How to file a claim for Reimbursement Mediclaim
- Insights into Reimbursement Claim process
- Points to note before filing a claim
- Grounds for Rejection of 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 the list of Network Hospitals of 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 your Health 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 your Health Insurance Policy covers expenses related to your treatment.
Though reimbursement claims fall into the picture after you are done getting the treatment, these claims do offer some benefits to the policyholders. Read on to find out:
In Case of Planned Hospitalization, the Insurer needs to be informed 2 days before the admission. In Case of Emergency Hospitalization, you must inform the Insurer within 24 hours of 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 to renew your health policy on 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 a third-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.
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.
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.
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.
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, you have the freedom to select a healthcare facility of your choice in reimbursement claims.
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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