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Reimbursement Health Insurance: Everything you need to know about it
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Reimbursement Health Insurance: All you need to know about it

Arun (30 years old) lives in Chennai with his parents (father: 61 years, and mother: 54 years). Arun’s father has a prolonged heart problem. Being the sole earner of the family, Arun has purchased a comprehensive family health insurance plan to protect the health and finance of his family during the time of a medical emergency. Suddenly, Arun’s father had experienced chest pain and discomfort, and he got admitted to a nearby hospital. But that hospital was not impaneled in Arun’s family health policy. That’s why Arun had to pay all the expenses initially for his father’s treatment. Once discharged, Arun can claim for health reimbursement by submitting all the documents and discharge papers to his insurance company. But unfortunately, Arun doesn’t have adequate knowledge about insurance reimbursement. So, here we are going to highlight what mediclaim reimbursement is and how reimbursement health insurance policy plans play a pivotal role in the claim process.

A health problem can be agonizing and painful to the patient and his/her family members. In such a traumatic situation, the financial assistance offered by a health insurance policy is appreciated. While purchasing various health insurance policies, policyholders are paying attention to the claim settlement process of the insurers. Customers are looking for a hassle-free and convenient claim process so that they can get financial support at the earliest.

Whenever a customer needs to file a claim under any emergency, like Arun’s case, the policyholder should look out if the hospital has a cashless facility or not. If not, then a cashless reimbursement could be the best option to clear your hospital expenses.

What is a reimbursement claim?

A reimbursement claim means that you first need to pay your medical bills and hospitalization charges to avail of medical treatment during your hospital stay. Later, you can get a health insurance refund from your insurer after submitting bills, receipts, discharge paper, etc., along with the claim initiation form.

Some salient features and benefits of medical insurance reimbursement

Reimbursement in insurance is a plan where policyholders can reimburse their hospital expenses after getting discharged from the hospital. An imperative facility of medical reimbursement plan is it offers the flexibility of availing of medical treatment at any hospital in case of an emergency. Though your selected hospital may not be tied up with your insurance company still, you can get the best treatments for your ailments. Here are some benefits of medical reimbursement insurance.

  • You don’t need to find a network hospital in case of an emergency
  • You are free to choose any hospital (non-network hospital) for your treatment
  • Don’t need to follow tedious insurance-related procedures while seeking medical treatment
  • You can raise a claim after the completion of your treatment by submitting all the bills and discharge summary


The medical reimbursement insurance process

Below, we are mentioning some steps that you need to follow for a health insurance reimbursement plan.

  • Intimate your insurance company about the treatment and all the details of the hospital
  • Now, you are eligible for healthcare treatment at any hospital
  • Collect and submit all hospitalization bills, receipts, and discharge summary
  • By applying online or writing to your insurer, you can make the claim
  • Once your documents are verified, and the scope of coverage is evaluated, the insurance company will initiate the payment to the policyholder after excluding the deductibles.


Reimbursement Health Insurance Claim Settlement

  • You can opt for a medical reimbursement facility if you choose any hospital at your convenience. You can get the best treatment there for your ailments and pay hospital bills first before initiating a claim.
  • If you want to raise a claim, you must submit all imperative documents, including original hospital bills, pharmacy bills, doctor certificates, discharge summary, etc.
  • After the completion of the submission, the insurance company will verify it with all the terms and conditions and will also analyze the scope of coverage of the health insurance policy
  • After approval, the insurer will make the payment to the policyholder


Also Read: How to file reimbursement claim for your Health Insurance

5 things you should know about medical reimbursement plan policy

  1. Should understand reimbursement in health insurance policy plan
  2. Initiative is yours
  3. Arranging Necessary Documentation
  4. Intense Scrutiny
  5. Laborious and time-taken process


1. Should understand reimbursement in health insurance policy plan

Reimbursement means you will get compensation for money that you have already spent. For example, in the field of medical insurance, reimbursement claims mean you need to pay the hospital expenses first and get them reimbursed from the insurance company after submitting all the documents.

2. Initiative is yours

For a cashless claim policy, the insurance company directly settles bills with the hospital. But for a reimbursement claim process, you need to put effort into getting your reimbursement from the company. So, you need to take the initiative for a reimbursement claim by arranging and submitting all documents, filling up the application, following up, etc.

3. Arranging Necessary Documentation

You need to meticulously collect all imperative documents and other supporting documents because this step plays a pivotal role in your claim policy. Sometimes, you need to deal with the Third Party Administrator (TPA) for your submission. This step is not the same for all insurance companies. You should keep photocopies of all the documents that you have submitted.

4. Intense Scrutiny

The insurance company or TPA needs to scrutinize every reimbursement claim application process before making any decision. Since policyholders are not treated at a network hospital, that’s why this is a crucial phase. The insurers and TPAs check everything very cautiously to ensure the legitimacy of the claim.

5. Laborious and time-taken process

A reimbursement claim process is time-consuming as compared to a cashless claim because the insurer needs to verify a lot. Thus, don’t lose patience and cooperate with the TPA/ insurance company if there is an issue regarding the documentation or any other query.

You should judiciously choose an insurer while purchasing a health insurance policy because every customer demands a smooth claim settlement process before making an investment. If you are not satisfied with the claim settlement process of your present insurer, you can migrate to another insurer during the renewal of your policy.

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