Reimbursement claim settlement is the process where an insurance company pays back an insured person for eligible expenses incurred. This typically occurs when the insured has paid for medical expenses out-of-pocket and then submits a claim to their insurance provider for reimbursement.
Yes, a reimbursement claim is different from a cashless claim settlement. Here is how.
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 your Health Insurance Company.
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If this is your first time filing a claim for Reimbursement Mediclaim Insurance, you might come across questions like
FYI- While filing a reimbursement claim, be assured that your Health Insurance Policy covers expenses related to your treatment.
While opting for a 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. So, it comes into the picture after you are done getting the treatment and paying the bill out-of-pocket. But these claims also offer some additional benefits.
To file a health insurance claim reimbursement, you need to fill out the form and submit it to your insurer within 24 hours of hospitalisation in case of emergency and 2 days before the admission, in case of planned hospitalisation.
It typically includes sections where you provide details about your:
Once you have the form, fill it out completely and accurately, and attach all required supporting documentation. This will help ensure that your claim is processed smoothly and efficiently.
However, before filing a health insurance reimbursement claim, you need to keep a few things in mind.
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. However, With the help of a third-party representative (TPA) and sufficient documentation, you can get your claim form corrected.
Know why your health insurance claim is rejected?
Is your health insurance claim rejected? Read here to know how to deal with it.
KYC documents are needed in case the claimed amount is more than or equal to INR 100K.
Yes, the original documents should be kept safe until the claim is settled.
It takes typically 15 to 30 days for a reimbursement claim to process, this totally depends upon the authenticity of the documents you submit.
No, health insurance reimbursement claims are generally not taxable.
The common documents required for a reimbursement claim are a duly filled claim form, original hospital bills, prescriptions, diagnostic and lab reports, and an original discharge summary.
In case of an accident, FIR will be the additional document required along with the other listed documents.
Yes, but all policies have waiting periods and exclusions for pre-existing ailments. Do check the waiting period duration before buying the plan.
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.
When you are admitted to any of the network hospitals of the insurer, you can avail of cashless claims, where your bills will be settled between the healthcare provider and insurer. In case of admission to a non-network hospital, the insurer mostly reimburses you for the hospital bills that you have paid out-of-pocket.
Yes, you have the freedom to select a healthcare facility of your choice in reimbursement claims.
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An explorer and a curious person, Simran has worked in the field of insurance for more than 3 years. Traveling and writing is her only passion and hobby. Her main agenda is to transform insurance information into a piece that is easy to understand and solves the reader’s query seamlessly.
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