Do Your Homework Before Filing Health Insurance Claim ?


Do Your Homework Before Filing Health Insurance Claim ?

It takes a lot of planning and research for selecting the best health insurance. Buying a health cover is an essential step in ensuring financial protection in times of medical emergency. When buying an insurance policy, it is advisable to thoroughly read and understand the policy terms so that there are no hassles at the time of filing a claim.

Here’s a simple guide you can follow to stay worry-free when it comes to enjoying the benefits of your health insurance policy.

Understand the Claims Procedures

Claims are settled in two ways - cashless claim if treatment is opted for in a network hospital and reimbursement claim where the policyholder has to initially pay for the expenses from his/her pocket.

Cashless and reimbursement claims procedures differ a lot from each other. Make sure you are aware of the steps involved, depending on the policy terms.

>> Check: Health Insurance Claim Process

Contact Your Insurer on Time

You may miss out the benefits of your health insurance policy if you do not intimate your insurer on time.

Ensure your claim is not denied by adhering to the timeline specified by your insurer:

  • In case of emergency hospitalisation, within 24 hours of admission in hospital
  • In case of planned hospitalisation, 48 hours prior to admission in hospital

Keep Documents Safely

Do not forget to provide important documents that are needed for processing your claim.

  • For cashless claim you will require:
    • Pre-authorization form
    • Health Card along with Photo Identity Proof 
  • For reimbursement claim, you would be required to submit:
    • Hospital discharge summary
    • Investigation Reports
    • Bills/receipts of diagnostic tests, consultation, pharmacy, etc.
    • Identity Proof

Further, when filing claims for personal accidents, you may also have to provide First Information Report, to the insurer.

Be Aware of the Waiting Period

Hiding any kind of fact concerning your health condition is a big no-no. Pre-existing aliments get covered after you complete the specified waiting period, as per the policy terms. So, reveal all your pre-existing conditions at the time of buying the insurance policy.

Also, in many health policies, there is an initial waiting period, usually 30 to 90 days. In case, you find the need to avail medical treatment during this period, you cannot get a claim. This is applicable for all cases except for emergency hospitalisation due to accidents.

Find Out About the Sub-limits

In health policies, there is a cap on certain medical treatment procedures or specific diseases. That is, they would cover the expenses, but only up to a specified sum as mentioned in the policy terms. There is a sub-limit usually on ICU and ambulance charges, room rent, etc. Sub-limits are also applied on medical procedures such as cataract treatment, hernia, knee surgery, removal of kidney stones, etc.

In some plans, there is a co-payment feature wherein the insured person must pay a fixed amount for every claim.

So, it is recommended that you find out about the costs from the total payable amount that you have to share from your pocket.

Situations can get problematic without prior planning. Medical emergencies can be stressful. So, make sure you have the best health insurance with you that will cover all the major medical expenses. Care Health Insurance offers a wide range of health insurance plans and has seamless procedures when it comes to claim settlement.

Disclaimer: Please read the brochure and prospectus to know more about our health insurance plans cover as conditions may vary.

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