Mandatory Documents for Cashless Treatment Insurance

Policyholders can avail the benefits of their purchased health insurance plan at the time of the claim settlement process. Claim settlement procedures are of two types namely cashless claims and reimbursement claims. Under cashless claims, the policyholders can get cashless treatment at the network hospital of the insurer without spending a penny from their pockets while, under reimbursement claims the medical dues are initially borne by the policyholders and later the amount is reimbursed into their bank accounts. Depending on the financial budget of the policyholders, they can go with any of the claim settlement procedures. At the time of cashless claim process of health insurance, the policyholders must produce a set of documents for verification, insufficiency of which can lead to the rejection of the claim settlement request.

Documents Required For Cashless Treatment Insurance

Following are some of the documents that must be produced by the policyholders to their health insurance companies at the time of cashless claim settlement process:

Must Read: Simple Steps To Make Cashless And Reimbursement Claims In Health Insurance

• Duly Filled Claim Form

The policyholders must submit a duly signed and correctly filled claim form along with other documents, to the health insurance provider at the time of the claim settlement process. You can get the form online from the official website of your respective insurer or you can get it from the hospital desk after producing your healthcare card issued by the insurer.

• Medical Certificate

A medical certificate authorized by the hospital and issued by the doctor should be attached with your other claim settlement documents.

• Diagnosis Reports

The policyholders must submit their medical reports like diagnosis reports, blood test reports, x-rays, etc. and attach it with the policy-related documents to avail the full benefits of your purchased health insurance plan. These documents are directly processed by the insurer with the network hospital in case of cashless claim process, without involving the policyholder.

• Valid ID Proof

Depending on the requirements of your health insurance provider, you must attach the necessary identity proofs like Aadhar card, driving license, pan card, ration card, etc. You must attach a copy of these ID proofs alongwith the other documents.

• Discharge Documents

You can collect your discharge documents from the hospital after receiving the treatment. But, in case of cashless claims the medical bills are settled directly by the insurer with the hospital and therefore, you might not be asked to produce your discharge papers. However, it is always better to have them handy.

• Medical Bills

You must always collect all your medical bills like invoices, pharmacy bills, etc. after receiving the treatments. You must keep this as a proof of your hospitalization. Sometimes, cashless claims are not processed and then you can use these to make a reimbursement claim.

• Copy of FIR

A copy of the FIR report is mandatory with the claim documents in case of an accident. If the bodily injuries are because of an accident, you must file an FIR at the nearby police station and attach a copy to claim your purchased health insurance policy.

Procedure of Cashless Claim Settlement Process

Let us look at the steps involved for cashless claim settlement process at the time of a medical emergency:

• Get hospitalized in a network hospital of the insurer. You must intimate your insurer or the TPA about your hospitalization as early as possible to give the insurer enough time for processing your request. In case of planned hospitalization, you must inform well in advance.
• After informing, you must produce your health ID at the network hospital and submit a duly signed and filled claim settlement form along with the other required documents to get the sum assured for your treatment.
• After the proper verification of your submitted documents, your medical dues will be cleared by the insurer directly with the hospital.

Conclusion

You must produce the above-mentioned documents at the time of the cashless claim settlement process to avail the benefits of your purchased health insurance policy without any hassles. To get the list of required documents you can also refer to your policy related papers.

Also Read: Challenges Related To Cashless Treatment

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.