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Health insurance plans have become a must-have in today’s age when medical costs have gone through the roof. A health insurance plan, like Health Absolute, covers your medical bills and provides much-needed financial relief. Moreover, if you buy the best health insurance in India, like Health Elite, you can enjoy comprehensive coverage. The D.I.Y Health Insurance policy also gives multiple benefits. You can also choose a women's health insurance plan for women-centric coverage.
But do you know the health insurance claim process?
There are two types of health insurance claims – cashless and reimbursement.
Under cashless claims, the insurance company settles your medical bills directly with the hospital. Under reimbursement claims, though, you pay the bills first. Later, you can get them reimbursed by the insurance company.
In both instances, certain documents are required for health insurance claims. These documents help the insurance company verify the health insurance claim. After verifying the documents, the insurance company settles the claim.
For a speedy claim settlement, the right documentation is essential. So, let’s check out the documents required for health insurance claims.
Documents required for health insurance claims
For cashless claims
Insurance companies use the cashless health insurance claim process if you get admitted to a networked hospital. For a cashless claim, the insurer needs the following documents–
· Pre-authorisation claim form
The pre-authorisation claim form is needed to get approval for cashless claims. This medical claim form is available from the insurance company. You must complete the form and submit it to the company 3-4 days before a planned hospitalisation. In case of emergency hospitalisation, submit this medical claim form within 24 hours.
Besides the pre-authorisation form, you don’t have to offer other documents. The hospital does the documentation and submits it to the insurance company for claim processing. However, you can ensure proper documentation for smoother claim settlements.
For reimbursement claims
If you are treated in a non-network hospital or your cashless claim is not approved, the insurer will settle your claim on a reimbursement basis. For reimbursement claims, you have to take care of the documentation. The list of documents required for reimbursement claims is as follows –
· Claim form – Download the health insurance claim form from the insurance company’s website or get it from the branch office. Fill it out and submit it.
· Medical documents – The following documents are needed in original –
· Doctor’s prescriptions
· Reports of diagnostic tests
· Medical bills
· Hospital bills showing the breakdown of all treatments and their relevant expenses
· Pharmacy bills
· Bank details – Under reimbursement claims, the insurance company pays you back for the expenses that you have incurred. To receive the payment, the following bank-related documents will be needed –
· ECS (Electronic Clearing Service) form
· Cancelled cheque, which contains your bank account number and IFSC code
Once the documents are submitted, the insurance company will process and settle the claim.
Things to remember
While proper documentation is needed, there are some things that you should keep in mind when understanding how to claim health insurance. Have a look at what they are –
· In most cases, the original documents are needed for the claim. So, make a copy of all the documents and keep the copies with yourself. This will help you maintain a record of the claim.
· Do you know how to claim health insurance if you have more than one health insurance policy? If you are making multiple claims, the documentation would be slightly different. First, submit the original documents to the first insurer and get the attested copies of the document and a settlement certificate. Submit the attested documents and the settlement certificate to the second insurer for claim settlement.
· Insurance companies specify a maximum period in which you must submit the documents after claim intimation. Make sure to submit the documents within the period for speedy settlements.
It is vital to understand the claim process and know how to claim health insurance. Thereafter, you can raise a cashless or reimbursement claim depending on which hospital you choose for treatment. Collect all the medical documents in original, fill out the health insurance claim form and submit it to the insurer for claim settlement. For multiple claims, collect attested copies and a settlement certificate from the first insurer and submit them to the second insurer for claim settlements. You should also keep your documents handy so your health insurance claim process stays smooth and convenient. Also, submit the documents timely so that your claim is settled quickly and you get the financial assistance you need.
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