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Health Insurance Claim Process

Claim Process for Reimbursement and Cashless Hospitalization

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92.3%

Claim Settlement Ratio (OND 2018)

II

8250+ +

Network Hospitals across 500 cities

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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 filing a health insurance claim? She does not want to trouble her husband, where she does not know the process. Every time she piled up the papers, she found it a mess.

People get into such a situation when they are not aware of the claims procedure. So, know the below-mentioned easy steps to ensure hassle-free claim settlement.

  • Cashless Claim: The cashless claim facility keeps you worry-free during a medical emergency as you can avail of treatment at any of the network hospitals empaneled with us. We will settle the hospital bills directly, subject to policy terms and conditions. It reduces your stress of making direct cash payments to the hospital.
  • Reimbursement Claim: If the policyholders opt for a non-network hospital for treatment, they have to bear the medical expenses from pocket. We will reimburse the costs, subject to policy terms and conditions, after submitting 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 avail of the coverage under a health insurance policy. At Care Health Insurance, we follow a set of procedures to settle the claim. For a hassle-free claim settlement, you need to inform our customer support team about your hospitalization within 24 hours in emergency hospitalization and before 48 hours for planned hospitalization.

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 for cashless hospitalization and reimbursement cases to avoid last-minute chaos. Here are the steps in the health insurance claim process:

Cashless Hospitalization Claim Process:

  • Request for pre-authorization
  • Complete the pre-authorization form available at the hospitals insurance/TPA Desk and send us through fax
  • Approval letter sent by the claim management team
  • Hospital/Insured to response to the query raised by the claim management team
  • You may initiate the treatment and file for re-imbursement claim

Reimbursement Claim Process:

  • Submission of claim form along with required documents, as per the policy terms & conditions
  • Approval letter sent by the claim management team
  • Insured to response to the query raised by the claim management team
  • We will communicate the reason in case of rejection

Planned Hospitalization Claim Process:

Intimate us 48 hours prior to your hospitalization. For cashless hospitalization at the network hospital, follow the cashless claim procedure. In case you have selected a non-network hospital, follow the steps for reimbursement of expenses.

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.

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, 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?

For cashless claim, your bills will be directly paid by us once you get discharge from the hospital after approval from the claim management team. For reimbursement you have to submit the required documents within 15 days after you get discharge from the hospital. Once our claim management team will approve your claim within the stipulated period.

>> Check: Health Insurance Claim Settlement Ratio

List of the Documents Required for Health Insurance Claim Process for Cashless and Reimbursement

Below is the list of documents that are required to file a claim:

  • Claim form - duly filled and signed
  • Doctor's prescription and referral letter
  • Diagnostic tests and medical reports
  • Original bills, receipts, and discharge papers from the hospitalization
  • Original bills from pharmacy/chemists
  • Police Report or FIR in case of personal accident
  • Post-mortem report, if conducted
  • Death certificate
  • Health 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 us, 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
After buying a health insurance policy, the first step 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 us. The claim procedure is simple, and its insurance advisors help you 24x7 if you are stuck in an awkward situation while filing a claim.

FAQs

How to get your Health insurance claim approved faster?

If you want to have faster claim approval under your health insurance, go for cashless hospitalization at the network hospitals. You have to intimate our claim management team for the health insurance claim process within 24 hours in emergency hospitalization and 48 hours in case of planned hospitalization.

What are the documents required for filing a reimbursement claim?

Claim form and documents such as medical practitioner's prescription advising hospitalization, drugs, diagnostic test or consultations, original bills, receipts and discharge summary from the hospital, indoor case papers, etc. required to file a reimbursement claim.

What do I do if my health insurance claim card is lost?

In case you lost your health insurance claim card, inform our customer support team immediately. They will help you to get the new one and assist you in the claim settlement.

What is reimbursement in the health insurance claim process?

Reimbursement in the health insurance claim process means that you initially pay your hospital bills and apply for a refund within the stipulated time to get the entire amount back.

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