Health Insurance is an extended life support to any individual. After choosing the policy as per our requirement we should know how to use it as well. Claims settlement is hassle-free process once few things are taken care of.
To begin with; we should remember the amount that will be settled can’t be more than sum assured of an Insurer. Also, we should be very clear about terms and conditions of the policy. As once the cooling time i.e. usually 15 days is over we can’t withdraw the policy. It’s recommended that we should take the policy that suits our financial requirement and health conditions.
Before understanding how to raise claim we should understand methods of availing it. First of all, there are two ways why which we can settle our claims through cashless treatment or by reimbursement.
In either of the cases, there are few things we must remember before settling our claims to prevent rejections.
Read the Policy documents properly:-
Policy documents mention in details what all illness are covered as per the Health Insurance plans. In some policies chemotherapy is not covered however in others it may be covered. Same applies to other diseases as well. At the same time, pre-hospitalisation before 30 days and post-hospitalization after 90 days are not covered in some of the policies. Claim settlement is directly related to these terms and conditions.
Pay Premium on time:-
Before getting hospitalized or any urgency we should ensure that policy premiums are paid on time as per the terms and conditions of our plans. Usually, for Health Insurance, it’s paid annually. In case of non-payment of same, our policy may get lapsed and we may not be able to avail any claim.
Ensure KYC is complete:-
IRDA (The Insurance Regulatory and Development Authority of India) rules keep providing fresh guidelines to all policyholders and Insurance companies. We must adhere to the same. KYC (Know Your Customer) is one of the mandatory aspects of Insurance policy. We must keep track of regular updates from our Health Insurance providers. Whenever any documents are required we should share the same as required. At the time they may need our Pan card and at other times our Adhaar card might be required. We should be ready with all that as this can be the reason for claim rejections.
Remember your Policy Number:-
That’s most important step while going for settlement of our claims. At times Insurance Company’s issues health card for faster processing. At the time of admission to the hospital, we must produce the same to the Insurance Department. Once all our details are in place it will convenient to take cashless treatment in any of the network hospitals.
All the bills should be documented properly.
This applies at the time of treatment taken from non-empanelled chain of hospitals. In such case, we need to pay all the bills ourselves initially. Same can be reimbursed after the treatment through our Insurance Company.
At the time of taking such claims, we much take care of few things as follows.
- Collect all the bills from hospitals.
- Take discharge file from the hospital after authorized signatories from the hospital staff.
- Take Claim form from the Insurance policy provider if required.
- Submit all the bills along with claim form.
Usually claim is settled within maximum 30-45 days after producing all the documents in case of reimbursement and immediately in cashless treatments. Furthermore, to avoid any hassle during hospitalization it’s better to inform Insurance agent in advance or at times of admission. This will further assist the agent to keep all documents ready especially in case of cashless transactions.
Any good policy can help in the speedy settlement of claims. It’s good to go for cashless treatment as it’s faster; prompt and more convenient. All the Health Insurance policies work as per the guidelines of IRDA. If we don’t adhere to required details and documents than even Insurance Policy companies may not be able to do much. However even after providing all the details as required if our claims get rejected then we should escalate the issue to the concerned authority.
In such cases, first of all, we should check about the same from our Insurance agents. If they are unable to provide with the adequate solution than we should contact TPA (Third Party Administrator) if applicable and IRDA for possible solutions.
Finally, if our policy is active and all our documents are in place then no one can hold our claims.
About the author:
Chandresh kamal is a Marketing Content Manager at Policyx.com with 5 years of experience in content marketing. His passion for helping people in all aspects of insurance plans flows through in the expert industry coverage he provides.