- Cashless Claims
- Reimbursement Claims
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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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
- Accident Case: If it is an accident case, then the FIR or Medico Legal Certificate (MLC) is required.
- 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.
- 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.
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