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An Overview on Mediclaims - Learn How to File Reimbursements

Mrs Malhotra’s husband was returning home after a long stay at the hospital. Instead of being happy and relieved Mrs. Malhotra was flustered and worried. The steps to file a claim for her husband’s healthcare left her in a completely harassed state.

Medical reports, receipts and bills were everywhere. She was aware that she had to fill in a form but she had no idea about the fact that original documents would be required to file the claim. However, Mrs. Malhotra soon met a friend who had been through the same procedure recently. With her friend’s assistance Mrs. Malhotra’s task became easier.

Points to Bear In Mind While Filing Claim

A mediclaim is one of the most important insurance investments which an individual needs to make in his life. Mediclaim policies in India provide a facility by which you can have a cashless treatment done in the hospitals or in case of a hospitalization you will be reimbursed provided the insurer is informed within the stipulated time. Before you get a mediclaim there are certain things which you should keep in mind:

Pre-existing diseases:Disclose details of pre-existing diseases before you opt for the policy.

Yearly affair:It is important to remember that the mediclaim is a yearly thing. The policy will get renewed and reviewed every year.

Higher premiums with age: As your age increases you will have to pay higher premium for the same policy. Unlike life insurance, a mediclaim will require you to pay higher premium with increasing age.

Reimbursements only for hospitalization: When you opt for a mediclaim policy, you will be reimbursed for hospitalization for a time frame of 24 hours. Hospitalization for less than 24 hours will not be covered by the mediclaim. Additionally day care procedures too will not be reimbursed.

Renewal and maximum age: It is important to opt for a mediclaim policy with a higher age limit as once you reach a certain age, the mediclaim policy will stop to exist for you. You may require a separate senior citizen plan.

Looking into the fine print: Read the fine print carefully and find out about the sub-limits and day limits

Clauses: Most mediclaims do not cover maternity expenses. Even if they do, the cover may be offered three years after you have paid the first premium. Any expense which is related to the birth of the child is not covered. Additionally, dental procedures, cataract and cosmetic procedures are also not covered by the mediclaim.

Filing a mediclaim

Filing a mediclaim is not complicated. Steps to take to file mediclaim:

  1. At the onset make sure that bills, medical reports and receipts are in chronological order.
  2. All the documents should contain signature, patient name, cost price, document number and serial number.
  3. Ask the insurance company for the claim form. You can download the form from the company’s website. Read the instructions on the form carefully and fill in relevant and accurate details in the claims form.
  4. Get the claims form signed by the policy holder and the treating consultant. It should have the official hospital seal.
  5. Attach relevant policy and medical documents to the claims form. Make sure that you make copies of all the documents and review the documents carefully. If any of the documents are missing, you claim may be rejected.

It is important that you submit the documents with the name of the correct TPA. You can ask for the name of the TPA from the insurance company.