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Market inflation and future predictions bring to an individual a feeling that s/he should have health insurance. Bearing medical health costs is no easier. In this situation, the health insurance comes to our rescue whether it covers your expenses fully or partially.

It is necessary to know the types of health insurance catered in the market by insurance companies. How to Claim Health Insurance Successfully

What Are The Types Of Health Insurance?

The following are the types of health insurance being offered by insurance companies at present.

  1. Individual Health Insurance
  2. Critical Illness plan
  3. Senior Citizen Health Plan
  4. Maternity Health Insurance
  5. Family Floater Health Insurance
  6. Unit Linked Health Plan
  7. Top-up Health Insurance

Whenever you buy an insurance policy, it becomes mandatory for you to know how the claim process works? In case you are unaware of the facts then it will be a headache for you when you will be hospitalized and heavy bills need to be paid before you get discharged. So, all you need to do is, read carefully the upcoming paragraphs.

Health Insurance Can Be Claimed In Two Ways

1. Cashless Settlement

As a part of PPN (Preferred Provider Network), normally insurance companies do have a list of network hospitals. A policyholder is liable to a cashless treatment health insurance claim process where the insurer/third party administrator settles the cost of hospitalization and associated expenses directly with the hospital without involving the insured in case of any medical emergency.

Must Read: How To File A Complaint Against Health Insurance Claim?

How To Go About Cashless Settlement

  • Settlements can be easily handled if one goes stepwise smoothly with patience. In case of planned hospitalization, the policyholder has to intimate the insurance company at least 1-2 days in advance. But in case of emergency hospitalization, intimation should be sent to the insurance company within 24 hours.
  • Normally, you will get to see a dedicated TPA (Third Party Administrator) helpdesk in the network hospitals that helps in the entire documentation and formalities associated with the claim process. That is why it’s important to connect with the TPA desk and get a smooth experience.
  • Thereafter receiving the document by the insurance company/TPA, they are scrutinized to check against the policy coverage and terms.
  • In the continuation of the process, approval is sent to the hospital for a specific amount. In case the cost of treatment exceeds the approved amount, the hospital can request the reapproval.
  • For the time being the person can pay towards the hospitalization and treatment from his pocket and then can file a claim for the reimbursement.

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Categories Of Health Insurance Cashless Claim

A. Claim Against Planned Hospitalization

The medical treatment of diagnosed illnesses is based upon cashless claims against planned hospitalization. 

  • What Happens In Planned Hospitalization?

To avail the cashless treatment under planned hospitalization for the policyholder, the most essential part is to make the insurance company aware of the nature of illness and get approval for its treatment from the TPA. One needs to fill up the necessary documents for admission, like pre-authorization forms before hospitalization. After which these are to be submitted at the insurance desk (every network hospital will have a dedicated insurance desk). Based on the terms and conditions listed in the policy, the form will get approved or rejected. If the form is approved, then the TPA will send the sanction letter to the hospital and the treatment can be started thereon.

  • Stepwise Instruction To Avail Cashless Facility
    • Fill the claim form along with details regarding the network hospital where the insured will be hospitalized. 
    • The form is to be sent by mail or fax to the third-party administrator(TPA) to get the approval for a cashless claim at least 48 to 72 hours before in case of planned hospitalization.
    • The insurance company or TPA informs the hospital about the approved claim amount after approval.
    • Once the treatment at the hospital completes the insurance company or the TPA directly pays the approved claimed amount to the hospital.

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B. Claim Against Emergency Hospitalization

This claim applies to an accident or critical illness, and in unforeseen emergencies arising.

  • What Happens In Emergency hospitalization?

In case of emergency hospitalization, the policyholder can show his or her Health ID card at the network hospital to avail cashless facility. After admission, the request can be sent to the TPA. As emergencies are unpredictable a policyholder needs to carry his/her Health ID card at all times. The health ID card can later be shown at the time of hospitalization. An ‘Emergency certificate’ also has to be submitted with the claim settlement form to the TPA, stating the emergency nature of admission.

  • Stepwise Instruction To Avail Cashless Facility
    • The claim should be filed within 24 hours or TPA/Insurance company should be intimated regarding the same.
    • Within 24 hours of hospitalization send the filled up claim forms.
    • The insurance company or TPA informs the hospital about the approved claim amount after approval.
    • Once the treatment at the hospital completes, the insurer directly pays the approved claimed amount to the hospital.

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2. Reimbursement of Medical Expenses

In extreme conditions when the policyholder is unable to get treated at a network hospital, s(he) can opt for the hospitalization and the subsequent treatment in his/her choice of hospital, pay for the same through his/her pocket and then claim for reimbursement. Because of the huge costs involved that you need to bear at the time of discharge from the hospital, this may not appear to be a preferred choice for many.

  • How To Go About Reimbursement Claim Settlement

Intimation to the insurance company is mandatory even if you wish to go for reimbursement, as in cashless settlement. The policyholders have to submit the necessary documents to the insurance company/TPA to kick-start the process after the hospitalization post necessary treatment. 

  • Here’s the list of documents to be submitted to enable smooth processing:
    • Duly completed claim form
    • Discharge summary signed by the treating doctor/hospital
    • All medical bills along with the related prescriptions
    • As per the pre-post hospitalization cover clause in your policy document, you can also submit the expenses/OPD costs related to the hospitalization sought
    • Copy of canceled cheque
    • Any other necessary documents at the request of the insurance company.


Buy a health insurance plan and get rid of heavy medical expenses. Health insurance is a necessity in the present scenario. And with several insurance companies mushrooming all over the country you have many options from which you can choose the best one suiting your preferences.

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Naval Goel is the founder of 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 Insurance Web Aggregator.
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