How to Claim Health Insurance

health insurance claim

When you or one of your family members fall ill, the very last thing you will concern about is how to pay for the medical treatment. And, health insurance India fulfills the same purpose at really affordable rates. Under this policy, insured don’t need to worry about how he or she can manage adequate funds for treatments.

This type of policy ensures that the outflow of such funds does not create a big hole in your wallet. Policyholders take advantage of health insurance benefits only when they know online health insurance policies:

  • When to Claim Health Insurance

Generally, this insurance can be claimed when the policyholder has been taken into a hospital for a period of at least 24 consecutive hours. It has some exceptions such as ‘Day Care treatment’ for which a policy can be claimed even if the patient is admitted into a hospital for less than 24 hours.

It includes chemotherapy, eye surgery, tonsillectomy, prostate surgery and ligament repair procedure among other processes and will be mentioned in a policy document, if applicable.

  • What to Claim Under Mediclaim Policy

Health insurance covers the costs policyholder incurs during hospitalization like surgery and procedures, room charges and medical tests and so on. Also, it pays for some pre- and post-hospitalization expenses which are connected to the condition for which insured person is hospitalized.

Policyholder can register a claim only for those conditions that are included in a policy document. Therefore, read your health insurance policy carefully to know both the exclusions and coverage. Insurance companies in India provide plans which include a list of related expenses like ambulance from the residential location to the hospital.

Some plans even pay for treatment at home or domiciliary treatment under certain situations. Policy clearly mentions in a document if such expenses can be claimed.

  • Health Insurance Claim Procedures

The claim process is based on whether insured selects the reimbursement of expenses or cashless facility at the time of admission into the hospital. For cashless claims, policyholder must avail treatment at a network hospital. Request the hospital administration to fill in the claims cashless request form at the time of admission and then submit it to insurer.

For reimbursement of expenses, insured must contact insurer regarding hospitalization, at least 24 hours after hospitalization in case of emergencies. Policyholder has to pay the medical bills at the time of discharge and later submit it to insurer along with diagnostic reports, prescriptions, discharge summary, other specified papers etc.

  • Claim Rejection

Sometimes, claim rejection does happen because of different reasons like non-disclosure of material facts regarding health issues, lack of clarity with regard to the policy terms and misunderstandings of the procedure to be followed. 

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