Having a health insurance policy during unexpected medical emergencies is a blessing. If someone knows how to claim health insurance beforehand, the procedure is less stressful for them and their family.
This health insurance claim guide will explain the step-by-step process for filing claims so that policyholders can access their benefits without unnecessary delays or rejections.
Understanding the Health Insurance Claim Process
What is a health insurance claim? It’s a formal request you submit to your health insurance provider to recover the expenses incurred during a medical treatment.
How to claim health insurance? There are primarily two ways: cashless and reimbursement.
- Cashless claim process in health insurance
A cashless claim allows you to avail yourself of medical treatment at a network hospital within your insurer’s network without any upfront payment. The insurer directly settles the bill with the hospital.
- Reimbursement claim process in health insurance
Suppose you choose a non-network hospital or incur medical expenses outside of hospitalisation. In that case, you must pay the bills and then file a medical insurance claim for reimbursement. The insurer will review your claim and reimburse you for the covered expenses per your health policy terms.
How to Claim Health Insurance in a Hospital: A Step-by-Step Guide for Cashless Claims
Here’s a step-by-step breakdown of how to claim health insurance in a hospital for cashless claims:
1. The first step is to choose a hospital within your insurer’s network. A list of network hospitals is included in your mediclaim policy or on the insurer’s website.
2. Inform your insurance company about your hospitalisation as soon as possible. Planned procedures should be done at least 3 days in advance. In case of emergencies, notify them within 24 hours of admission.
3. Obtain the pre-authorisation form from the Third-Party Administrator (TPA) desk at the hospital or your insurance company. Fill it out accurately and submit it with proof of your ID and health e-card at the hospital’s TPA desk.
4. The insurance company will verify your claim and, upon approval, directly settle the bill with the hospital.
Here are some tips that you need to consider during the health insurance claim procedure for a cashless claim:
- Double-check that the chosen hospital is indeed part of your insurer’s network to avoid later claim rejection.
- Ensure you have the necessary documents, such as your ID proof, health e-card, and medical records, handy for a smooth claim process.
How to Claim Medical Insurance: A Step-by-Step Guide for Reimbursement Claims
If you opt for treatment at a non-network hospital or for outpatient medical expenses, here’s a guide on how to claim medical insurance for reimbursement:
1. Similar to cashless claims, notify your insurance company within 3 days of planned procedures or 24 hours for emergencies.
2. Collect the claim settlement form from your insurance company or the TPA desk at the hospital.
3. Once discharged, collect the discharge summary, bills, and receipts from the hospital.
4. Fill out the claim form accurately and submit it to the insurance company with the required documents.
Here are some tips that you need to consider during the health insurance claim procedure for a reimbursement claim:
- Maintain a paper trail by collecting and keeping photocopies of all bills and receipts.
- Know the documents required for a health insurance claim and submit them within the timeframe specified in your policy to avoid delays.
- Carefully review your claim form for any errors or omissions before submission.
Documents Required for Health Insurance Claim
Having the correct documentation is necessary for a quick medical insurance claim process. Here’s a comprehensive list:
- Duly filled claim form
- Your health e-card or your mediclaim policy
- Photo ID proof
- Proof of address
- Original discharge summary
- Doctor’s prescription recommending hospitalisation (if applicable)
- Doctor’s consultation slips and prescriptions for diagnostic tests
- Certificate from the attending doctor (if applicable)
- Prescription of medicines and original pharmacy bills
- Diagnosis reports (X-rays, blood tests, etc.)
- Other original receipts from the hospital
- Breakup of the hospital bill
- Ambulance receipt (if applicable)
- FIR (in case of an accident)
- Identity proof (e.g., Aadhaar Card, passport, voter ID)
Tips to Avoid Health Insurance Claim Rejections
To ensure your medical insurance claim process goes smoothly, follow these tips:
- Timely Notification: Notify your insurer within the specified timeframe.
- Accurate Information: Ensure all information provided is accurate and complete.
- Understand Policy Coverage: Familiarise yourself with your policy’s inclusions and exclusions.
- Use Network Hospitals: Opt for cashless services at network hospitals when possible.
Following these tips and the health insurance claim guide will ensure your claim is accepted without issues. Generali Central not only makes the claim process in health insurance simple but also offers a range of policies designed to suit your different needs. Explore the DIY Health Insurance, FG Health Absolute, and FG Health Elite plans to find a policy that provides comprehensive coverage and a hassle-free claim process.
Understanding how to claim health insurance will make a difference during a medical emergency. By following these steps and understanding the intricacies of the claim process, you can avoid common pitfalls and ensure a seamless experience. Remember, a well-prepared claim is a successful claim.
