Back in the older times, getting a health insurance was a choice. But nowadays with the astronomical rise in the expenses towards medical treatments and other procedures, getting a health insurance is not a really a choice anymore. Health insurance for self and loved ones provides a person with ease of mind and a monetary help in dire situations. There are many great health insurance plans available nowadays such as HDFC Ergo health insurance. Here are 5 steps to remember while claiming health insurance so that you don’t face any difficulty in doing so

First of all, there are two types of settlement claims; cashless claims and reimbursements and both of the types have their own steps you should take care of.

5 steps to claim cashless settlements

1. Check: Cashless claims can be opted if planned hospitalisation is being summoned. Planned hospitalisation is when you have a lot of time to plan on your admission into a hospital and planning on claiming your health insurance. Whenever you choose to opt for cashless settlement, you need make sure of two most important things. The first thing is to check if the illness or ailment is covered in the health insurance policy’s Terms and Conditions. The second important thing to make sure about is which hospital network is tied up to your insurer where you can claim your cashless claim.

2. Intimate: It is most important to let the insurance company know when you wish to claim your health insurance in cashless settlements or in reimbursements. In the hospital at the time of admission you will be given a pre-administration form to fill up to submit at the third party administration (TPA) counter. They will then forward the pre-administration form to the insurance company for the cashless settlement.

3. Submission of documents: At the third party administration counter you will be asked to provide documents required for the admission and to claim the cashless settlement such as the cashless health card given to you by your insurance company with certain KYC documents such as your Aadhar card for identification. They will make a copy of the documents submitted by you and return you the original documents.

4. Record Keeping: Once the cashless settlement claim is received from the insurance company, the documents submitted by you to the hospital will be retained by your insurance company. It is advised to get a copy of your records and keep a track of all the procedures.

5. Pre-Post Hospitalisation: Check about coverage you get before hospitalisation and after hospitalisation in your health policy. You will have to save the bills, prescriptions and all the medical reports to claim the said coverages. This claim is done on the basis of reimbursement. Refer to the wordings of the policy for the time frames related to the claim of the coverage.

5 steps to claim reimbursements

Some plans do not provide cash less settlements. In such cases you will be reimbursed the expenses by the insurance company. Reimbursements may also be done if you get treatment from a hospital which is not a part of the network of hospitals connected with your insurance company. Here are the following steps you need to follow to claim reimbursements.

1. Inform: You should inform the insurer about your treatment. You will receive a reimbursement claim form by the insurer to fill. You must fill this form and submit it within the 30 days from your discharge date from the hospital. In case of emergency hospitalisation, you may be rushed into a hospital that may not be the part of the network of hospitals connected to your insurance company. In such cases, reimbursement claim is your only chance of getting your expenses covered by your insurance providers.

2. Documents: After your discharge from the hospital you must provide the insurance company with all the necessary documents required to claim your reimbursements. Make sure to attach all the original copies of your medical reports, bills of medicines and bills from hospital signed and stamped with your reimbursement claim form. The reports should mention the date and the patient’s name clearly. The reports should be attached with the prognosis prescription provided by your doctor who advised your hospitalisation as a proof that your medical prescriptions and hospitalisation was not voluntary but done as per the advice of the doctor. The hospital bills should also have the registration number of the hospital mentioned clearly.

3. Discharge: After being discharged from the hospital, you will be issued a discharge summary or a discharge card by the hospital which is a proof of you being fit to be discharged from the hospital. This card is further submitted to the insurance company.

4. Post Discharge: The following prescription from your doctor that is used as a proof of fitness after hospitalisation is also to be submitted to the insurance company in original and not a copy. For the reimbursement of post hospitalisation and post discharge expenses you can submit your bills to the insurance company within 60 to 90 days from discharge, also depending on the terms and conditions of your insurance policy.

5. Settlement: Make copies of all the documents you have submitted. These copies can be used as reference in the future. Your claim of reimbursement should be settled between 2 weeks to 3 weeks after the registration of your claim.

Following these steps will ensure you of a fast and
valid settlement of your health insurance policy claims. Your health insurance
will only prove useful if it your expenses can be claimed successfully and
following these steps shall help you make your claim successful.