Health insurance policies provide financial protection against unexpected medical expenses. It works as a great asset to tackle medical emergencies. To reap maximum benefit from your health insurance policy, it is important to know the process to make health insurance claims. You get two options to settle health insurance claims: cashless and reimbursement claim settlement.
Read on to know about the two types of health insurance claims in detail. Also, get to know the documents required to file a claim, and tips to avoid health insurance claim rejections.
How to make a health insurance claim?
The first thing to do when making a health insurance claim is to inform the insurance company as soon as possible. It is important to adhere to the time limit specified in the policy for filing a claim. The insurer’s representatives guide you through the claim process on documents you need to submit and how to fill out the claim form. If you do not inform the insurer in time, your health insurance claim may get rejected. For more details on how to claim medical insurance, refer to the policy guidelines and insurer's instructions.
Types of health insurance claims
Here are the two ways that you can file a health insurance claim.
Cashless claim settlement
In a cashless health insurance claim, the insurer directly deals with the network hospital. Here you only need to get treated or admitted at any of the nearest network hospitals and inform the insurer. You need to give a claim intimation within 48 hours of emergency admission or 72 hours before planned hospitalisation. Also, contact the insurance desk at the hospital immediately after getting admitted. Following which the admin will send a pre-authorisation form, claim form, and necessary documents to the insurer.
If you already got the pre-authorisation form approved by the insurer, the process will start sooner. Upon reviewing the documents, insurer will approve the claim if it is within the policy terms and conditions and settle the bills directly with the network hospital.
Reimbursement claim settlement
This facility enables you to choose any of your preferred hospitals to get the treatment. The only difference here is that you will need to clear the hospital bills first and then claim for reimbursement. You need to give a claim intimation to the insurer within 48 hours of emergency or three days before planned hospitalisation for the reimbursement claim process.
For effective management of health insurance claims, after getting discharged, submit the hospital bills, discharge summary, doctor’s prescriptions, and reports to the insurer. You may need to submit a few documents as required or asked by the insurer. After reviewing the documents and verifying the claim’s authenticity, the insurer will reimburse the claim amount within 10-15 working days. In some cases, it may take up to 30 days. This depends on the insurer and their policy terms and conditions. You will receive the claim amount in your registered bank account.
Types of hospitalisations covered by health insurance claims
Health insurance policies typically cover various types of hospitalisations, enabling you to make a medical insurance claim for different medical needs. Here are the main types:
- Emergency hospitalisation: Immediate treatment required due to sudden illnesses or accidents.
- Planned hospitalisation: Scheduled treatments or surgeries for known medical conditions.
- Daycare procedures: Treatments that do not require an overnight stay, such as cataract surgery.
- Pre- and post-hospitalisation expenses: Costs incurred before and after hospitalisation for diagnostics and follow-up treatments.
Also, check the claim settlement ratio in health insurance.
