How to Fill Health Insurance Claim Form Part A

Posted on: Dec 12, 2023 | 3 mins | Written by: HDFC ERGO Team

How to Fill Health Insurance Claim Form Part A

Q: How soon should I file my claim?

It is best to file your claim as soon as possible for smooth processing. For cashless claims, inform the insurer or TPA 48 to 72 hours before planned hospitalisation, and within 24 hours in case of an emergency. For reimbursement claims at non-network hospitals, file the claim within 7 to 30 days from the date of discharge as per your insurer’s policy.

Q: What if I forget to inform the insurer within 24 hours?

If you do not inform the insurer or TPA within 24 hours of an emergency hospitalisation, your cashless claim may be rejected. However, you can still apply for a reimbursement claim after discharge by submitting required documents such as bills, prescriptions, and the discharge summary.

Q: Is pre-authorisation needed for every cashless claim?

Yes, pre-authorisation is required for every cashless claim. For planned hospitalisation, send the request 48 to 72 hours before admission. In case of a medical emergency, inform the insurer or TPA within 24 hours of hospitalisation.

Health insurance helps cover the cost of medical treatment and reduces the stress with unexpected medical bills. Whether it is an emergency or a planned procedure, you can get cashless treatment at a network hospital or apply for reimbursement if you are treated a non-network hospital. However, to ensure your claim is processed quickly and without delay, it is important to fill out the claim form correctly.

The claim filing process involves filling out the health insurance claim form and submitting the required documents. Read on to learn how to claim health insurance in hospital.

Types of Health Insurance Claims

There are two categories of health insurance claims: cashless and reimbursement.

1. Cashless claim

If you opt for a medical procedure at a network hospital of your insurance provider, you can file a cashless claim with them. In this case, the insurance company will settle your medical bills directly with the healthcare establishment, so you will not have to pay the same from your pocket.

2. Reimbursement claim

If you choose a non-network hospital, you will need to pay the bills out of pocket and then claim reimbursement for the expenses.

Before you file a cashless or reimbursement claim, you must notify the insurance provider of the same. You must also complete the claim form correctly and submit it to the hospital's desk for verification. If you are filing a reimbursement claim, you must attach original bills and receipts with the claim form. The insurer will verify the same before reimbursing your healthcare expenses.

How to Fill Out a Health Insurance Claim Form?

Whether you choose a network or non-network hospital for a medical procedure, you must fill out the claim form of your insurance provider. You can download the form online or it from the insurance company or TPA.

Once you have the claim form, here’s how you must fill it out:

1. A health insurance claim form has two sections, i.e., Part A and Part B. While Part A is to filled out by the policyholder, Part B is for the hospital.

2. Wondering how to fill claim form Aart A? Start by entering your name, address, policy number, email ID, phone number, medical history, details of your hospitalisation, etc.

3. Enter all the details correctly and review the form minutely before you submit it to the insurance company. Any incorrect or incomplete information can lead to a claim rejection.

4. If you are filing a cashless claim, you must submit your cashless card along with the duly filled claim form at the hospital’s TPA desk. The insurer will verify your claim before settling your bills with the hospital.

5. For a reimbursement claim, you must submit the claim form, discharge summary, and the original bills and receipts to the insurance provider. If you are wondering how to fill reimbursement claim form, remember to provide accurate details and attach all necessary claim.

6. Collect everything, arrange them date-wise and submit them to the insurance provider. Since you have to submit original documents, remember to take their photocopies for your records.

How Soon Should I File My Claim

To understand how to claim medical insurance without hassle, it is important to be aware of the timelines for submitting a claim. Every health insurance policy specifies a maximum period within which claims must be filed. Referring to your policy document helps ensure you meet these deadlines and avoid unnecessary delays or rejections. As a general rule, submitting claims as early as possible gives insurers enough time to verify documents and process the claim smoothly. While timelines can vary across insurers, the following are widely accepted guidelines:

Cashless Claims

For treatment at a network hospital, you are usually required to inform your insurer or third-party administrator (TPA) two to three days before hospitalisation in cases of planned procedures. This allows time for pre-authorisation and approval.

In the case of emergency hospitalisation, health insurance claims should typically be intimated within 24 to 48 hours of being admitted, as per standard policy terms.

Reimbursement Claims

If treatment is taken at a non-network hospital, reimbursement claims are generally required to be filed within 7 to 30 days after discharge. However, check the exact timelines mentioned in your policy document.

For emergency hospitalisation under reimbursement claims, most insurers require claim intimation within 24 hours of admission.

Conclusion

Whether you are filing a cashless claim or a reimbursement claim, carefully reviewing your policy document is essential. Claim timelines, required documents, and billing requirements for planned or emergency hospitalisation can differ between insurers. Understanding these details helps reduce the risk of claim rejection and ensures a smoother, more hassle-free claim settlement process. Also, this leads to clearer communication and a better experience with your insurer or third-party administrator.

FAQs

1. How soon should I file my claim?

It is best to file your claim as soon as possible to ensure smooth processing. The general timelines for filing cashless and reimbursement claims are:

Cashless claims:

◦ Planned hospitalisation: Inform the insurer or third-party administrator (TPA) at least 48 to 72 hours before admission, or as mentioned in your policy terms and conditions.

◦ Emergency hospitalisation: You must notify them within 24 hours of admission.

Reimbursement claims:

If you choose a non-network hospital, file your reimbursement claim within 7 to 30 days from the date of discharge, depending on your insurer’s policy.

2. What if I forget to inform the insurer within 24 hours?

If you don’t inform the insurer or TPA within 24 hours or the stipulated time of an emergency hospitalisation, they may reject your cashless claim. However, you can still apply for a reimbursement claim after discharge by submitting all the required documents like bills, prescriptions and the discharge summary.

3. Is pre-authorisation needed for every cashless claim?

Yes, you need pre-authorisation for every cashless claim. If it is a planned hospitalisation, send the request 48 to 72 hours before getting admitted. In case of a medical emergency, inform the insurer or TPA within 24 hours of hospitalisation.

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

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