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Things to Consider When Making Health Insurance Claim

Updated On Sep 18, 2021

India is seeing an increase in health insurance penetration since the COVID-19 pandemic has struck. People have started realising the importance of health insurance better than ever. But a health insurance policy is most useful when the insured is able to make a claim under it as and when required. However, not many health insurance policyholders in India are well-versed with the details related to the health insurance claim process. But as claim settlement is one of the most important aspects of health insurance, hence we have curated a list of things that one must consider in order to make the claim settlement process smoother.

Things to Consider When Making Health Insurance Claim

1. Waiting Period

A waiting period is that period during the policy tenure during which no claims are admissible. So, to avoid any discrepancy at the time of claim in future, you must be aware of different types of waiting periods such as waiting period for pre-existing diseases, initial waiting period, and waiting period for specific illnesses.

Must Read: Difference Between Incurred Claim Ratio And Claim Settlement Ratio

2. Inclusions And Exclusions

In order to avoid any confusion at the time of claim settlement, you must be aware of the inclusions and exclusions under your health insurance policy. To understand your policy better, you must read the policy document thoroughly. It keeps you prepared for the future, thereby saving you time in case of a claim in future.

3. Terms And Conditions

Just knowing the inclusions and exclusions of a health insurance policy is not enough. You must also be aware of other terms and conditions like the co-payment clause, sub-limits, etc. If you fail to follow the terms and conditions at the time of making a claim, then the chances are highest that your claim will be rejected.

4. Minimum Hospitalisation

If you are not aware until now, then you must be informed that a minimum of 24 hours of hospitalisation is required to be able to avail of health insurance policy benefits. However, there are certain daycare procedures that do not require 24-hours hospitalisation. These are chemotherapy, radiotherapy, dialysis, etc. So, if you go for a tetanus shot at the hospital, then you should not make a claim for the same as you would not be covered for it.

5. Network Hospitals

Every insurance company offering health insurance plans has tie-ups with hospitals known as network hospitals where the insured can avail cashless treatment. You must check the list of network hospitals in your area to avoid wastage of time in case of an emergency as well as to avoid any confusion at the time of claim settlement. You can find the list of network hospitals in the policy document or at InsuranceDekho. You can also contact customer care executives in case any help is required.

Final Words

Claim settlement is an important aspect of health insurance. Hence, when purchasing a health insurance policy for yourself and your loved ones, you must not only consider factors like coverage features, exclusions, type of policy, etc, but also the claim settlement process offered by an insurance company. Also, understand the terms and conditions related to the claim settlement to avoid any discrepancy in future. You can take the help of customer care executives at InsuranceDekho and they will be happy to solve your queries.

Also Read: How To Make A Cashless Health Insurance Claim?

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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