As an initiative to provide health insurance to all India's citizens, the IRDAI has introduced Arogya Sanjeevani Health Insurance Policy. It is a standard health insurance plan that offers ample coverage to you and your family. Under this health insurance policy, you can also file a claim against the hospitalization expenses. It is the most critical aspect of the health insurance policy. So, let's understand how you can get a hassle-free claim settlement.
What is Claim Settlement?
A health insurance claim is a process where all your medical bills settle according to the policy terms and conditions. Like other health insurance plans, in Arogya Sanjeevani Policy, you can also file a claim in two ways:
- Cashless Claim
- Reimbursement of Claim
Under a cashless claim, hospitalization in any of the network hospitals is necessary. You need to submit the required documents. After verification, you get approval, and your hospital bills will be paid directly to the hospital subject to the terms and conditions of the policy. With the help of a cashless claim facility, you do not need to worry about cash and avail the best possible treatment for yourself and your family.
Under reimbursement of claim, you can admit in any of the hospitals. At the time of discharge, you need to pay the medical bills from your pocket. However, for in-patient, daycare, and pre-hospitalization, you get the reimbursement within 30 days of the date of discharge from the hospital. For post-hospitalization, you can get the reimbursement within 15 days from the completion of post-hospitalization treatment.
>>Click Here to Know Why You Should Opt for Arogya Sanjeevani Health Insurance Policy
Claim Settlement Process
The claim settlement process under the Arogya Sanjeevani Health Plan is simple. It can avail of in two ways:
Cashless Claim Settlement:
If you are looking for a cashless claim settlement, then you need to get admitted to the network hospitals and follow these steps to avail of a timely claim.
Intimation- In case of emergency, you have to intimate the claim management team within 24 hours of hospitalization, and in planned hospitalization, you should inform 48 hours before admission.
Pre-Authorization Form- For a cashless claim, you have to fill the pre-authorization form. It is available at the hospital's insurance / TPA Desk and sends it to the claim management team through fax.
Approval Letter-After verification of your documents, you will get an approval letter by the claim management team.
Query- If there is any query from the claim management team, you or the hospital can respond to it.
Rejection- Your claim can get rejected by the claim management team subject to policy terms, conditions, information, and documents.
Re-filing - In the denial of a cashless claim, you can carry on your treatment as per doctor's advice, and file for reimbursement claim.
Reimbursement Claim Settlement:
Under the reimbursement claim settlement process, you will get a refund for the money that you have spent on your treatment. Follow these simple steps:
Claim Form- You need to submit the claim form and the required documents according to the terms and conditions of the policy.
Approval Letter-After verification of your documents, you will get an approval letter by the claim management team.
Query- If there is any query from the claim management team, you or the hospital can respond to it.
Rejection- The claim management team has the discretion to reject your claim. The reason will communicate with you.
>>Also Read Ways to Avoid Medical Insurance Claim Rejection
Documents
For reimbursement claim, you have to submit the following documents within the specified time:
- Duly completed claim form
- Photo identity proof of the patient
- Medical practitioner's prescription advising admission
- Original medical bills
- Payment receipts
- Discharge summary
- Investigating/Diagnostic test reports, etc.
Suggestion
Care Health Insurance Arogya Sanjeevani Health Insurance Policy offered by is a boon for the youngsters who have started earning recently or people who already have various financial responsibilities. If you also have economic implications but want to protect yourself and your family from any medical emergency, then it is the right health insurance plan for you. Foremost, its claim settlement process does not include any cumbersome formalities.
Therefore, opt for it to have extensive health care coverage with a quick claim settlement facility.
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.
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