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Things To Keep In Mind When Making A Health Insurance Claim

Updated On Sep 13, 2021

Buying a health insurance plan can be hectic as there are a plethora of options to choose from. But, after analyzing your choices and requirements, you can choose a suitable health insurance plan for yourself and your loved ones from the insurance market. The most important part of buying a health insurance plan is the claim settlement process. After having paid for your policy cover and customizing it according to your needs, you can avail all its benefits and features at the time of claim settlement process.

There are two different types of claims that can be made. One of which is the cashless claim benefit under which you do not have to pay any sum of money from your pocket and your medical dues are cleared directly by the insurer to the hospital. Another type is the reimbursement claims under which the customer must clear their medical dues before getting discharged and later on claim request the amount is reimbursed into their bank accounts. You can avail cashless claims at the network hospital of the health insurance provider, while for a reimbursement claim you can seek treatment in any hospital of your choice. Therefore, choosing a certain type of claim settlement process depends on your financial budget.

Things To Keep In Mind When Making A Health Insurance Claim

Key Points To Consider At The Time of Making A Health Insurance Claim

After having bought a health insurance policy, you would want to claim it in case of a medical emergency. While making the claims, you must consider the following points in your mind to make the process smooth and hassle-free:

  • Policy Tenure

You must keep a track of your purchased policy tenure to make sure that you renew your plans on time. You cannot make claims on an expired health insurance cover, therefore it is important to consider the tenure of your policy before making a claim. Most of the health insurance providers offer lifetime renewability options to their customers so that they can make as many renewals as required throughout their lifetime.

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

  • Difference Between A Mediclaim And Health Insurance Cover

You must very well know the difference between a mediclaim and a health insurance cover as they both differ in their coverage. Also, at the time of filing a claim, make sure to go through the terms to know the inclusions of your policy.

  • Fine Print

You must always read the policy terms and conditions carefully to make sure that your demands have been included by the health insurance provider in your purchased health insurance cover. You must read it before filing the claim, as a claim request for a disease excluded in your policy will not be accepted.

  • Intimating The Health Insurance Provider

In case of a planned hospitalization, you must inform your health insurance provider about the treatment, and in case of an emergency you must intimate the insurer as soon as possible. Informing your insurer on time helps in kick starting the procedure of claim settlement without any unnecessary delay.

  • Reimbursement Claims

If you want to seek treatment in any hospital of your choice, then you can go for reimbursement claims, under which you must clear the medical dues at the hospital and later the amount is reimbursed into your bank account. For making reimbursement claims, you must collect necessary documents like discharge papers, invoices, medication bills, prescriptions, etc. and attach them with the claim settlement form submitted to the insurer.

  • Proper Communication

Sometimes claim settlement procedures can become complicated due to the lack of proper communication between the insurer and the policyholder. At various stages like intimating about hospitalization, inquiring about the treatment, claim settlement request, tracking request, etc. you have to communicate with your health insurance provider.


To get the maximum out of your health insurance plan at the time of claim settlement process, you must consider the above-mentioned points and then accordingly go with the necessary procedures.

Also Read: All You Need to Know About Filing a Claim with Star Health Insurance

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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