Steps to take care while claiming health insurance

Want to know how to Claim Health Insurance? Click to find out the complete health insurance process, thing to keep in mind while health insurance claim process & more

Read More
Health insurance claim process can become tedious in many cases. Here is an article that will help you.jpg

Importance of Health Insurance

There is no effective cap on healthcare prices, and the instances of serious ailments have also been increasing over the years, necessitating for everyone to sign-up for a health insurance policy. Health emergencies can occur anytime and jeopardize your financial position through the sheer weight of the economic implications of the entire treatment. To be prepared for any such medical emergency, you need to have a comprehensive health insurance plan that will cover the cost of medical expenses incurred due to an injury, illness, or accident. Several health insurance plans are available for your consideration, viz. Individual Health Insurance Policy, Family Health Insurance Policy, Group Mediclaim, and Unit Linked Health Plans.

How does one make a claim for a health insurance policy?

There are innumerable reasons to subscribe to a health insurance plan for yourself as well as your family. The changing lifestyle in modern times has made people vulnerable to various ailments. Pollution, quality of food, eating disorders, and stressful work schedule pose serious threats to one's wellbeing. Apart from this, medical costs have also increased manifolds as treatment costs in private hospitals are going through the roof. The mainstream medical cost increased, and the cost of the out-patient department (OPD) and diagnostic expenses have skyrocketed. Health insurance policies not only cover the mainstream medical costs but also takes care of the OPD costs.

If you already have a health insurance plan, then the next thing that you will naturally have in your mind is how to claim a health insurance policy? Filing a claim against a health insurance policy is essentially submitting a request to the insurance company to obtain reimbursement for the cost of treatment and services covered in a health insurance policy. There are two types of claims – cashless claims and reimbursement claims. Here we will discuss the health insurance claim process under both policies.

Cashless Health Insurance Policy

If you are covered under a cashless health insurance plan, you will not have to pay cash to a network hospital listed with your insurance company for the treatment received. In a cashless health insurance plan, your insurance company directly deals with the network hospital. The unsteady growth of medical expenses and the uncertainty of medical emergencies have made cashless health insurance plans very popular these days. Cashless claims are best suited for situations where you may be going through temporary financial instability and little access to cash during medical emergencies. The main agenda of a cashless health insurance policy is to do away with any kind of cash payments. Whatever services or consumables are covered in your cashless insurance plan, the payments are dealt with by your insurer. You should just make sure that the hospital you are admitted into is empanelled with the insurance company or the TPA for a hassle-free cashless health insurance claim procedure.

Documentation while claiming health insurance

Before you initiate the process of filing a health insurance claim, you must keep the following documents ready with you, for this will serve as your checklist for reimbursement of medical claims: -

  • Signed claim form (duly completed).
  • KYC Documents (Aadhar Card, PAN Card, etc.)
  • Doctor's prescription recommending medical tests, hospitalization, and medicines.
  • Original bills from the pharmacy
  • Copy of the FIR (if applicable)
  • Original Policy documents (ideally for the last 2 years)
  • Ambulance receipt (if applicable)
  • Hospital bills, case summary, discharge summary, and other diagnostic reports.

In the case of a cashless claim, a pre-authorization form must also be filled at the time of hospitalization to initiate the health insurance claim process. Make sure you keep a copy of all the submitted documents safely with you till the entire claim settlement process is completed.

How to claim a cashless health insurance policy?

Here is your comprehensive guide on how to claim medical insurance from your insurance company: -

- While you are being treated for any ailment, you should choose the cashless hospitalization option. You will then have to pay for only those services that are not covered under your health insurance plan. You should go through the Terms & Conditions of your health insurance plan properly.

- You should make sure that the hospital where you are admitted is listed with your insurance company or the TPA. Only network hospitals can offer cashless treatment facilities.

- At the time of your admission to the hospital, you will have to fill and submit a pre-authorization form to the third-party administration counter. Here you must inform your insurer about the pre-authorization form that will come their way for final approval.

- You should carry all the required documents because the third-party administration counter can ask for important documents pertaining to your health insurance policy, including copies of KYC documents.

- Once your insurance company has approved your cashless hospitalization, your insurer will receive all the information and important documents relating to your treatment. It is advisable that you also keep copies of such documents for future reference.

- If you follow the above steps cautiously, your cashless claim will be easily settled. You will be required to submit all the original medical reports and bills with the insurance company after the claim has been settled, but you may certainly keep the copies of such documents with you for future reference.

How to claim medical reimbursement?

A reimbursement health insurance policy is one in which you pay the medical expenses for your treatment upfront in a hospital and later request the reimbursement against the cost incurred for the treatment from the insurance company. Although the cashless health insurance plan is more popular, many hospitals do not accept cashless claims. So, to stay on the safer side, people do opt for reimbursement for health insurance plans. The most important things for a reimbursement claim are the hospital bills and reports. You should safely preserve all the medical bills along with medical reports for maximum benefit on your health insurance policy. Only when these bills are fully assessed and approved will you be reimbursed. It is important to note here that you will get reimbursement on only those services or consumables covered in your reimbursement health insurance plan.

How to make a claim for reimbursement health insurance policy?

Here are the medical insurance claims processing steps you must follow under the claim settlement process in health insurance for the reimbursement of expenses incurred: -

- The reimbursement mechanism is especially for those hospitals that are not a part of the insurance company's network. First, you will have to fill a reimbursement form and submit it to your insurance company. Make sure that you are submitting the reimbursement form within a month from your discharge date.

- Along with the reimbursement form, you will also have to submit the medical bills for your treatment. Remember that these bills should be attested by the hospital and signed. You should check your documents for mandatory fields like hospital's registration number, date of admission, patient's name, etc.

- The hospital's discharge card should be preserved as you are required to submit this to your insurer.

- In reimbursement health insurance policy, you can also claim pre and post-hospitalization expenses. You will have to submit all the pertinent bills to your insurer. You will have to submit these within the time frame stated under your health insurance plan.

Reading through the terms and conditions of your health insurance policy is particularly important. You can ensure a smooth claim settlement process in health insurance if you are aware of the services covered in your health insurance plan. For filing claims under both options, it is especially important to safely store all medical records and bills.


Share This page


Navi General Insurance Limited
IRDAI Registration No: 155 | CIN: U66000KA2016PLC148551