Knowledge Centre

How To Be Prepared For Making A Health Insurance Claim During Emergencies

Filing a claim for your health insurance would be something that you may not want to do in case of a medical emergency, but it needs to be done if you want to avoid hefty bill payments. It can be very daunting if you do not know how to go about it and you have to learn by yourself at such a distressing juncture. So, it is in your best interest that you know how health insurance claims work well before you encounter an emergency.

Health Insurance claim settlement process flow diagram

  1. Before the claim settlement, please ensure that you hold on to all bills and receipts towards your healthcare treatments.
  2. Make 2 -3 copies of these bills and receipts.
  3. The health insurance claim process begins with you procuring the claim settlement form from the insurance company.
  4. This can be done online. Just go to their website, download the PDF, get it printed and fill it up.
  5. Please enclose all the bills and receipts to support your claim. Check and verify whether all the necessary supporting documents are enclosed.
  6. Once you have validated the documents, go on to the webpage and upload the form and supporting documents on the ‘Claim Settlement’ section of the portal.
  7. Retain the photocopies for reference.
  8. Alternatively, if you are physically submitting the documents, call up the insurance company to find out which third party administrator the claim settlement forms and documents have to be submitted to.
  9. Once the insurance company scrutinizes the veracity of your claim, they will approve the reimbursement to your account.

Documents required for health insurance claim

Please find below the checklist for documents required for claim settlement:

  • Filled and signed claim form
  • All bills, receipts and invoices
  • Discharge card issued by the hospital
  • Confirmation of hospital bill payment
  • Medical investigation reports/diagnostic reports
  • FIR filed in the case of accidents

Health insurance claim denial reasons

There are a number of reasons why your health insurance claim could be rejected. The health insurance claim time limit is usually 7 days post completion of treatment or discharge. If you exceed this duration, your claim will be denied. If you miss out any of the documents listed under the terms and conditions of your policy, your claim could be denied. Mismatch between reported claim amounts on the form and supporting bills and receipts is also a major reason for claim denial.

Now that you are up to speed with the claim settlement process, you will be able to devote attention to your loved ones during a time of emergency and not fret about your health insurance. The health insurance experts at HDFC ERGO are ever-ready to help you out with your claim settlement process.

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

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