Hospital

The policyholder will need to get admitted in a non network hospital of the insurance company to avail treatments.

Step 2: Payment of Bills by the Policyholder

All the original medical bills and reports should be retained by the policyholder. The policyholder will also need to pay the bills from his pocket.

Step 3: Discharge Card

On being discharged from the hospital,the policyholder will get a Discharge Certificate or Discharge Summary from the hospital from which treatment was availed.

Step 4: Submission of Discharge Card

The discharge Certificate or Summary will be then submitted to the insurance company along with a duly filled and signed in claim form, medical reports and bills in original and other required documents.

Step 5: Claim Settlement

Then, The insurance company would analyse the claim, related documents and the amount of expenses incurred. The expenses would then be reimbursed and the reimbursed amount will be transferred to your provided bank 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.

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