Steps to claim your health insurance policy

insurance policy

Steps to claim your health insurance policy  7thAugust 2021


The Covid-19 pandemic shook the world's medical infrastructure from the ground. As a result, the cost of medical services and its subsequent operations is now more than ever. With the huge inflation in the expenses of medical bills, investing in health insurance coverage is no longer an option but a necessity.

To live carefree in these uncertain times without worrying about medical expenses, a trustworthy health insurance cover for every family is a must. And, if you're someone who is already holding a health insurance policy, you should be familiar with the claim settlement process as well.

In this space, we help you to understand steps to claim your health insurance policy so that in the future, if need be, you're prepared beforehand.

There are mainly two types of claim settlements.

1. Cashless settlement:

The cashless claim facility relieves you of concern during a medical emergency when receiving treatment at any of the networked hospitals. According to the policy features, the health insurance company will pay the hospital bills directly. Therefore, it frees you of the burden of making direct financial payments to the hospital.

Steps to claim a cashless facility:

• Select a hospital from the list of network hospitals provided by the insurance company

• Then, notify the third-party administrator (TPA) and provide them with your membership number

• At the hospital, fill out a cashless request form. However, remember that a valid certification by a doctor with proper stamps and signatures is a must

• Next, mail the form along with the medical records physically or digitally to TPA

• TPA will then inspect all the documents submitted by you, and if the settlement is approved, the charges will be paid by the insurance company directly to the hospital

If in case of disapproval, you should apply for reimbursement. We cover this in the following category of claim settling.

2. Reimbursement settlement:

If you choose a non-network hospital for treatment, you must first pay the medical expenditures out of pocket. Then, following the submission of relevant papers, the health insurance company will reimburse the charges according to the terms and conditions of the policy.

Steps to claim the reimbursement facility:

• Contact your health insurance provider using the toll-free number and give them your membership number

• Settle all your medical bills with the hospital

• Then, download and complete the reimbursement form that is available on the health insurance company's website

• When requesting reimbursement, attach the downloaded form, include the invoices, medical bills along with reports, discharge summary, and any other relevant papers

• Then, submit everything to the claim office in your vicinity. You can even digitally mail the documents to the insurance company

• After the approval of your claim, a cheque will be sent to your registered bank account by the insurance company. The whole procedure takes 20-30 working days from the day all papers are presented

Additional tips to speed up your claim settlements:

• Fill the reimbursement form correctly. Make sure all of the medical records and subsequent documents have stamps and signatures of the concerned authority

• Register for a claim as soon as possible after admission to the hospital

• Take regular updates from the insurance company after the submission of all the documents

• Always go for cashless claims whenever possible

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