Health insurance has become a basic necessity for everyone. The right health insurance plan can help you deal with an unannounced medical emergency and give you the much-needed peace of mind that your finances are secure. While there is no denying that your health plan has got you covered, one of the main issues you may be concerned about is the health insurance claim.
You may have heard about insurance claims being delayed or, in worst-case scenarios, rejected. This can indeed cause worry in an already distressed time. While it is your insurer who approves the claim, you need to understand that the onus of a smooth health insurance claim lies in your hands. Incomplete paperwork, insufficient information, and lapses in following procedures are some of the factors that can affect your claim settlement.
With India’s medical inflation as high as 14%, investing in a health insurance plan is essential; however, it is also crucial to understand the health insurance claim meaning and how the claim procedure works. After all, claim settlement is the reason you purchased the health plan. Knowing the types of claims in health insurance and understanding the company procedure can be helpful in avoiding trouble when raising a claim.
The claim settlement procedure depends on the type of hospital that you seek admission in.
Some healthcare centres and hospitals collaborate with your insurer to give you the advantage of cashless treatment. Here, the medical bills are paid by the company.
In a non-network hospital, you’ll have to pay the bills upfront. Only post-discharge you’ll be able to raise a claim along with the submission of all the required documents.
Did you know, Care Health Insurance has a vast network of more than 21500+ cashless healthcare providers?
>> Also Know: How to Make Health Insurance Premium Payment Online
Whether it is you or a loved one who is hospitalised, in case of medical urgency, things can get a little stressful. In such a scenario, it may happen that you miss out on a few things. It is extremely important for you as a policyholder to be aware of some simple tricks/ hacks that can help you streamline your health insurance claim. Read on.
You might have heard this a hundred times, but it is imperative that you not just read but also understand all the terms and conditions of the policy document. A superficial reading can lead to a lot of misinterpretation and/or misinformation. Given below are some of the common terms that you need to be aware of:
a. Sub-limits: Irrespective of the sum insured that you choose, typically, there are sub-limits in almost all health plans. Certain aspects of hospitalisation are covered but up to a specified limit only.
b. Waiting period: Every health insurance plan comes with different waiting periods that may vary from plan to plan and insurer to insurer.
c. Co-payment: Co-payment means the percentage of the claim that you need to pay from your pocket. Whether it is mandatory or voluntary, it is important to know how the co-payment would affect your out-of-pocket expenses.
d. Exclusions: Despite having a comprehensive insurance policy, there are certain conditions that are not covered. Understand the exclusions well in advance.
Tip: If there are certain terms that you find difficult to understand, take the help of an insurance expert who would help you get a clear understanding of the inclusions and exclusions of the policy.
Notifying the insurance company is an essential step that should be taken timely. In case of planned hospitalisation, you should inform the insurer at least 3-4 days before the admission.
In case of an emergency, you should inform the insurance company within the first 24 hours of hospitalisation, even if you plan to opt for a reimbursement claim. The notification can be done in a way convenient to you. You can write to the insurer, call customer care or raise the claim through the company website/ mobile app.
Did you know, Care Health Insurance has successfully settled 38 Lakh+ Insurance claims since inception?
While most insurers these days follow minimal paperwork procedures, certain documents such as pre-authorization forms for cashless hospitalisation, approval letters, FIR (if needed), doctor’s prescriptions etc., are often asked for. Make sure you keep all the pre and post-hospitalisation documents, original bills and receipts and medicine bills safe.
Tip: Keep the health card, policy papers, ID proofs and other such documents safely in a file and make sure your immediate family members are aware of it. In case of emergency hospitalisation, it would be easier to gather the documents.
The 4 most important documents to definitely submit for a smooth health insurance claim process, especially in the case of reimbursement, are:-
Opting for a cashless claim can make the claim process very convenient. As the medical bills are cleared directly by the insurance company/the TPA, it reduces your running around significantly. Most of the formalities are completed by the insurer, and you end up only paying for the uncovered expenses.
If you had to seek admission to a non-network hospital, fret not, you can still get the coverage in the form of reimbursement.
Tip: Make sure you stay updated with the list of network hospitals, especially the ones in your vicinity. This way, you would be able to reach the nearest hospital in your time of need and avail the benefits of a cashless claim.
Hiding information in order to avoid paying a higher premium can be a serious mistake. Trying to save a few bucks today may lead to claim rejection as well as legal trouble for you in the long run.
Tip: Rather than hiding the facts and giving incorrect information, try opting for plans well-suited to your medical condition. With Care Health Insurance, you get comprehensive coverage even when you have pre-existing illnesses.
To make the most of your health insurance policy, it is imperative that you understand the inclusions and exclusions that come with it. Not being aware of the details can cause confusion and heartburn when raising your health insurance claim. It is also essential that you know about the health insurance claim settlement ratio of your insurance provider.
A company that has a higher claim ratio would surely have a more customer-centric approach and would ensure customer satisfaction. With Care Health Insurance, getting your health insurance claim settled is not a hassle at all. Just make sure you follow the tips given above and settle your claim instantly and easily. You can check your Care Health Insurance claim status online instantly.
Disclaimer: Plan features, benefits, coverage, and claims underwriting are subject to policy terms and conditions. Kindly refer to the brochure, sales prospectus, and policy documents carefully.
Published on 21 Sep 2023
Published on 21 Sep 2023
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