Health insurance is the best way to cope up with the rising medical cost and emergency medical expenses. There are different types of health insurance plans. Although people have now become aware of the importance of health insurance plans, some people are still doubtful about the claim process. The fact is that if you have purchased the insurance policy from a credible health insurance provider, then the health insurance claim process is going to be simple and easy.
Health Insurance Claims
What is a health insurance claim?
The health insurance claim is a request which the policyholder submits to the health insurance provider to provide the services which are covered under the health insurance policy. The policyholder can either get reimbursed or can opt for direct claim settlement; it is also known as the cashless settlement option.
Cashless Claim Process
One of the key benefits of a health insurance policy is that most insurance providers offer cashless claims. But to avail of this offer, one has to be treated in the empanelled hospital. When you reach the hospital, you are required to present the details of your health insurance and e-card and other physical proof that you have taken the insurance from a particular insurance provider. Once you submit all the documents, you can avail of the cashless claim and treatment at the hospital. After the treatment, you must send all the medical bills and discharge papers to the insurance provider. The insurance provider will assess the expenses and settle the payment.
Claims for Planned Treatment at the Cashless Network
In the usual circumstances, the insured has to inform the insurance provider about the hospitalization or treatment requirement before availing of the cashless treatment. The usual time limit is four days before the treatment. One can submit the cashless claim to the relevant address of the insurance provider via email or fax, or you can also send it by post. After successfully completing all this process, the insurance provider will notify the policyholder and the covered hospital about the policy cover and eligibility. On the day of admission, the policyholder has to furnish the health card and the confirmation letter, and the medical bill will be directly paid by the insurance provider to the hospital.
Claims Process In Case of Emergency Treatment at the Cashless Network
In case of an emergency, the policyholder can connect with the customer care of the insurance company to know about the nearest network hospital. After showing your healthcare, you can get the benefit of cashless claim hospitalization. The hospital will fill the cashless claim request form and submit it to the insurance provider. Then an authorization letter is issued by the insurance provider and sent to the hospital highlighting the policy coverage.
Reimbursement Claim Process
In case the insured opts to visit a non-empanelled hospital, then they can opt for the reimbursement claim process. In this case, the insured pays all the bills and costs of hospitalization. Later the insurer submits the bill to the insurance company. The company will evaluate the bills and will then make the payment. In case the treatment is not covered under the policy, then the claim will be rejected.
What are the documents required for a health insurance claim?
To make the insurance claim, one has to submit the following documents:
- Fill up the claim form correctly. Make sure that all the details are apt
- Medical certificate signed by the doctor
- All the medical bills and receipts ( the insurance provider will require original copies)
- Investigation report
- Prescription and cash memos of the hospital or the pharmacy
- In case of an accident, the policyholder must provide the FIR copy and Medico-Legal Certificate or MLC.
- Understanding Insurance
- Insurance FAQs
- Insurance Terms
- Tax Savings
- How To
- Term Insurance
- Investment oriented insurance
- Moneyback Plans
- Individual Health Insurance
- Family Health Insurance
- Group/commercial Mediclaim
- Own damage motor insurance
- 3rd party motor Insurance
- Commercial motor Insurance
- Home Insurance
- Travel Insurance
- General Insurance