Useful Tips for Speedy Health Insurance Claim Settlements

Investing your hard-earned money into a health insurance policy so that you protect yourself and your family from any financial burden in case of medical emergencies is the most prudent course of action. A health insurance policy is a must for every individual in this modern day life because of the rising incidence of illnesses and the corresponding rising trend of medical costs. In such a scenario, you should insure yourself with a sufficient amount so that the claim does not burn a hole in your pocket.

Read More

Policybazaar exclusive benefits
  • 30 minutes claim support*(In 120+ cities)
  • Relationship manager For every customer
  • 24*7 claims assistance In 30 mins. guaranteed*
  • Instant policy issuance No medical tests*

*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C Apply

*Tax benefit is subject to changes in tax laws. Standard T&C Apply

Back
All health plans cover Covid-19 treatment
  • 1
  • 2
  • 3
  • 4

Who would you like to insure?

  • Previous step
    Continue
    By clicking on “Continue”, you agree to our Privacy Policy and Terms of use
    Previous step
    Continue

      Popular Cities

      Previous step
      Continue
      Previous step
      Continue

      Do you have an existing illness or medical history?

      This helps us find plans that cover your condition and avoid claim rejection

      Get updates on WhatsApp

      What is your existing illness?

      Select all that apply

      Previous step

      When did you recover from Covid-19?

      Some plans are available only after a certain time

      Previous step
      Advantages of
      entering a valid number
      You save time, money and effort,
      Our experts will help you choose the right plan in less than 20 minutes & save you upto 80% on your premium

      Even after availing optimum health insurance coverage, we still fear the claim scenario almost always expecting one or more hassles at the time of settlement. Our fears are reasonably justified because the health insurance claim settlement process, unless otherwise known, can be a cause of concern. Therefore, simply buying a health plan is not enough; you need to also know the claim settlement process of your policy to avoid future hassles. So, let us take a look:

       

      Types of Claim Settlements:

      There are two ways in which your claim can be settled namely -

      • Cashless - This is by far the easiest settlement process. Under the process, if the policyholder gets admitted in a network hospital referred technically as the Preferred Provider Network (PPN), all expenses are directly settled by the insurance company through Third-Party Administrators (TPA) who act as an intermediary between the hospital and the insurance company.
      • Reimbursement - Under this process, the policyholder needs to foot the hospital bills and then claim for reimbursements from the insurer by providing the required documents.

      In both of the above claims, there is a specified process and certain pointers that can enable a hassle-free claim experience.

      Cashless Claims

      If your policy provides for cashless claim facility, you need to keep the following pointers in mind at the time of hospitalization:

      • Always look for the list of hospitals tied with the insurer called PPNs and ensure to avail treatment in any one of those hospitals for being eligible for cashless facility.
      • Your hospitalization can either be planned or emergent. In case of planned hospitalization, inform the TPA by filling and submitting a Pre-Authorization Form well in advance so that the TPA begins the formalities to co-ordinate with the insurer. It is generally mandatory to submit the form at least 48 hours before a planned hospitalization. In case of an emergent hospitalization, the form needs to be submitted within 24 hours of hospitalization to begin proceedings.
      • The Health Card that comes with the policy document should be produced at the hospital, which contains the identity of the insured.
      • Insurers generally pay the claim in tranches where they pay a lump sum amount initially and later cover the remaining bill. So keep the TPA informed at all times and keep a copy of all hospital bills and doctor’s prescriptions as document proofs which will be required to ascertain a fair settlement.

      Reimbursement

      Though the cashless claim is the norm of modern times, there are policies which have reimbursement claim settlement. Even the cashless settlement may at times result in a reimbursement claim if:

      • There is an anomaly in the Pre-authorization Form whereby the TPA rejects the cashless facility
      • The policyholder is admitted in a non-network hospital
      • The medical treatment costs less and the policyholder decides to get the bills reimbursed
      • There is a coordination problem between the TPA and the insurer

      At such times and for reimbursement policies, the following points should be remembered:

      • The reimbursement claim form should be filled and submitted along with supporting documents in original.
      • The supporting documents include the doctor’s prognosis prescription advising for hospitalization. This needs to be submitted to prove that the hospitalization was advised and not voluntary.
      • All hospital bills, bills for tests conducted or surgeries performed, etc. need to be submitted in original.
      • The Discharge Card issued by the hospital stating that the policyholder is declared fit to be discharged is also required.
      • A follow-up prescription showing that the policyholder is fit after hospitalization is needed.
      •  A copy of all original bills and forms needs to be retained by the policyholder for future use.
      • After receiving all the required documents, the insurers generally settle the bill within 15-21 working days.

      The Final Word!

      Whatever be the nature of your claim, keeping the relevant points in mind is very necessary to ensure a speedy settlement without the additional hassle involved at times when you are already under a lot of stress.

      Search
      Disclaimer: Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.

      Health insurance articles

      Recent Articles
      Popular Articles
      10 Essential Things that Should be Included in your Health Insurance Policy

      12 Sep 2023

      The cost of healthcare has risen threefold in the last decade
      Read more
      Short-Term Health Insurance

      06 Sep 2023

      With technological advancements in India, the health insurance
      Read more
      Know Everything About Cashless Mediclaim Insurance

      23 Aug 2023

      Health emergencies come without a warning. Usually, people realize
      Read more
      List of Diseases Covered by HDFC ERGO Health Insurance

      11 Aug 2023

      In the world we live today, diseases are spreading like wildfire
      Read more
      Dengue, Malaria Cases Surge in Delhi: Know Why Health Insurance is a Must

      26 Jul 2023

      Delhi witnessed its first flood in 45 years due to incessant rains
      Read more
      How to Apply for Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY)?
      Ayushman Bharat Yojana is a flagship health insurance scheme launched by the Government of India to offer universal
      Read more
      10 Major Benefits of Ayushman Bharat Yojana
      Pradhan Mantri Jan Arogya Yojana (PM-JAY) is the second component under Ayushman Bharat Scheme. PM Narendra Modi
      Read more
      Best Health Insurance Plans for Senior Citizens in 2023
      Senior citizens are the most prone to diseases. Considering the medical inflation in India, buying health insurance
      Read more
      Does Health Insurance Provide Coverage for LASIK Eye Surgery?
      A vast majority of the Indian population is suffering from vision problems. For some of them, LASIK eye surgery is
      Read more
      Waiting Period in Health Insurance
      The waiting period in health insurance refers to the duration before which certain diseases will not be covered by
      Read more

      top
      Close
      Download the Policybazaar app
      to manage all your insurance needs.
      INSTALL