Duties of a Policyholder in the Event of Filing the Claim


Duties of a Policyholder in the Event of Filing the Claim


It always gives you a sigh of relief that you have health insurance. From a cashless treatment facility to no claim bonus, you are in a win-win situation when you get insured. Care Health Insurance-as the name indicates, care for its every customer and settle their claims timely. But do you know policyholders also have some duties that ultimately help us to serve them better? Here are some essential responsibilities that every insured should follow while filing a health insurance claim settlement. But, before that, below is the brief about claim settlement. Take a look!

How Can You Get the Claim?

Under the health insurance policy, you can get a claim in two ways: 

  • Cashless Facility
  • Reimbursement

Cashless Facility: For a cashless facility, you should admit to any network hospitals empaneled with us. You need to inform the hospital TPA desk and our claim management team about the hospitalization. We will bear your in-patient hospitalization, treatment, and medication expenses to the hospital subject to the sum insured and policy terms and conditions under cashless hospitalization

Reimbursement: In this case, you will get the compensation against the expenses you have made for your treatment, hospitalization, and medication once you submit all the required documents to the hospital TPA desk and our claim management team. 

>> Click here: guide for health insurance claim process

Responsibilities of a Policyholder in the Event of Filing the Claim 

Follow these responsibilities to ensure timely claim settlement under health insurance:

Check the list of Network Hospitals: During any medical emergency, the first thing you should do is check the network hospitals' list. Ensure the hospital is adequately offering the necessary treatment.

Admission in Network Hospitals: For cashless treatment facility always go for network hospitals. It is so because a cashless hospitalization facility is available only at the network hospitals. You cannot get it in any non-network hospitals. 

Read Exclusions List Carefully: It is the foremost duty of a policyholder to read the exclusion list before filing the claim carefully. You cannot ask a claim for a situation/treatment/medical procedure/condition that is not part of the policy coverage. 

Submit Required Documents: As a responsible policyholder, you should collate all the necessary bills for hospitalization, surgery, medicines, doctor's prescriptions, and pre-authorization form. You should keep all the originals in one folder and submit them to the hospital TPA desk and claim management team.

Timely Intimation: If you want to get a timely claim settlement, you should intimate to the claim management team and hospital TPA desk timely.  In case of an emergency,  it should be within 24 hours and before 48 hours in case of planned admission.

Never Hide Past Medical History: To ensure claim settlement, you should never hide your past medical history. Share your information about your pre-existing disease at the time of buying the policy. 

Over to You!

Care Family health insurance protects you and your loved ones. It always helps you during a medical emergency and keeps your hard-earned money safe. Therefore, as a policyholder, you should follow your duties to ensure timely claim settlement and avoid last-minute chaos.

Disclaimer: Underwriting of claims is subject to policy terms and conditions.

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