How to File a Claim?

The claim process should be hassle-free and straightforward. Look for a plan that has a simple and quick claim settlement process, and the insurer has a good track record of settling claims on time.

People get into such a situation when they are not aware of claim settlement process in health insurance. So, know the below-mentioned easy steps to ensure a hassle-free health claim process. You can file it in two ways:

Filing a claim for health insurance is an essential aspect of the policy. There are two ways to file a claim: health reimbursement claims and cashless claims.

Reimbursement Claims

In case of admission to a non-network hospital, you can settle your bills with the hospital and file for reimbursement of those expenses with us within 30 days of discharge. Your claim will be processed within given time varying from insurer to insurer, normally it is 7 days of submission.

Cashless Claims

Cashless claims are quick, easy & hassle free. You get treated at one of insurance company's network hospitals and we pay for the expenses directly to the hospital. Reach out to insurer at least 48 hours before the treatment in case of planned hospitalization, within 24 hours of admission in case of emergency hospitalization. After completing the treatment, the insurance company settles the bill directly with the hospital.The process for filing claims for planned and emergency hospitalization may vary as given below:

For Planned Hospitalization

  • Inform the insurer at least 48 hours before the treatment.
  • After getting approval from the TPA, file for reimbursement and cashless claims by submitting the claim form.
  • Submit other related documents such as medical bills, reports, discharge summary, etc.
  • The insurer pays the claim amount directly to the policyholder for reimbursement claims.
  • For cashless claims, the hospital bill is directly settled by the insurer.

For Emergency Hospitalization

  • Inform the insurer at least 48 hours before the treatment.
  • After getting approval from the TPA, file for reimbursement and cashless claims by submitting the claim form.
  • Submit other related documents such as medical bills, reports, discharge summary, etc.
  • The insurer pays the claim amount directly to the policyholder for reimbursement claims.
  • For cashless claims, the hospital bill is directly settled by the insurer.

Documents required

List of Documents required from Health Insurance Claim for Cashless and Reimbursement
  • Claim form – duly filled and signed
  • Doctor’s prescription and referral letter
  • Diagnostic tests and medical reports
  • Original bills, receipts, and discharge papers from the hospitalization
  • Original bills from pharmacy/chemists
  • Police Report or FIR in case of personal accident
  • Post-mortem report, if conducted
  • Death certificate
Health Policy details including number, name of the policyholder, nature of the illness, address, and other required information

Tips to Avoid Claim Rejection

Sometimes, claims may get rejected, and this can be due to various reasons. Here are some tips to help you get a claim and prevent rejection of claims:
  • Do not hide any information such as any pre-existing condition at the time of buying a policy
  • Contact the insurer as per the time specified for planned and emergency hospitalisation
  • Keep vital documents securely including medical reports and submit them when filing a claim
  • Original bills, receipts, and discharge papers from the hospitalization
After buying a health insurance policy, the first step is to read the policy documents carefully to understand its features, inclusions, exclusions, waiting period, and, more importantly, health insurance claim procedure. This way, you will escape the last minute hassles and ensure you get the most out of your health policy.
Moreover, the online facility helps to initiate health insurance claim process, submit documents, and track the claim status, thus saving your precious time and efforts. Investing in health insurance is a wise decision to protect yourself and your loved ones in case of any medical emergency. A good acquaintance with the various aspects of the claim procedure for health insurance helps you to avoid medical insurance claim rejection. For quick claim- settlement check the health insurance plans offered by us. Our claims processing steps are simple, and our insurance advisors help you if you are stuck in an awkward situation while filing a claim.

FAQs

Cashless hospitalization is a process wherein the insured person doesn't have to pay for medical expenses in case of a hospitalization if patient gets admitted to a network/empanelled hospital. However, you may have to pay certain deductibles or non-medical expenses at the time of discharge.

Network hospitals often referred as cashless hospitals are hospitals which have tied up with your insurance company for providing cashless hospitalization benefit.

If you get admitted at a non-network hospital, you have to pay the bills first and later claim for reimbursement.

Step 1: Approach TPA desk of Network Hospital (recommended at least 48 hours before the treatment in case of planned hospitalization, within 24 hours of admission in case of emergency hospitalization)
Step 2: Share Health Card or your policy number, and Passport size photo, PAN card or Aadhar card along with your medical records.
Step 3: Network Hospital would check your identity for validation and submit preauthorization form to us.
Step 4: We review and provide our confirmation to the network Hospital by e-mail and send a text message and e-mail to you.
Step 5: Get your treatment done and sign all documents, forms and invoices on discharge. Step 6: We make payment to the hospital for preapproved treatment as per policy terms and conditions.

Step 1: Get admitted to any recognized hospital for treatment.
Step 2: Settle your bills with the hospital.

Step 3: Collect all relevant documents, invoices, medical reports, discharge summary from Hospital in original and receipts of the payment made to the hospital.
Step 4: Please ensure that claim is submitted to insurer company within 30 days from date of discharge with documents. Step 5: Insurer will review and process the claim as per Policy terms and conditions .

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