The health insurance claim process involves either cashless transaction which is a direct claim settlement option or medical claim reimbursement
New Delhi: With Covid-19 still a health threat across the globe, people are looking for health insurance to safeguard themselves and their families. An informed health insurance policy can help individuals avail maximum benefits from the policy. One should be informed about the needs and requirements, as well as the reimbursement process as per the medical history and requirements of the family.
The health insurance claim process involves either cashless transaction which is a direct claim settlement option or medical claim reimbursement. In the latter, the policyholder pays the hospital bills from their own pocket and later claims reimbursement by the insurance provider. Reimbursement facility can be availed both at network and non-network hospitals.
However, as opposed to the cashless settlement, the reimbursement process is time-consuming and relatively slow. While filing reimbursement claims, there are certain chokepoints that claimants find difficult to navigate.
The first step is intimating the insurance provider, third party administrator (TPA) about the hospitalisation or treatment within at the earliest. The insurer may also be informed after hospitalisation in case of an emergency.
Here’s how you can file a reimbursement claim and receive the claim amount from the insurer.
First, you must inform your insurer/Third Party Administrator (TPA) about the treatment within the stipulated time. If there is an emergency case then the intimation can be given to the insurer/TPA after being admitted.
Documents required
The documents required to file for reimbursement claim are health card issued by TPA, original copy of hospital discharge summary, duly filled claim form, investigation reports (like X-rays, blood report, etc.), invoices of pharmacy/chemist supported by respective prescriptions, copy of KYC documents, and bank details for NEFT purposes.
All documents must be carefully checked before submitting to the insurer. The policyholder must keep copies of all documents being sent the insurer for reimbursement claim. This will help you in your communication or disputes, if any, in future. Reviewing the documents is necessary before submission because your claim may be rejected if insufficient or wrong documents are submitted to the insurer.
