Knowledge Centre

Steps to File Health Insurance Claims

Those days are long gone when buying a health insurance plan was an option or even a luxury to have. The rate at which the expenses related to medical procedures or hospitalization, in general, are on the increase, you will find yourself in a tricky situation if you do not have a health insurance plan.

However, the equation just doesn’t stop at buying a good health insurance plan. You should be able to claim it at the time of need and do so without taking a lot of stress. Unlike the general notion, health insurance claims these days are much smoother than what one would imagine.

Here is all that you would need to know regarding a health insurance claim.

Type of Claims

There are primarily two types of settlement, as far as health insurance claims are concerned.

  • Cashless Claims
    • As the name suggests, if you opt for this type of claim, you do not have to pay for the expenses from your pocket. Your insurer would directly interact with the hospital and take care of the expense. There are two pre-requisites for the same.

    • Firstly, your health insurance plan must cover the ailment that you or your family member is diagnosed with.

    • Secondly, the hospital you want to visit should be in the list of network hospitals of your insurer.

    • If the above two conditions are fulfilled and it is a planned hospitalization, you can opt for a cashless claim.

  • Reimbursement Claims

    • Reimbursement claim is the opposite of cashless claims. If you fail to opt for the cashless facility or have to be hospitalized in a non-network hospital, reimbursement claim would come into the picture.

    • You can go through your normal hospitalization process and complete the payment. Once you are discharged, ensure that you reach out to your insurer at the earliest and submit a claim along with all the relevant hospital documents. The approved amount will then be submitted to your bank account.

Filing Process

Depending on the type of claims that you are opting for, the filing process would vary a bit. In the case of planned hospitalization, you can intimate your insurer about the same. If you do so, they will provide you with a Pre-Authorization Form which you need to fill and submit at the Third Party Administration counter of the hospital.

In case of reimbursement claims, you must inform your insurer about the procedure within 30 days of discharge and fill the reimbursement claim form. Both the process require their own set of documents which your insurer will help you out with.

Things to Consider

Before you start filing your claim, here are a few things that you must consider.

  • It is advisable to go through the pre-authorization form very carefully and provide all the details as accurately as possible.

  • You are required to submit all the original documents to your insurer, and thus taking photocopies of the same for future reference is recommended.

  • Do not forget to renew your insurance on time or else you might miss out on a few benefits.

Read more about Reasons why health insurance claims get rejectd

Disclaimer: The above information is for illustrative purpose only. For more details, please refer to policy wordings and prospectus before concluding the sales.


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