How To File A Claim For Medical Insurance In India?
Introduction
Filing a claim for medical insurance in India can be a daunting task, especially if you’re unfamiliar with the process or dealing with a medical emergency. However, understanding the necessary steps and documentation can make the experience smoother and help you get the financial support you need. In this blog, we’ll guide you through the entire process of filing a claim under your health insurance policy, whether it’s a cashless claim or a reimbursement.
What is health insurance?
Health insurance is a safety net that helps cover medical expenses when you fall ill or face an unexpected health issue. It’s not just about saving money on hospital bills—having a policy gives you peace of mind, knowing that in a medical emergency, you can focus on recovery without worrying about the financial burden.
Types of Claim Processes available in India
Cashless– The cashless claim process allows you to receive medical treatment at a network hospital without paying out of pocket at the time of admission or discharge. Instead of paying upfront, the insurance company settles the hospital bills directly. To use this facility, you need to show your health insurance card at the hospital, fill out a pre-authorization form, and once the insurer approves it, your treatment expenses are covered under the policy terms, minus any exclusions or deductibles.
Reimbursement– The reimbursement claim process involves you paying for your medical treatment upfront and then claiming the expenses from your insurance company. After you’re discharged from the hospital, you submit the necessary documents such as hospital bills, discharge summary, prescriptions, and other medical reports along with a filled claim form to your insurer. The insurance company will review your claim, and if everything is in order, they will reimburse the amount as per your policy coverage, directly to your bank account.
Step by step guide on How to file Medical Insurance Claim
Whether you’re opting for a cashless claim or a reimbursement claim, the process of filing a medical insurance claim in India can be made easy by following these steps:
- Understand what your policy covers
Before initiating any claim, properly review your policy to understand what medical expenses are covered, such as hospital stays, treatments, medications, and any exclusions or waiting periods.
- Inform Your Insurance Provider
Cashless Claim: Contact your insurance company as soon as possible, ideally before hospital admission, or within 24 hours in case of emergencies.
Reimbursement Claim: Inform the insurer about your hospitalization and treatment soon after being admitted. Each insurer has a specific timeframe, so ensure you notify them within that window.
- Choose a Network or Non-Network Hospital
Cashless Claim: Select a hospital from your insurance company’s list of network hospitals to avail of the cashless facility.
Reimbursement Claim: You can choose any hospital (network or non-network), but you’ll need to pay upfront and file for reimbursement later.
- Submit a Pre-Authorization Form (For Cashless Claim Only)
At the network hospital, present your health insurance card and fill out a pre-authorization form available at the hospital’s insurance desk. The hospital will submit this form, along with required medical details, to your insurer for approval.
- Get Approval from the Insurance Provider
Cashless Claim: Once the insurance provider reviews the pre-authorization form, they will approve or deny the cashless claim. Upon approval, you don’t need to pay for treatment (excluding non-covered expenses or co-payments).
Reimbursement Claim: There’s no pre-authorization here. Instead, focus on collecting all treatment-related documents.
- Collect and Organize All Required Documents (Both Claims)
You should carry all the original documents which were used for the treatment like diagnosis reports, discharge Summary, bills/receipts, and medical reports/tests along with KYC and bank related documents for reimbursement claims.
- Submit the Documents
Cashless Claim: The hospital typically handles this process once your treatment is completed, coordinating with the insurer directly.
Reimbursement Claim: You need to submit all the collected documents to your insurance provider after discharge. Some insurers allow this to be done online, while others may require physical submission.
- Follow Up on Your Claim
Stay in touch with your insurer for any updates or additional document requests. Most companies offer a claim tracking option through their website or mobile app.
- Claim Settlement
Cashless Claim: Once approved, the insurer settles the bill directly with the hospital, and you only need to cover expenses not included in the policy (like non-medical items).
Reimbursement Claim: After reviewing the documents, the insurance company will reimburse the covered amount directly to your bank account, usually within a few weeks.
Conclusion
Filing a medical insurance claim in India doesn’t have to be complicated if you’re well-prepared and know the steps involved. Whether you opt for the convenience of a cashless claim or the reimbursement route, understanding the process and having the right documentation can make a world of difference. By staying informed about your policy, acting promptly, and keeping track of your paperwork, you can navigate the claims process with ease. Health insurance is meant to reduce financial stress during medical emergencies, and with the right approach, you can fully benefit from the coverage your policy provides.
