How to Fill Claim Form Part A for Health Insurance

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

How to Fill Claim Form Part A for Health Insurance

Health insurance helps cover the cost of medical treatment and reduces the stress associated 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 at 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 fill health insurance claim form correctly.

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 need to pay the bills from your pocket and then claim reimbursement for the expenses.

Before you file a cashless or reimbursement claim, you must notify the insurance provider about the same. You must also fill out the claim form correctly and submit it at the TPA desk of the hospital 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 obtain 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 be filled out by the policyholder, Part B is for the hospital.

2. If you are thinking about how to fill claim form Part 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 health insurance 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 documents, such as your medical certificate, ID proof, and any other papers related to the 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.

Conclusion

Make sure you fill out the health insurance claim form correctly to avoid rejection of your claim. Also, remember to inform the insurance company about your medical procedure at least 48 to 72 hours in advance. For medical emergencies, you must inform the insurer within 24 hours of hospitalisation. Submit all bills and receipts with the claim form so the insurer can verify them and reimburse the expenses.

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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