How to Claim the Diabetes Cover in Health Insurance?


how to claim the diabetes cover in health insurance

It may sound alarming, but it is a fact, diabetes is becoming a serious health problem in India, with the leading cause being obesity and an unhealthy lifestyle – to which, ironically, many people have become prone. We are living in an age where we are witnessing a rise in lifestyle diseases and healthcare costs at the same time. On any average family, it can be a financial burden unless one has a health cover. Thankfully, nowadays, one can easily get a health insurance for diabetic patients and save the family from the hardships often resulting from expensive medical treatments.

While you take into account several factors before buying health insurance for diabetes, there is one more thing you should be clear about - that is the procedure to file a claim on your diabetes cover.

>>Read: Things to Check Before You Choose a Diabetes Insurance Plan Online

This article is a guide on filing a claim on your diabetes health insurance plan:

Note the Waiting Period

When opting for any health insurance cover, a person must take a close look at the policy wordings and understand the waiting period and other terms like inclusions, exclusions, and sub-limits. It will ensure to make your claims process easy and hassle-free.

For those having diabetes at the time of buying a health cover, they must wait for a specific waiting period before they can get a claim. Many health insurance plans come with a waiting period of 48 months for pre-existing medical conditions. According to the Insurance Regulatory and Development Authority of India (IRDAI), a pre-existing disease is any disease, illness, or injury, or related condition(s) for which medical advice was received/ or was diagnosed by a medical practitioner within 48 months before the effective date of the policy issued by the insurer or its reinstatement.

On the other hand, health insurance plans for diabetic patients have a waiting period of 24 months for the pre-existing disease. Also, there is an initial waiting period of 30 days.

Opting for health insurance much early is advisable, as it will eliminate the chances of a person having any pre-existing condition. Thus, one does not have to bear out-of-pocket expenses.

Filing a Claim under Your Diabetes Health Insurance Plan

Health insurance for diabetic patients is extremely beneficial, especially those who incur high medical expenses due to their long-term treatment. It is a plan specifically designed for them and offers various benefits and adequate coverage for treatment. There are two ways one can make a claim – the cashless claim and reimbursement claim.

The Cashless Claim Facility

When dealing with an emergency hospitalization, a family will save crucial time by opting for the cashless claim facility. Under this facility, available only at a network hospital, the insured person does not have to pay for the hospital bills and later apply for a reimbursement claim. If you have opted for the diabetes insurance plan by Care Health Insurance, you can stay relaxed about the bill payments. We will settle the expenses directly with the hospital.

The cashless facility will reduce your effort and valuable time and let you concentrate on your health and recovery. It will prevent even any temporary burden on your savings.

The more comprehensive the hospital network, the higher your chances are of finding the best hospital near your location. We have over 8,250 network hospitals empaneled with us. All you are required to do is to select the network hospital of your choice in your vicinity to get the cashless treatment.

Here are the steps for getting a cashless claim:

  • Step 1: Choose a network hospital for medical treatment
  • Step 2: Notify us within 24 hours in emergency hospitalisation, and 48 hours before admission for planned hospitalisation
  • Step 3: Show your health card and a valid photo ID proof to avail of the cashless benefit
  • Step 4: Submit the duly filled and signed pre-authorisation form at the hospital insurance desk
  • Step 5: After verification of documents, our claim management team will send an approval
  • Step 6: The claim management team may raise a query if required
  • Step 7: After approval, the medical bills are settled, as per the policy terms and conditions

The Reimbursement Claim Facility

There is a basic difference between network and non-network hospitals. While the former enables you to get treatment on a cashless basis, the latter does not offer this facility. In case you have chosen a non-network hospital for your medical treatment, you still need not worry. You may have to spend for the expenses from your pocket initially, but the expenses will be reimbursed as per policy terms and conditions.

Here are the steps for getting a reimbursement claim

  • Step 1: Avail of medical treatment at any non-network hospital
  • Step 2: During the claim intimation, provide relevant details including name, Customer ID, and hospital details
  • Step 3: Download the claim reimbursement form from our official website
  • Step 4: Submit the duly filled and signed claim reimbursement form, along with required documents, including the specified medical documents
  • Step 5: Our claim management team will review the case. If required, it may raise a query
  • Step 6: The team will send an approval letter
  • Step 7: In the case of claim rejection, the reasons will be communicated to the policyholder

Final Word

To avoid facing any confusion or hassle when filing a claim under your diabetes health insurance plan, make sure you have the right knowledge of the claims process, including the time limit for notifying the insurer. Further, one has to be honest when disclosing information when buying a health cover, particularly any pre-existing illness. These are some of the tips to avoid any claim rejection or delays.

The online facility helps a policyholder to initiate a claim online. Moreover, once you file a claim, you can also track the status online. To check the status, visit our website and go to the claims section. Enter the relevant details, like your policy number.

In case you have a query, you can feel free to reach our customer care team, where experts will be ready to assist you.