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Ways to Claim Health Insurance

Ways to Claim Health Insurance

Thursday October 25, 2018,

4 min Read

We have reached a stage where we don’t have to meet an agent and spend a lot of time in buying health insurance. Due to the power of internet and smartphones, health insurance can be bought easily and swiftly. The reason for the same is the online presence of a lot of insurance companies, both government or private. With people becoming more and more tech-savvy, online platforms have gained preference for buying anything and everything, be it an LCD TV or a health insurance policy.

What is a Health Insurance Policy?

A health insurance policy is a mutual contract between the policyholder and insurance company, where the latter agrees to pay a certain amount of money in the event of hospitalization of former due to an ailment. The amount paid by the insurance company is the sum assured under the policy. So, a health insurance policy eases the financial burden on the policyholder in the event of a medical problem involving hospitalization.

LGI Health Insurance
LGI Health Insurance

Things to Consider while Buying Health Insurance

1. The coverage offered by the health insurance plan should be sufficient for you and your family.

2. Coverage of pre-existing disease is subject to a waiting period, so check the same.

3. Cashless treatment can only be availed at network hospitals. Make sure those are accessible to you.

4. Health insurance provides No-Claim Bonus which starts with 5% and can go up to 50%.

5. A health insurance plan should have critical illness rider, as the treatment costs of such illnesses are very high.

6. Read the terms and conditions properly to avoid problems and confusion in the future.

How to Claim Health Insurance?

Usually when it comes to health Insurance, there are two types of claim process. One is a cashless claim facility which can be availed at a network hospital of the health insurance company. Network hospitals are the ones with which insurance company has tie-ups. The other is a reimbursement claim wherein the policy holder pays the hospitalization expenses, which are later repaid by the insurance company as per the terms and conditions of the insurance plan.

Claim Process for Planned Treatment

In this case, the policy holder should intimate the insurance provider at least 4 days prior to the treatment date. A cashless claim request form has to be submitted to the insurer through post, email or fax. Then, the insurer will notify the policyholder and the hospital on the matters of coverage and eligibility. While getting admitted to the hospital, the policyholder needs to submit the insurance card and the confirmation letter from the insurance provider as well.

Unplanned Treatment at the Cashless Facility

The policyholder needs to inform the customer care of the insurance provider regarding the emergency admission by mentioning the health insurance card number. Then, the policyholder has to fill the cashless request form at the network hospital and get the same approved by the treating doctor. After that, the cashless request form along with other necessary documents has to be sent to the insurance company. The insurance company will then issue the authorization letter to the hospital, notifying the policy holder’s eligibility and coverage. The medical expenses will then be paid by the insurance company to the hospital.

Reimbursement of Claim Process

In case the policyholder gets admitted to a hospital which is not a part of insurance provider’s network, then he or she has no option but to go for the reimbursement of the claim process. The policyholder has to bear the charges for the hospitalization and then claim reimbursement from the insurance company. For the purpose, all original medical bills and other necessary documents have to be presented before the insurance provider. The insurance company will estimate the claim and pay according to the coverage offered under the health insurance policy.

So, the responsibility of a policyholder does not end with buying a health insurance policy. He or she has to understand the coverage before filing a claim. Hence, it is pertinent on the part of the policyholder to understand the terms and conditions of the policy thoroughly.