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A health emergency always grips you unprepared. While you would try to receive a cashless healthcare facility, an emergency may land you at a non-network hospital–burdening you with financial stress before filing for reimbursement. That’s why it is essential to learn about how to fill a health insurance claim form required during the reimbursement process. We have curated a step-by-step guide to help you raise a claim request smoothly and successfully.
You need to fill out the reimbursement claims form when your hospital is not empanelled with your health insurance company. This means you are unable to avail the cashless hospitalization facility. The reimbursement form is filled out after the patient is discharged from the hospital. You must submit the same along with the other documents to the insurer within 15 days of discharge.
There are two parts of the claims reimbursement form as explained below-
|Part A of the Claims Reimbursement Form||Part B of the Claims Reimbursement Form|
|This part is meant for you as an insured person, to fill in your contact details, and information about your insurance, hospitalization, and other relevant particulars.||This part is meant for the hospital where you or any other insured member was admitted. The hospital will fill in all the necessary details related to the hospitalization process, ailment, and claim.|
Filling up the claims form is a careful process, especially if this is your first time. To start with, collect the claims form from the hospital TPA desk as soon as the patient is discharged. You need to send the completely filled out form along with the required documents to the health insurer’s address via post.
Now, let’s understand how to fill claim form for health insurance step by step-
The first step is to fill out all the information related to the primary insured under your health insurance policy. For instance, the health policy can be registered in your name with your parents listed as beneficiaries.
To fetch the primary insured’s details, you need to keep your policy documents handy and follow the instructions below-
The form’s second section requires information about whether the insured patient is covered under any other mediclaim or not. If yes, you must fetch all the details of the other insurance policy, including-
Under the form’s ‘Section-C,’ you need to fill out all the personal information of the insured member who is hospitalized and for whom you are raising a claim. The particulars include-
Remember, if there are more than one insured members who are hospitalized, you need to fill out separate claim forms for each of them.
The next step is to enter all the hospitalization specific. For this, you need to be well aware of-
In case it is difficult for you to gather this information, you can get help from the hospital’s TPA desk to fill it out.
This is the most critical section of the claims form, requiring the claim details. Make sure you arrange all the hospital bills chronologically (date-wise) before filling out this section. For this, you need to collect and organize these documents-
To calculate the treatment expenses in the claim form, follow the category-wise segregation as below-
Also, this section contains a checklist of the documents you are going to attach along with the claims form. Tick all that applies.
This is another critical section that needs your utmost attention. Once you have your medical bills arranged chronologically, filling in this information becomes easy under these four categories-
The final step is to enter accurate bank details of the insured person. You can find this information on the insured's bank cheque. This includes-
As you reach the end of the claims form, double-check all the information you have filled in. Close the form by adding the insured’s signature and date. Reach out to the hospital’s TPA desk to complete the ‘Part-B’ of the claims reimbursement form.
Filing for a reimbursement claim can be a lengthy process with a lot of queries raised by the insurer. Yet, it is not an impossible task to receive your claim amount through reimbursement. All you need to do is maintain and preserve all the hospitalization paperwork and bills carefully while constantly staying in touch with the insurer’s claims team.
Here’s when Care Health Insurance supports you with a quick and effective claim process with an internal claims management team. With a high claim settlement ratio of 95.2%, we promise instant customer support during an emergency to ensure maximum financial security for the insured members. Learn more about our products and services.
Disclaimer: Filling out the claim form should not be taken as an admission of liability. The reimbursement process is at the team’s discretion that follows a standard process and set of guidelines.
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