Health Insurance Claim Process

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, but 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 claim settlement process in health insurance. So, know the below-mentioned easy steps to ensure a hassle-free health claim process. You can file it in two ways:

• 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 medical insurance claim procedure.

What is the Health Insurance Claim Process?

A health claim process 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 Procedure

Once you have invested in health Insurance to secure your savings, it is vital to understand the health claim process for cashless hospitalization and reimbursement cases to avoid last-minute chaos. Here are medical insurance claims processing steps:

Cashless Claim Process

Cashless hospitalization is one of the best features of health insurance. It serves your purpose and gives you a financial cushion in a difficult time. Our cashless claim process is simple and has the following steps:

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

Reimbursement Claim Process

At times, it happens you have to admit to non-network hospitals for different reasons. But, do not worry! All you can do is follow these steps for the reimbursement process in health insurance:

• Submission of claim form along with required documents, as per the policy terms & conditions
• Approval letter sent by the claim management team
• Insured to respond 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 process. In case you have selected a non-network hospital, follow the steps for for the reimbursement process in health insurance.

Claim Process for Accidental Injuries

A medical emergency can knock on the door anytime. We understand the urgency of hospitalization; that's why we kept the medical insurance claim process for accidental injuries and death simple. Below are the steps:

1. Immediately intimate us via writing or call along with the particulars required
2. Duly submit our claim form and 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?

We will directly pay your bills for the cashless claim process once you get discharged from the hospital after approval from the claim management team. For medical claim reimbursement, you have to submit the required documents within 15 days after getting discharged from the hospital. 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 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 the 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: