Knowledge Centre

All You Need to Know About Health Insurance Claim

Life is uncertain. And with medical expenses skyrocketing, a health insurance policy is considered a must. Almost everyone today has a health insurance policy. But how many of us actually know the procedure of filing for a claim when the need arises?

Imagine this scenario where a 45-year-old man meets with a severe road accident and ends up in the hospital for almost a month. He does have a health insurance policy but had never explained anything to his wife or daughter about the procedure of filing. For months, they might have to keep running from pillar to post to understand which documents are required and how to file a claim.

So, to avoid such a situation, here is everything you need to know about how, when and where to file a health insurance claim:

How to File a Health Insurance Claim?

  • Collect all your itemized receipts from the hospital or from your doctor as these will be needed to assess the expenditure incurred.

  • Complete your claim form. This can be submitted online or sent to the insurance company by post.

  • Keep a copy of the documents in case the company asks for the originals.

  • Call the company and let them know that you have filed a claim. Follow up regularly and also ask them about the expected time for payment.

When to File a Health Insurance Claim?

There are two types of health insurance claims and it’s important not to delay in claiming your health insurance:

Cashless Treatment: In this case, you will have to inform the insurer about your pre-planned hospitalization of 48 or 72 hours in advance. In case, you have to get admitted in emergency, you need to inform you insurer within 24 hours after hospitalization.

  • You can visit the hospital and show your insurance card along with a valid ID proof.

  • You might also need to fill in the pre-authorization form and send it to the insurer.

  • Your insurer will then send an authorization to the hospital to begin the treatment and you can enjoy a cashless one.

Reimbursement Claim: Under this facility, the insured person has to file for a claim with the insurer to get back the amount spent by him/her on the treatment covered in the insurance plan. This has to be filed within 15 days of being discharged from the hospital.

  • Submit a claim form along with a photo ID proof.

  • You will also need other documents like – final bill from the hospital, itemized receipts, payment receipts, breakup of the hospital bill, discharge summary, operation theatre notes, ambulance receipt, certificate from the attending doctor, medical reports and prescriptions, medicine bills and final police report, if applicable.

We know how a health insurance policy can save us from rising medical expenses. Similarly, a little information about how to file an insurance claim, when to file and where to file, can also prevent us from getting into bigger problems later. If you delay in filing your insurance claim, the insurer might refuse to accept your proposal completely. So, whenever you buy a health insurance policy, make sure you and your family members are well aware of the terms and conditions for filing the claims. Know claim process for health insurance plans

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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