Things to keep in mind while claiming health insurance

If you by now have a health insurance plan, then the next question that you will have in your mind is how to lodge a claim in a health insurance policy? Filing a claim alongside a health insurance policy is fundamentally submitting a request to the insurance company to obtain reimbursement for the cost of treatment and services concealed in a health insurance policy.

Oct 13, 2021 12:10 IST India Infoline News Service

The conventional medical cost has increased in the past few years, has gone through the ceiling. Health insurance policies not only cover the mainstream medical costs but also take care of the IPD (Inpatient Department) and OPD (Out Patient Department) costs depending upon the plan features opted by any individual/s. If you by now have a health insurance plan, then the next question that you will have in your mind is how to lodge a claim in a health insurance policy? Filing a claim alongside a health insurance policy is fundamentally submitting a request to the insurance company to obtain reimbursement for the cost of treatment and services concealed in a health insurance policy. There are two types of Claims in Health Insurance:
  • Cashless Claims
  • Reimbursement Claims
Apart from the timely intimation of claim to the insurer, one must read the ‘Inclusion and Exclusions of the policy’ while logging the claim, one should remember the following points:

For Cashless Claims:

In a cashless Health Insurance claim, you do not have to pay cash to a network hospital listed with your insurance company for the treatment received or you are about to receive.
  1. Insured Person’s ID Proof: it is vital to provide the ID proof of the insured or dependents for the process of claiming the Health Insurance.
  2. e-Cards: For a Cashless Health Insurance claim, it is essential to provide the eCard to receive hassle-free medical assistance and treatments without delay.
  3. Intimation to TPA (if involved): Usually it is mandatory to inform your TPA (Third Party Administrators s that they can check it out for you whether or not the hospital of your choice comes under the covered hospitals' list of your cashless health insurance provider. TPA will also help you in processing your cashless claims for the treatment you have undergone.
  4. Panelled Hospital Or Network Hospital List: it is vital to check that the hospital you are getting admitted into for treatment comes under the panelled list of hospitals or network hospitals to claim your health insurance.
For Reimbursement Claims:
  1. Duly Filled Insurance Company Claim Form: To claim a reimbursement claim, you need to fill the insurer company’s claim form in order to get a claim and the amount is credited to your bank account. Get in touch with your insurance company via their toll-free number and provide them with your eCard or membership number. You need to make sure that the form filled is correct otherwise the claim will be rejected.
  2. Medical Certificate/ Form Which Is Signed By The Treating Doctor: You must produce the medical certificate duly signed by your attending doctor in order to claim your reimbursement for your medical expenses. It is required to validate that the hospitalisation of the insured was mandatory on the recommendation of the treating doctor apart from emergency cases.
  3. Original Discharge Summary Availed From The Hospital: During the process of claiming your reimbursement, make sure you submit your original detailed discharge summary provided by the hospital to the insurance company’s claim department.
  4. All Original Bills and Receipts: Present the bills, prescriptions, discharge summary, and cash memos from pharmacies or the hospital, and other necessary documents when you request reimbursement because usually the health insurance policy covers the pre and post hospitalisation expenses as well for the treating disease.
  5. Investigation Report If Any: Submit your medical investigation report (if it was required to the insurance company to claim the reimbursement of your health insurance
  6. Accident Case: If it is an accident case, then the FIR or Medico Legal Certificate (MLC) is required.
  7. Submit ID Proof and Cancelled Cheque: One must submit the ID Proof and Cancelled Cheque for the amount to be credited to their bank account. Also, one should keep in mind that the Cancelled Cheque copy must carry the claimant’s name on the cheque.
  8. Turnaround Time: the turnaround time for reimbursement health insurance claim is about 10 – 15 working days from the date of receipt of all the claim documents or receipts. However, few of the companies do accept soft copies nowadays wherein TAT (Turn Around Time) is about 3-4 working days from the date of submission of entire claim documents as per their checklist given for the reimbursement.
The author of this article is Mr. Ankit Agarwal, Managing Director, Alankit Ltd

The views and opinions expressed are not of IIFL Securities, indiainfoline.com

Related Story

Open Free Demat Account (Rs699)