Types of Health Insurance Claim Settlement
Updated On Oct 11, 2021
Table of Contents
Health insurance plans play an important role in the daily lives of the people as it protects them against the high costs of medical treatments in case of an emergency. It also ensures quality treatment of the individuals in the private hospitals without making the people worried about their monetary constraints. The health insurance plans offer a wide range of benefits like pre and post hospitalization costs, ambulance charges, medication costs, room rents, no claim bonus, tax saving benefits, and much more. The health insurance plans come with a specified waiting period during which the policyholders cannot avail the features and the benefits of the health insurance plans. After the waiting period, the policyholders can file a claim of their health insurance plan to get the benefits.
Claim settlement process is important as it helps the people in overcoming the medical dues and lets them to avail their accumulated benefits like the rewards, sum assured, claim amount, and much more. To get a quick and hassle-free claim settlement, you must choose a suitable health insurance provider. You can consider certain factors like the incurred claim ratio and claim settlement ratio, which determines the capability of the health insurance provider to settle the claims of the policyholders effectively. Therefore, while choosing a health insurer, you must make sure that it offers quick and efficient claims on their health insurance plans. You must also go through the policy terms to avoid any inconvenience at the time of the claim settlement process.
Types of Health Insurance Claim Settlement
Following are the two different types of health insurance claim settlement procedures which can be availed by the policyholders:
1. Cashless Claim Settlement Process
Under this certain type of claim settlement process, the policyholder can receive cashless treatment at the network hospital of the health insurance provider. It is important for the policyholders to seek hospitalization and treatment at the network hospital linked with the insurer. Policyholders can show their health card, issued by the insurer, at the hospital desk and receive cashless claims. Under this claim process, the people need not pay a penny from their pocket as the entire medical bill of the policyholder is borne by the insurer directly with the hospital without involving the individuals.
2. Reimbursement Claim Settlement Process
This type of claim settlement process can be availed by the individuals who wish to seek hospitalization in a hospital of their choice. Under this claim settlement process, the policyholders can receive treatment in any hospital of their choice and clear the medical dues incurred. Later, they can get the medical dues reimbursed in their bank account by providing the necessary documents like diagnosis reports, lab reports, medical bills, etc. to the insurer. This claim settlement process is suitable for people who can borne the initial expenses of medication at the time of the treatment.
The cashless claim settlement procedures are considered to be more beneficial as under this process, the policyholders do not have to pay any sum of money from their pocket. It not only saves the money of the policyholders, but also helps them in receiving quality treatment at the network hospital linked with the health insurance provider.
Documents Required For Health Insurance Claim Settlement
Let us look at some of the possible documents that are necessary for a smooth claim settlement process:
- Health card, issued by the health insurer.
- Doctor’s consultation papers
- Duly filled and signed claim form
- Investigation and diagnosis reports like X-Rays, CT scans, lab reports, etc.
- In case of an accident, medico legal certificate (MLC) and FIR must be submitted.
- Prescriptions and invoices of medications and pharmacies.
- Discharge papers.
- Any other relevant documents mentioned in the policy papers.
You can make any type of claim based on your choices, medical condition, financial budget, etc. It is important in a claim settlement process to intimate the insurer about the hospitalization as early as possible, to get the claim settled on time without any hassles.
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.