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Health insurance policies in India are offered by insurance companies to cover the individual’s medical and surgical expenses. These companies are monitored by the Insurance Regulatory and Development Authority of India and The General Corporation of India both of which run healthcare campaigns in the country.

To keep you and your family financially secure in the event of unforeseen health issues, it is best to invest in a health insurance policy and to file a claim in the hour of need. There are two ways to apply for a health insurance claim- cashless and reimbursement. Let’s discuss both in detail. 

Cashless Claims- How it’s Done?

Whether planned or unplanned, cashless processes typically vary according to the type of treatment provided at the network hospital. 

Process for Planned Treatment 

  • Before you avail of the cashless treatment, inform the insurance provider of the treatment or hospitalization that you are about to undertake. The company requests information at least 4 days before the treatment date. 
  • Submit a cashless claim request form to the address of the provider and reach out to the health insurance provider’s customer care number.
  • The insured and the concerned hospital will both receive a notification from the provider concerning the policy and eligibility. 
  • During hospitalisation, the policyholder must display the confirmation letter along with the health insurance card. 
  • The hospital gets directly paid by the provider.

Process for unplanned treatment

  • Emergencies are unwarranted and require the policyholder to reach the hospital as soon as possible to undergo treatment. In such situations, the insured must provide the health insurance card to avail of cashless hospitalisation at the ER. 
  • A cashless claim request form will be filled in at the hospital to be sent to the insurance provider, who will then issue an Authorization Letter to the hospital, indicating the extent of the coverage. Here too, the medical bills will be fulfilled by the insurance provider.
  • In the event of a rejection, the insured receives a letter or communication from the provider stating relevant reasons for refusal.

Reimbursement Claims- How it’s Done?

  • If the insured chooses a non-network hospital, (s)he has to pay all the medical bills, hospitalization and treatment costs before submitting a claim for reimbursement. 
  • The insured has to provide all the necessary documents and the original bills to the provider, which will be evaluated for the scope of policy cover. 
  • Once inferred that the insured is eligible for the reimbursement, the amount will be transferred to the insured’s registered account. 
  • In case of a rejection, the provider notifies reasons for refusal to the insured. 

Health Insurance Claim Process

Read: 1 Crore Health Insurance Plan

Documents Required

To place a claim, the following documents will be required:

  • Claim form filled in
  • Policy document
  • A medical certificate signed by the doctor treating the ailment
  • Discharge summary in case of hospitalization
  • Original bills and receipts
  • Cash memos for prescriptions encashed at the hospital or pharmacy
  • Complete investigation report as recorded by the hospital
  • FIR or Medico-Legal Certificate (MCL) in the event of an accident

Health insurance keeps you funded in case of unanticipated or anticipated medical needs. Read the terms of your document carefully before you apply for a claim. Ensure that you are choosing health parameters that you regard as most probable in the near future.

Naval Goel is the founder of PolicyX.com. He is an Associate Member of the Indian Institute of Insurance`, Pune. He has been authorized by IRDA to act as a Principal Officer of PolicyX.com Insurance Web Aggregator.
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