Health Insurance is a type of insurance plan in which the insured gets financial coverage for broad-ranging medical expenses including the cost of an ambulance, the cost of consultation, the cost of medical tests, the cost of surgery, etc. Health Insurance claim is a significant part of insurance policies that help insured persons to get the funds at the time of financial requirements as mentioned in the plan.
Meaning of Health Insurance Claim
When policyholders legally request a pre-determined amount from the health insurance company or insurance provider to fulfil their financial obligation related to the treatment covered in the Health insurance plan such as a critical illness, sudden injury, accident and other medical conditions. It is the formal approach of claim or reimbursement of medical expenses of the insured person in case of any health emergency.
Types of Health Insurance Claims
There are two types of Health Insurance claims known as cashless claims and reimbursement claims discussed below-
Cashless claims– The cashless claim in health insurance plans allows policyholders to get medical attention without being involved in the payment process. In a cashless claim process, the hospital and Insurance Company coordinate and settle the medical bill based on the purchased policy coverage. Cashless claims are divided into two types; cashless claims for planned hospitalisation and cashless claims for emergency hospitalisation.
Reimbursement claims– A Reimbursement claim is a type of Health Insurance claim in which the hospital and medical expenses are paid by the policyholder and later refunded or compensated by the insurance provider making a formal request based on policy terms. A reimbursement claim insurance company compensates incurred out-of-pocket medical costs.
Documents needed for Health Insurance Claim
The policyholders are required to submit the following documents for a successful health insurance claim process –
- Duly Filled ClaimForm
- Original Hospital Bills and receipts
- Medical Certain and Reports
- Prescription and pharmacy bills
- Discharge summary
- Ambulance receipt
- Valid ID and Health card
Tips to successfully get a Health Insurance Claim
- The policyholder should regularly review the health insurance policy to determine coverage benefits and expiry date.
- It is recommended to fill out the health claim application form by the policyholder to avoid mistakes.
- While making a Health Claim it is essential to disclose all important information related to health and medical conditions.
- It is recommended to notify the health insurance company within 24 hours for emergencies and 3 days for planned hospitalisation.
- Individuals should carefully handle medical-related documents such as invoices prescription bases and other related documents.
- Health insurance policyholders should seek professional guidance while claiming the benefits to avoid claim rejection.
Conclusion
Health Insurance claim is an important part of the purchased insurance policy because it compensates the medical expenses in case of planned and emergency hospitalisation or medical expenses. Policyholders need to determine each aspect of the purchased policy and process accordingly to successfully get a Health Insurance claim whenever needed.
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