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Tips For A Smooth Health Insurance Claim Settlement Process

Published On Oct 21, 2021 11:00 AM By InsuranceDekho

Health insurance plans are bought by the policyholders to receive financial aid at the time of a medical emergency. Health insurance plans also ensure quality treatment of the people at the time of receiving treatment at the private hospitals without worrying about the financial constraints. Health insurance plans offer benefits like pre and post hospitalization expenses, room rents, ambulance charges, domiciliary expenses, medication costs, and much more. Apart from such benefits, the plans also provide tax saving perks, no claim bonuses, rewards, and a lot more. These accumulated benefits can be availed by the policyholders at the time of the claim settlement process.

Claim settlement process of a health insurance plan is the process during which the policyholders can claim their health insurance plans and avail the benefits. To ensure a smooth and hassle free claim settlement process, you must buy the health insurance policy from a well-known insurer. To look for a suitable health insurance provider, you can compare their claim settlement ratios as it determines the capability of an insurer to settle the claim request received in a policy year. You should also read the policy terms carefully to avoid any inconvenience at the time of the claim settlement process.

Tips For A Smooth Health Insurance Claim Settlement Process

Tips For A Smooth Health Insurance Claim Settlement Process

Let us look at some of the key points that must be considered while claiming your health insurance plans to ensure a smooth and hassle-free claim settlement process:

Must Read: How To Check Health Insurance Claim Status?

1. Hospitalization of At Least 24 Hours

You must make a claim on your health insurance plans for hospitalization of minimum 24 hours. If the treatment is for less than that of 24 hours, then you can claim a specific feature of your purchased policy like daycare procedures, etc. You must not make small claims on your pla as it can lead to the exhaustion of your accumulated benefits, that can be of better use at time of a medical emergency.

2. Go Through The Sub-Limits

Some perks under the health insurance plans have restrictions on them like under room rents you can choose a certain type of room during hospitalization. Therefore, you must be aware of the applicable sub-limits on your health insurance plan to avoid the denial of your claim request at the time of a medical emergency. You can learn about the sub-limits on your purchased health insurance plan by going through the policy terms carefully.

3. Waiting Period of The Plan

Different medical conditions listed under a health insurance plan have a certain waiting period, which is the time frame during which the policyholder cannot avail the benefits of the plan for that particular medical ailment. You must be aware of the waiting period of your plan so that you can claim the policy accordingly. When looking for a suitable health insurance plan, you must buy a plan with a short waiting period.

4. Co-Payments

According to the co-payment clause of the health insurance plan, a specified portion of the medical bills are to be borne by the policyholders. This percentage of co-payment is pre-specified by the health insurance provider at the time of purchase of a health insurance policy. You must be aware of your co-payment portions to make a quick claim of your health insurance policy.

5. Exclusions Under The Health Insurance

Health insurance plans come with a set of inclusions and exclusions for the policyholders. Claim requests made for any of the excluded medical conditions will not be accepted by the insurer, and it can lead to hassles at the time of the claim settlement process. Therefore, you must make a claim only after going through the list of exclusions under your purchased health insurance policy.


You must consider the above mentioned points when claiming your health insurance policy to avoid any inconveniences and confusions at the time of the claim settlement process. You must also keep the claim settlement documents handy so that you can make quick claims at the time of an emergency.

Also Read: Essential Tips To Buy An Individual Health Insurance Policy

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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