AP
Ashwini p
Q&A
| Ref. No: 254795039 | 10 Aug, 2021, 07:46 PM
How to claim health insurance need to know what all procedure
Policybazaar Team
14 Aug, 2021, 04:08 PM
Hi Ashwini, there are two types of health insurance claims and they are explained hereunder
- Cashless Claim - If you or the member covered under the health insurance policy are getting treatment in a specified network hospital of the insurer. You are liable to a cashless claim settlement. In such a scenario the hospital's TPA desk writes to the insurer along with your Policy and KYC details. Post verification of all documents and hospital papers your claim is approved and paid directly to the hospital, minus any administrative or expenses not covered in your policy. If the amount of claim is greater than your Sum Assured, the company will only pay an amount equal to the sum assured. The insurer still maintains the right to refuse a cashless claim under a couple of other circumstances
- Non-Cashless Claims- If the policyholder is getting treated in a non-network hospital, then they would need to submit all original hospital papers, diagnostic reports, prescriptions, and discharge summaries to the insurer. These need to submitted in hardcopy to the insurer, along with a claim assistance form which is available on their respective websites.