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Claiming Your Health Insurance

Today, health insurance does not only cover hospitalisation benefit but also provides for certain procedures that are completed within a day. Such procedures are called Day Care Procedures and most health insurance policies offer cover for such procedures.

This is just one example of the exhaustive benefit suite available with a health insurance policy and there are many other benefits apart from the core feature of hospilisation benefit that covers the medical treatment costs in case a policyholder is hospitalised for a period of more than 24 hours.

Thus, it is highly imperative for a policyholder to know what is covered inthe policy he has bought and how he can ensure that the claim is paid to him without any hassles.

1. First you need to know your plan in and out.

Few of the things that you should know in your policy are:

  • List of hospitals that provide coverage under the policy
  • Details of deductibles co-pay and sub limits
  • Room rent limit and other waiting period details

2. Types of claim that you can make under the policy.

Cashless claim: This kind of claim is permissible only if the policyholder is treated in a network hospital empanelled with the insurance company. Thus, the
claim directly gets settled between the insurance company and the hospital. And the policyholder gets such claim without paying anything to the hospital.

Reimbursement claim: These claims can be made in any of the hospital that may not be empanelled / tied up with the insurance company. In such claims the policyholder needs to pay the hospital bills and later get the same reimbursed from the insurance company. Such claims can be made both in network and nonnetwork hospitals.

It is highly imperative for a policyholder to know what is covered in the policy he has bought and how he can ensure that the claim is paid to him without any hassles

 3. Process of filing the claim.

Keep all the documents properly: Post discharge, one should be very meticulous in keeping each and every document that the hospital provides in a proper way. Though the process of making a reimbursement claim is very simple but one needs to ensure that all the documents sought by the insurance company are provided timely and completed in all aspects.

Checklist of documents required to file the claim

  1. 1 Discharge Summary
  2. 2 Original Bills
  3. 3 Prescriptions given by doctor before
  4. and post hospitalisation
  5. 4 Advance and discharge payment receipts
  6. 5 All original reports, Scans, Sonography
  7. reports, ECGs, EEGs, and other films
  8. 6 Claim Form filled up in all aspects

4. Submission of Documents

Depending whether you procured the policy through a distributor or directly from an insurance company, you may submit the documents to your distributor or directly to the insurance company. Your distributor may advice you in case the documents that you are submitting are complete in all aspects before you file the same with the insurer. Post submission of the documents, you should also record each and every communication that happens between you and the insurer.

All in all, the most critical thing to remember is that one should buy the insurance policy with thorough due diligence so that claim can be availed without any hassles.

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