Do you know how to claim your health insurance policy?
To be prepared for times of medical emergency, it is a good idea to know about the claim process of health insurance policies. A health insurance policy provides necessary financial support to get medical treatment in time. Hospitalization can burn a hole in your pocket and wipe out your savings, so being able to claim the benefits of your health insurance plan becomes a necessity.
Read along to find out how to claim your health insurance plan.
A health insurance policy takes effect when a policyholder gets hospitalised or faces a medical emergency. At that time, the insured person can make a request to the insurance company to cover their medical costs. This is referred to as making a claim for a health insurance policy.
Insured individuals can either opt for a direct claim settlement (cashless treatment) or get reimbursement for availed health services. In the cashless claims process of health insurance, an insurer pays the claim amount directly to a network hospital.
A cashless facility is only available when you go to a hospital with which the insurer has prior agreements to offer this facility. Such hospitals are called network or empanelled hospitals.
With a reimbursement facility, you have to pay all medical expenses upfront and request for claim settlement from the health insurance company later.
Cashless claims are ideal in situations where you are going through financial instability and do not have access to cash during times of medical crisis.
Here is a step-by-step guide for you to get a cashless claim with planned hospitalisation:
Insurance companies allow reimbursement claims when an insured person gets treatment from non-network hospitals or when they cannot approve cashless claims. You will need to pay the costs of treatment and medicines from your own pocket and file for reimbursement claims after discharge.
Here are the steps you should follow to make a reimbursement claim:
On many occasions, policyholders need urgent hospitalisation. This can happen in case of an accident of the insured person or a sudden illness that requires urgent hospitalisation.
Here are the steps to get cashless claims during an emergency:
Most insurance companies require the following documents for the claims process:
Note that insurance providers may ask for other relevant documents.
Insurance companies offer two methods with regard to the claim process for health insurance policies- cashless and reimbursement. The former provides hassle-free treatment from a network hospital. The latter allows you to get medical treatment from out-of-network hospitals and in cases where cashless claims do not work.
Navi ensures a simple and hassle-free process that gets your claim approved in 20 minutes. You can use the Navi app from Google Play Store to purchase health insurance products from a company with over 10,000 network hospitals across India.
Ans: A third-Party Administrator (TPA) facilitates claim settlement by coordinating between the insurance company and the insured person. TPAs are available at reception desks of hospitals and serve as the point of contact for policyholders.
Ans: Yes, if you have multiple health insurance policies, you can choose to make claims from all of them. You will need to inform all the insurance providers and submit relevant documents with each insurer separately.
Ans: Reimbursement claims can be made when the insured person does not get treatment from a network hospital. In such cases, they will have to bear all expenses themselves and ask for payment later.
Ans: Here are some common reasons for claim rejection:
When the policyholder provides incorrect or wrong information
Lapsed policy due to non-payment of premiums
Exclusions of the insurance policy
Claim made without proper reasons
Ans: If you do not manage to submit your claim within the prescribed time, the insurance provider will take more time to settle the claim. In case of long delays, they can choose to reject your claim.
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