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Health Insurance Claim Process

Claim Process for Reimbursement and Cashless Hospitalization

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I

93%

Claim Settlement Ratio (OND 2018)

II

7800 +

Network Hospitals across 500 cities

III

400 Lacs+

Lives covered

About Health Insurance Claim

Mrs. Narang is overwhelmed as her husband is back home after spending a couple of weeks in the hospital, but, now she is concerned about how to file a health insurance claim? She does not want to trouble her husband and has no knowledge about the process. Every time she piled up the papers, she found it a mess.

A person is bound to be in this situation when he or she is not aware of the claims procedure. You will not face the hassle like Mrs. Narang did if you file your claim by following the right steps. 

To avail of your health insurance policy benefits, you should be aware of the process of making a claim in the following ways: 

  • Cashless Claim: The cashless claim facility keeps you worry-free during a medical emergency as you can avail treatment at any of the network hospitals of the insurer using a health card. The insurer will settle the hospital bills directly, subject to policy terms and conditions. Thus, there is no hassle of making direct payments to the hospital.
  • Reimbursement Claim: If the policyholder opts for a non-network hospital for treatment, then he or she has to bear the medical expenses from the pocket. The insurer will reimburse the costs, subject to policy terms and conditions, and after submission of valid documents. 

We simplify things for you as we explain more about the claim process.

What is the Health Insurance Claim Process?

A health insurance claim is a request from a policyholder to the insurer to avail of the coverage under a health insurance policy. Health insurance companies follow a set of procedures to settle the claim. For a hassle-free claim settlement, you have to inform the insurer about your hospitalization within the stipulated time and submit necessary documents.

Steps for Health Insurance Claim Process

Once you have invested in health insurance to secure your savings, it is vital to understand the claim process in both cashless hospitalization and reimbursement cases to get the hassle-free settlement. Here are the steps in health insurance claim process:

Cashless Hospitalization Claim Process:

  • Inform the insurer about the hospitalisation within the time specified
  • Show the Health Card and a valid photo ID proof to get cashless benefit at the network hospital
  • Submit the duly filled and signed Pre-Authorisation form at the insurance help-desk of the hospital
  • An approval letter will be sent from the side of the Religare’s claim management team
  • The team may raise a query in case of any information deficiency or further information requirement
  • Upon approval, the medical bills will be settled, as per policy terms and conditions

In case your cashless claim request is not approved, based on the information provided to the insurer, you can file for reimbursement of expenses after discharge from the hospital.

Reimbursement Claim Process:

  • Provide relevant details during the claim intimation such as Name, Customer ID, Hospital details, etc.
  • Download the Care Health Insurance (Formerly Religare Health Insurance) claim reimbursement form from the official website
  • Submit the duly filled and signed claim reimbursement form and attach all the required documents including medical documents issued by the hospital/doctor
  • Our claim management team will review the case and may raise a query if required
  • The claim management team will send an approval letter
  • In the case of claim rejection, reasons will be communicated to the policyholder

Planned Hospitalization Claim Process:

In case of planned hospitalisation, remember to contact the insurer 48 hours before getting admission to the hospital. For cashless hospitalization at network hospital, follow the cashless claim procedure. In case you have selected a non-network hospital, follow the below steps for reimbursement of expenses.

  • Inform the insurer 48 hours before admission to the hospital
  • Download the Care Health Insurance (Formerly Religare Health Insurance) claim reimbursement form from the official website
  • Submit the duly filled and signed claim reimbursement form and attach all the required documents
  • Our claim management team will review the case and may raise a query if required
  • The claim management team will send an approval letter
  • In the case of claim rejection, reasons will be communicated to the policyholder

Submit the following documents along with the claim form:

  • Valid photo-id proof
  • Medical certificate issued by the hospital/doctor
  • Discharge form issued by the hospital/doctor
  • Submit the Medical practitioner's prescription and referral letter advising hospitalization
  • Final Police Report or First Information Report (FIR), if applicable
  • Post-mortem report, if conducted
  • Medical documents issued by the hospital/doctor

Claim Process for Accidental Injuries:

  • Immediately intimate us via writing or call along with the particulars required
  • Duly submit our claim formand vital documents as given below:
    • Police Report or FIR if a personal accident is covered under the plan
    • Medical certificate issued by the hospital/doctor
    • Discharge form issued by the hospital/doctor
    • Report issued by a medical examiner
    • Medical documents issued by the hospital/doctor
    • Post-mortem report, if conducted
    • Death certificate, in case of accidental death

Show the health insurance card provided by us to get cashless benefit at our network hospitals.

In case of events like accident or injury, inform the insurer within 48 hours, or before discharge from the hospital. For planned hospitalisation, one has to notify the insurer 48 hours before admission.

Claim Process in Case of Accidental Death:

  • Submit the Police Report or FIR if a personal accident is covered under the plan
  • Post-mortem report
  • Death certificate
  • Submit the medical documents issued by the hospital/doctor

With Care Health Insurance (Formerly Religare Health Insurance), getting a claim is no more a cumbersome task. Follow the above steps based on the situation and get your claim timely without stress.

How Long does it Take to Process a Health Insurance Claim?

You must contact the insurer within 24 hours in case of emergency hospitalisation and 48 hours before admission in case of planned hospitalisation. After verification of the submitted documents, our claim management team processes your claim amount.

>> Check: Health Insurance Claim Settlement Ratio

List of the Documents Required for Health Insurance Claim Process

You can check the below list of the documents that you need to collate to file a claim.

  • Duly filled and signed claim form
  • Doctor’s prescription and referral letter
  • Diagnostic tests and reports
  • Original bills, receipts and discharge papers from the hospitalization
  • Original bills from pharmacy/chemists
  • Provide the Police Report or FIR in case of personal accident
  • Post-mortem report, if conducted
  • Death certificate
  • Policy details including number, name of the policyholder, nature of the illness, address and other required information

How to Track the Status of Your Health Insurance Claim?

You can check the status of your using the online facility. If you have opted for a policy from Care Health Insurance (Formerly Religare Health Insurance), all you need to visit the official website and track the status by entering relevant details. It is applicable in case of checking the reimbursement claim or cashless claim status.

Tips to Avoid Claim Rejection

Sometimes, claims may get rejected, and this can be due to various reasons. Here are some tips to help you get a claim and prevent rejection of claims: 

  • Do not hide any information such as any pre-existing condition at the time of buying a policy
  • Contact the insurer as per the time specified for planned and emergency hospitalisation
  • Keep vital documents securely including medical reports and submit them when filing a claim
The first step after buying a health insurance policy is to read the policy documents carefully to understand its features, inclusions, exclusions, waiting period, and, more importantly, the claims procedure. This way, you will escape the last minute hassles and ensure you get the most out of your health policy. Moreover, the online facility helps to initiate the claim process, submit documents, and track the claim status, thus saving your precious time and efforts.
 
Investing in health insurance is a wise decision to protect yourself and your loved ones in case of any medical emergency. A good acquaintance with the various aspects of the claim procedure helps you to avoid medical insurance claim rejection. For quick claim- settlement check the health insurance plans offered by Care Health Insurance (Formerly Religare Health Insurance). The claim procedure is simple, and its insurance advisors help you 24x7 if you are stuck in an awkward situation while filing a claim.
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