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Health problems become unavoidable owing to certain factors, and health insurance becomes essential when it comes to getting quality healthcare while ensuring financial safety. If you make a health insurance claim, you will get coverage for your medical expenses, subject to the terms and conditions of the policy. It will, thus, lessen the load on your savings. Moreover, if you spend a claim-free, your insurer rewards you with a no claim bonus by increasing your sum insured by a specified percentage, at the time of policy renewal.
To avoid any hassle at the time of making a claim, one should know the health insurance claim process. For instance, to prevent rejection of a claim, there is a specified timeframe within which the insured person must notify the insurer about the emergency or planned hospitalisation.
Similarly, there are certain things to keep in mind after the policyholder files a claim on his or her health insurance policy. We will discuss them in this article.
In case of an indemnity cover, the policyholder will get coverage for the actual expenses incurred, subject to policy terms and conditions. If he or she has opted for a cashless treatment facility at a network hospital, then the insurer will directly settle the bills with the hospital, subject to policy terms and conditions.
Moreover, if the person has filed for reimbursement, then he or she has to follow the required health insurance claim process that involves submitting relevant documents to the insurer. After verification of these documents, the expenses will be reimbursed, considering the sum insured and other terms and conditions of the policy.
Policyholders should note that the sum insured is reduced by the amount of claim paid for the rest of the policy year.
The insured person can check the status of their claims by contacting the customer care, sending a mail, or by visiting the branch. Also, they have the facility to track their claims online, which is extremely convenient as they will know the status in just a click. All they are required to do is visit the official website, go to the claims section, and key in the relevant details like policy number.
A health insurance policy will not only protect you by covering your current medical expenses, but it also offers a financial back-up for the future in the form of various benefits. In case the maximum limit of the sum insured gets exhausted as a result of making the claims; then, the entire sum insured will be reinstated once in a policy year under the ‘automatic recharge’ feature. The policyholder can utilise this amount for making new claims in the future.
The ‘no claim bonus’ is a benefit that gives you an additional financial cushion by increasing your coverage amount by a specified percentage every claim-free year. You will receive a 10% increase in your sum insured for the next policy year. There is a maximum limit to the increase in sum insured, which is 50% of the sum insured under the policy. In case you make a claim in a year, then the cumulative bonus accrued will be reduced by 10% of the sum insured. However, in no case will the total sum insured be lower than the sum insured. That is, the base sum insured will not be affected. If he or she does not make a claim next year, he or she will be eligible for the no claim bonus.
One should note that the recharge amount (in case of automatic recharge and unlimited automatic recharge) is not considered in calculating the ‘no claim bonus’.
Being thoroughly aware of the procedure of health insurance claim is necessary to avoid costly mistakes that could lead to claim rejection. The first step to easy claims experience is to read the policy documents that will give you a clearer picture of what your policy covers and the things it will not. While you take a look at the features, also read and understand about the waiting period, co-payment, sub-limits, exclusions, etc.
Know about the entire health insurance claims procedure to avoid any hassle. Care Health Insurance has a seamless claims procedure and 95.2% health insurance claim settlement ratio that ensures timely claim settlement.
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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