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What is a Reimbursement Claim?
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.
Article Highlights
If this is your first time filing a claim for Reimbursement Mediclaim Insurance, you might come across questions like
- ’What is the procedure for obtaining a Reimbursement Claim Form?’
- ’What is the best way to submit it?’
- ’What documents are required?’
- ’What is the deadline for submitting the form?’
FYI- While filing a reimbursement claim, be assured that your Health Insurance Policy covers expenses related to your treatment.
What are the Benefits of a Reimbursement Claim?
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.
Flexibility
Reimbursement claims offer treatment options, even in the company’s non-network hospitals, giving the policyholder a wide range of possibilities for receiving care in the hospital of their choice.Wide Coverage
A medical reimbursement claim covers a wide variety of costs, including doctor’s fees, surgeries, medication, ambulances and much more. They cover almost all the expenses of the plan.Timely Process
After submitting the document the company settles the reimbursement claims very quickly, and the customer will be paid instantly into their bank account. So it is a time-bound process that takes less time to settle.Convenience
The mediclaim reimbursement process enables you to go on with your treatment without waiting for the insurer’s approval.Reliability
All health insurance companies have designed a transparent reimbursement claim process. The claims can be filed online and you can even check the status of the claim on the official website of the company.
What is the Health Insurance Claim Reimbursement Form?
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:
Personal information
Name, address, policy number, etc.Claim details
Date of service, provider’s name, diagnosis, and procedure costs.Medical expenses
A breakdown of all costs incurred, such as doctor’s fees, hospital charges, and medications.Supporting documentation
A list of documents you’re attaching to support your claim, such as medical bills, receipts, and prescriptions.
How to Find the Health Insurance Reimbursement Form?
Check your insurance policy
Your policy should have information about how to file a claim and where to find the necessary forms.Visit your insurance provider’s website
Most insurance companies have online resources to download claim forms and other important documents.Contact your insurance provider directly
You can call or email your insurer to request a claim form.Visit our website
We are the best web aggregators in the market for health insurance. You can get the form here. For any assistance, you can
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.
Documents Required for Filing Reimbursement Claim
- Health Card Copy
- Duly Filled Claim Form
- Original Hospital Discharge Summary
- Investigation Reports like scans, X-rays, blood reports, etc
- Cash Receipts from Hospitals
- If an accident happens, then FIR or medico-legal certificate(MLC)
- Doctor’s Consultation Papers and Pre-Admission Investigations
- Copy of KYC documents
- Contact Info, NEFT details
- Invoices of pharmacy supported by respective prescriptions.
Steps You Need to Follow to File the Reimbursement Claim
Intimate the company
You must inform the company within the designated timeline.Get your Documents Ready
You must ensure that you have all original documents related to the treatment like Medical Bills, Doctor’s prescriptions, Diagnostic Reports, Pharmacy Bills etc.Fill and Submit the Claim Form
A duly signed & filled form must be submitted with other required documents.Evaluation of Claim Request
After submission, the Insurance Company will evaluate the documents as per the Terms & Conditions of the policy.Reimbursement Initiated by the Company
Once approved, the amount shall be transferred to the registered bank account.
Things to Remember
However, before filing a health insurance reimbursement claim, you need to keep a few things in mind.
- Read all the terms and conditions carefully to make sure that the policy covers all the necessary treatments.
- You might need to do out-of-pocket expenses.
- You need to collect and share all the documents before filing the claim.
- Read the policy wording thoroughly as many facilities are not covered under reimbursement claims. This will avoid future discrepancies in making a claim.
What if You Do Not Get a Reply from your Insurance Company?
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?
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How to file a Claim for Reimbursement Mediclaim?: FAQs
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. How reimbursement claim is different from a cashless claim in health insurance?
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.
3. Do I need to submit KYC documents?
KYC documents are needed in case the claimed amount is more than or equal to INR 100K.
4. Should I keep original documents safe?
Yes, the original documents should be kept safe until the claim is settled.
5. How long does it take for a reimbursement claim to be processed?
It takes typically 15 to 30 days for a reimbursement claim to process, this totally depends upon the authenticity of the documents you submit.
6. Are reimbursement claims taxable?
No, health insurance reimbursement claims are generally not taxable.
7. What are the documents required for a reimbursement claim?
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.
8. What are the documents required for reimbursement claims in the case of an accident?
In case of an accident, FIR will be the additional document required along with the other listed documents.
9. Even in the case of a reimbursement claim can I choose any hospital of my choice for treatment?
Yes, you have the freedom to select a healthcare facility of your choice in reimbursement claims.
10. Can I claim reimbursement in case of pre-existing conditions?
Yes, but all policies have waiting periods and exclusions for pre-existing ailments. Do check the waiting period duration before buying the plan.
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Written By: Simran Saxena
An explorer and a curious person, Simran has worked in the field of insurance for more than 3 years. Travelling and writing are her only passion and hobby. Her main agenda is to transform insurance information into a piece that is easy to understand and seamlessly solves the reader’s query.
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