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Are Health Insurance Claims Time Bound?

Updated On Jul 12, 2021

Even imagining your health insurance claim getting rejected possibly after doing everything correct, right from the beginning of purchasing a health insurance plan be it thorough comparison, choosing an ideal plan, making the payment, or raising the claim after facing any sort of medical emergency. All of this is possible if you delay raising your health insurance claim. Therefore, it is important for a policyholder to stick to the timeline at the time of applying for the claim.

Are Health Insurance Claims Time Bound?

What is the Term Time Limit?

A policyholder is required to adhere to a pre-decided time limit while taking into consideration the smooth flow of claim settlement of a health insurance plan in India. There are different timelines for different insurance companies and different time limits for differing types of claim. For instance, a time limit for cashless claims differs as compared to the reimbursement claim.

Why is there a Time Limit for Claim?

In India, a health insurance plan comes with a severe time frame in order to apply for a claim in order to mitigate the chances of fraud. An application with a deadline means a lesser timeframe for people with fraud intents to falsify the details.

For Reimbursement Claim

A reimbursement claim means that the policyholder is required to pay all hospital bills from their pocket and they can later claim it from the insurance company. In these cases, the policyholder is not required to inform the insurance company before hospitalisation. However, an individual is required to raise a claim between 7-15 days after getting discharges from the hospital.

For a Cashless Mediclaim

If a policyholder has a cashless Mediclaim health insurance plan, then they are required to inform their respective insurance company around 3 days prior to the hospitalisation. Intimating the insurance company, helps in further smoothening the entire process between insurance provider, network hospital and third party administrator.

For Emergency Cashless Mediclaim Plan

It is hard to predict a medical emergency situation, therefore, needless to say an individual cannot inform their respective insurance provider, three days prior to the emergency. As a result, the time frame to notify the insurance company for cashless emergency Mediclaim is 24 hours after getting hospitalized.

For Post Hospitalisation Claims

There are some health insurance plans offered by insurance companies that even settle claims for post-hospitalisation. Generally, due to the nature of these claims, it takes some time to raise them. Therefore, generally the time frame for these claims is two weeks after a month or two of hospitalisation.

Also Read: How To Appeal Against Rejected Health Insurance Claims?

How Cashless Health Insurance Claims Work

Documents Required During Claim Settlement

You need to provide the following documents at the time of filing for a claim:

  • Claim Application in detail
  • Hospital and other medical bills
  • Discharge Card
  • Reports
  • Prescription Details

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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