Documents Required for Health Insurance Claim

• Written by Bhawika Khushlani

  Reviewed by Munmi Sharma

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A medical emergency can knock at your door anytime. Buying a health insurance policy is necessary to protect your lifetime savings and ensure ultimate peace of mind at times of crisis. However, we only learn the policy's value when a medical emergency arises.

If you have already purchased a policy and due to some unforeseen event, want to file a claim, then the most important thing to focus on are documents required for a health insurance claim.

However, if all things are in order, then claiming the coverage is not a hassle. You just need to get well informed about the health insurance claim process.

Care Health Insurance has a convenient claim settlement process. We offer a simple and quick claim procedure. Visit our company's official website and connect with anyone from 21,700+ cashless healthcare providers. This article will teach you about our Care Health Insurance policy's required documents and claim process.

Documents Required to Claim Health Insurance

Here is the list of documents required for health insurance in India to file a claim:

• Insurance Claim Documents
• Duly filled and signed claim form
• Pre-authorisation form (for cashless claim)
• Valid identity proof, such as Aadhaar Card
• Policy details that include the name of the insured, policy number, illness and address
• First Information Report(FIR), if applicable
• Indoor case papers
• Ambulance receipt
• Any other document required to assess the claim, in case of any fraud
• Other documents required for the cashless facility

Medical Documents

• All diagnostics and medical reports
• Original payment receipts, hospital bills, and discharge summaries
• Pharmacy bills and prescriptions
• Doctor’s prescription recommending hospitalisation
• Doctor’s prescription advising medicines, diagnostic tests, and consultation

Tip: If you are wondering which of the following documents need not to be submitted for reimbursement of every medical claim, then any document submitted for a prior claim is not necessary to resubmit, like ID proof and duplicate documents.

Claim Process for Cashless Treatment

You can get a cashless facility at more than 21700+ cashless healthcare providers across the country. Find a network hospital where you can avail of cashless health insurance treatment. You need to follow the following steps:

• Get the pre-authorisation form available at the hospital's insurance / TPA Desk.
• Send it to customer support.
• You will get an approval letter after verification.
• For any further queries from the claim management team, you or the hospital staff must respond to them.

Note- In case a cashless claim gets rejected, you can carry on your treatment as per the doctor's advice, and file for a reimbursement claim.Claim Process for Reimbursement

If the treatment is availed from a non-network hospital, the insured has to bear the medical expenses initially. However, they can file for reimbursement right after the discharge by submitting all the documents required for insurance policy claim. This facility is also helpful if cashless treatment is denied by the insurer.

You need to abide by the following steps to claim reimbursement:

• Submit a claim form along with the required documents, as per the policy terms & conditions.
• You will receive an approval letter sent by the claim management team.
• Ensure to respond to the query raised by the claim management team.
• The team will communicate the reason in case of rejection.

Final Word!

The insured should not delay in intimating the insurer regarding the claim, as it may lead to claim rejection. Make sure all facts are factual and the information provided is correct. It is crucial to follow the guidelines mentioned in your health insurance policy to ensure that your claim is settled on time.

Disclaimer: Plan features, benefits, coverage, and underwriting of claims are subject to policy terms and conditions. Please refer to the brochure, sales prospectus, and policy documents carefully.