Nothing in life is as valuable as our health. It is like a treasure that makes us strong and happy. We should always take good care of it, because when we are healthy, we can enjoy everything life has to offer. Taking care of our health means eating well,staying hydrated,regular exercise etc.And who does not love to do so?
But sometimes life brings together a few uncertainties which loom large.Here,the insurance policies stand as guardians of financial well-being, offering a shield against the daunting costs of medical care.
Enrolling in such policies cannot just offer a secure future,one needs to dwell deep into it to understand its commitments,benefits.To effectively claim these policies one needs to understand the complete procedure.
Types Of Claims
There are generally two types of claims: cashless claim and reimbursement claim.
Cashless Claims:
- To avail cashless claims, it is mandatory for the insured to be treated in an empaneled hospital with an e-card /physical proof of the health insurance for family in the name of the insured.
- Once hospitalised, all one has to do to initiate the claim settlement process is to provide the details of the health policy and health card to avail the cashless hospitalisation facility.
- The claim process slightly varies depending on whether the treatment is planned or unplanned. Here’s how –
Planned Treatment
- Inform the insurance provider of the required treatment at least 3-4 days in advance.
- Fill a pre-authorization form to avail cashless treatment feature and submit it to the company 3-4 days before hospitalisation. A confirmation letter will be provided to you from the insurance company.
- On the day of admission in the hospital, you will be asked to show your best mediclaim policy for the family card (as provided along with every health insurance plan for family with the cashless treatment feature) and the confirmation letter.
- Once the claim has been validated, the insurer settles the claim directly with the network hospital.
Emergency treatment
- In such emergencies,get yourself admitted to an approved hospital. If you do not know which hospitals are networked with the insurance company, you can contact their helpdesk and ask.
- Make sure that you have your health card with you in order to be able to make use of cashless treatment.
- Complete the pre-authorization form and send it to the insurer within 24 hours of hospitalisation. The insurer will then issue an authorization for cashless treatment.
- The insurer will then settle the medical bills directly with the hospital.
– The corresponding medical bills are forwarded to the insurer, who then assesses the costs incurred in accordance with the insurance cover and settles the payments.
If your claim is rejected, you will receive an official letter from the insurance company stating the reasons for the rejection.
You can contact the insurance company’s helpdesk at any time if you need further assistance.
Reimbursement
Hospitalisation
You need to submit an insurance claim form along with original copies of hospital bills, doctor consultation reports, and diagnostic reports.
File the claim
Within 30 days post discharge, you can initiate the claim online or at any of the registered offices of the insurance company. You need to fill a claim form and attach all the reports and bills.
Insurer’s decision
Based on the claim form and submitted documents, the insurance company will settle the claims as per policy terms and conditions .The major steps involved in the claim process are:
The insured individual seeks medical attention from a healthcare provider including affiliated hospitals or nursing homes etc.
The hospital submits charges to the insurer using the best mediclaim policy for the family.
Claim forms are sent electronically using a series of codes. The charges are received by the insurance company with each claim having a dedicated date and code to ensure timely payment.
The health insurance company reviews the charges to make sure they follow their policy guidelines.
An Explanation of Benefits(EOB) and a check/online transfer is initiated by the insurance company.
Documents Required for Filing a Claim-
The following documents are required to make claims under a health insurance plan in India;
- Duly filled claim form — cashless claim form and reimbursement claim form according to the claim made.
- Identity proof and policy document
- Medical Certificate or form as signed by the treating doctor.
- Authorised Prescription and cash memos from the pharmacy and hospital.
- All medical bills in original
- Referral letter from the doctor advising hospitalisation
- Discharge summary.
- Investigation report and other reports in original.
- In case of an accident, FIR or Medico Legal Certificate is also required.
Important steps for effective health insurance plans for family
1. Understand your mediclaim policy
Before making a claim, thoroughly review your health insurance policy. Understand what is covered (inclusions), what is not covered (exclusions), your sum assured, waiting periods, deductibles, co-payments, co-insurance clauses and network hospital details. This will help you simplify the claims submission process and minimise potential problems.
2. Choose network hospitals
Opt for a network hospital whenever possible for planned medical procedures. Network hospitals have agreements with your insurer, which makes claims processing faster and more efficient. Keep a list of network hospitals on hand for emergencies to expedite treatment and claims processing.
3. Organise and collect documents
Gather all necessary documents from the hospital, including bills, receipts, discharge reports, doctor’s orders, and diagnostic reports. Keep these documents organised and handy to facilitate the smooth submission and processing of claims.
4. Submit your claims promptly
If you need to submit a claim for reimbursement, submit it promptly within the time frame specified in your policy (usually within 1 week of discharge). Timely submission is critical as insurers may reject or delay processing claims submitted after the prescribed deadline.
To Conclude
In conclusion, claiming health insurance in India can seem daunting, but following these simple steps can ensure a hassle-free experience. Keep all your documents in order and provide accurate information to your insurance company to avoid delays or rejections if necessary.
With the right preparation and knowledge, you can make the most of your best family health insurance plan in India and secure your financial future.
To enroll in these plans in a smooth and subtle manner you can have an insight on the exclusive policy plans of Niva Bupa,the best family health insurance in India.