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Key Things To Keep In Mind While Making A Health Insurance Claim

Key Things To Keep In Mind While Making A Health Insurance Claim

Health insurance, not a new phenomenon for Indians and the number of people insured under the same in the country is also a less but with rising medical cost it is becoming necessity . Certified financial planners are also now considering Health insurance as a major component of your insurance portfolio other than your life insurance. Either you are consider covering for yourself or for your whole family, health insurance is becoming a must have thing.

When you are considering health insurance there are many factors which you should keep in mind, other than what is covered and what is excluded under your policy claim also becomes an important component. Settling claims with your insurance provider when you actually need it becomes an important thing. In terms of claims in health insurance they are of two types:

  1. Cash less claims
  2. Reimbursement claims

When it is cashless the process become very easy, say if you are policy holder you just need to admit in a hospital which is part of the network of hospitals registered with your insurers or third party agency. In case of a medical emergency post admission into the network hospital you either need to inform the insurers or the third party agency and the rest thing been taken care by them. All these third party agencies are commonly called TPAs and generally in all registered hospitals you will also find a person from your TPA sitting there as a part of the customer service team to address policy holder’s query. In case of cash less claim, the policy holder might not require paying anything in cash to the hospital and all the cost would directly paid to the hospital by your insurance company other than things which not part of the coverage.

The scenario become different if the claim is reimbursement based. It is not necessary that you always get networked hospital near you at the time of medical emergency. In a case like this also need to inform your insurer or the TPAs but the ease of cash less would not be there. You first need to bear the cost from your pocket and then put it before your insurance provider to get it reimbursed by them.

A claim be it cashless or reimbursement based you always need keep few things in mind so that you can enjoy maximum benefits from your policy. If you don’t keep these key things in mind then the claim process can be sometimes becomes frustrating. In a situation of claim you as a policyholder should keep the below things in mind:

  1. Keep all medical receipts with you or also somebody from your family to take care of the same and arrange the same in a chronological manner.
  2. Get the claim form from your insurance provider and fill the same with requisite as asked for to raise claims
  3. Prepare copies of original documents for the purpose of raising claims
  4. Review the documents once the same is prepared before dispatching to the insurance company
  5. Before raising any claim read through the fine print of the policy to understand the exclusions so that you know what the insurance company would pay or not.

While maintaining original document do keep in mind that all the documents should have name of the patient, name of treating consultant and date on which the product is purchased or the service been taken ,with appropriate taxes and sign of the authorized signatory to prove validity of the document submitted for claims.  Other than the bills you should keep all relevant medical proofs like discharged document, medical prescriptions and other related documents.

Most of the health insurance policies provide for coverage for pre and post hospitalization cost so while maintaining documents for claim settlement all the necessary document related to the same should also be kept.

Following a diligent process can help you get your out of the frustration of raising claims. Always try and understand the exclusions what you need to bear and what your insurance provider would so that you can plan your medical emergency well in advance.

At Myinsurancebazaar.com you can also raise your claims request through our team even if the policy is not brought through the website .To submit your request click on Submit Claim

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