How to file a claim for Reimbursement
Mediclaim
In case an emergency arises, you might have to rush to a nearby hospital for treatment. Even, when you have a planned surgery, you might want to avail the treatment at a hospital in your vicinity or near to where you reside. If the doctor treating you works at a specific hospital, you are likely to prefer it over others. That hospital may/ may not fall under thelist of Network Hospitalsof your Insurer.
It may be possible that your Health Insurance Company's Network Hospital is not affiliated with your preferred hospital. Then your only choice would be to file a Reimbursement claim with yourHealth Insurance Company.
If this is your first time filing a claim for Reimbursement Mediclaim Insurance, you might come across questions like:
In this article, we have shared insights on the entire procedure and its minute details.
You can file for Reimbursement Claim if you're admitted to/ getting treatment at a Non Network Hospital of the Insurer.
While opting for Reimbursement Claim, you need to primarily pay for your hospitalization on your own. Post submission of documents, verification & approval, the amount shall be transferred to your registered bank account.
While filing a Reimbursement Claim, be assured that yourHealth Insurance Policy coversexpenses related to your treatment.
In Case of Planned Hospitalization, the Insurer needs to be informed2 daysbefore the admission. In Case of Emergency Hospitalization, you must inform the Insurer within24 hoursof Hospitalization.
Before getting a Mediclaim there are certain things that you should keep in mind:
Pre Existing Diseases (PED)
There is a certain Waiting Period that you have to surpass in order to avail compensation against them.
Renewal
It is important torenew your health policyon time to continue availing the benefits. If the policy is not renewed, you might not be able to file for a claim.
DayCare Treatments
Treatments which require less than 24 hours of hospitalisation are not covered.
Look into the Contract
Read the contract carefully to understand Terms & Conditions & additional steps (if any), which are required to file a claim.
Sometimes, your claim could be rejected due to multiple reasons, which must be rectified in order to avail of the benefits of Reimbursement Claim.
Claim Rejection Circumstances
With the help of athird-party representative (TPA)and sufficient documentation, you can get your claim form corrected.
If you haven't received a response from your Health Insurer within 30 days, you must contact your Insurance Ombudsman.
You can go for legal assistance in addition to addressing the Ombudsman's office. However, you must keep in mind that legal assistance might cost a lot.
To avoid rejection and the struggle that comes with it, it is preferable to submit accurately filled forms & proper documentation.
You can check the status of your claim online. You can visit the official website of the Insurance Company and track the status by entering the relevant information.
1. Can I file my Reimbursement Claim online?
Yes, you can file your Reimbursement claim online. Insurance companies offer a paperless claim submission facility that allows you to submit your Reimbursement Claims online in a hassle-free manner.
2. Do I need to submit KYC documents?
KYC documents are needed in case the claimed amount is more than or equal to INR 100K.
3. Should I keep original documents safe?
Yes, the original documents should be kept safe until the claim is settled.
4. How is a reimbursement claim different from a cashless claim?
When you get admitted to a company partnered Network Hospital, you can avail Cashless Claim facility, wherein your bills will be settled directly by the Insurance Company.
On the other hand, when you're getting treated at a Non Network Hospital, you can avail of the Reimbursement Treatment which effectively means getting reimbursed at a latter stage i.e. after the treatment.
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Naval Goel is the CEO & founder of PolicyX.com. Naval has an expertise in the insurance sector and has professional experience of more than a decade in the Industry and has worked in companies like AIG, New York doing valuation of insurance subsidiaries. He is also an Associate Member of the Indian Institute of Insurance, Pune. He has been authorized by IRDAI to act as a Principal Officer of PolicyX.com Insurance Web Aggregator.
