Worried about Corona virus spreading in India? Buy Health Insurance and get coverage now. View Plans
Steps to File Reimbursement Claim for your Health Insurance cover
Take informed decisions with IIFL Insurance:

Steps to file reimbursement claim for your Health Insurance cover

These days, health insurance companies are trying to promote their products because people are inclined to purchase various health insurance policies to safeguard their families’ health as well as finance. But they often overlook the claim settlement process while purchasing health insurance policies. In the case of a medical emergency, policyholders need to opt for a claim settlement process to lessen their financial burdens. While making a claim, you should opt for a cashless reimbursement process. If not, then a medical reimbursement claim process could be your best choice to pay off the hospital bills.

A medical claim reimbursement is a process where you need to pay your hospital bills initially during your treatment. Then, after getting discharged from the hospital, you need to submit all imperative documents and bills to make a health insurance reimbursement claim for your treatment.

Reimbursement medical claims would be tiresome if you are doing it for the first time. How to make a medical insurance reimbursement claim? Where did you get the reimbursement claim form? What are the documents needed to submit for a reimbursement claim? Within how many days do you need to submit the claim form? An array of questions may boggle your mind if you plan to make a reimbursement claim for your treatment once you get discharged from the hospital. So here we are going to discuss the detailed process of a healthcare reimbursement plan.

Medical Reimbursement Plan

While purchasing health insurance from a leading insurer, the insurance provider welcomes you both cashless and reimbursement claim benefits. The cashless claim is applicable if you choose a network hospital (your insurer’s impaneled hospital) for your treatment. On the other hand, you can go for a health insurance reimbursement plan if you are not treated at a network hospital, i.e., a hospital that is not tied up with your insurance company. Initially, you need to pay all your hospital bills and other expenses for your treatment from your pocket. Later, you can reimburse these expenses after filing a reimbursement claim.

How to file a Medical Insurance Claim


Before or After Hospitalization

In the case of planned hospitalization, you need to intimate the claim in advance to your insurer. While for a medical emergency, you need to inform the TPA or your insurance company as soon as possible after hospitalization.

During Hospitalization

During your stay, you should collect all imperative documents related to hospitalization gradually. You may also need the registration certificate of your hospital for claim reimbursement. Now, fill up the reimbursement claim form to reimburse your expense as early as possible.

Post Hospitalization Formalities

Once discharged from the hospital, you need to submit the claim within 15 days. Along with the claim form, you need to submit all other relevant documents like all the bills of the hospitals, pharmacy receipts, and so on. In addition, you may need to submit a canceled cheque where your reimbursed amount will be credited.

Documents needed for Reimbursement Claim Submission

You need the below-mentioned documents to file for reimbursement claim

  • Health insurance card copy
  • Hospital discharge summary (Original)
  • Duly filled and signed claim form
  • Investigation reports of medical scans, X-rays, blood reports, etc.
  • All receipts from hospitals and pharmacists
  • In the case of an accident, then FIR or medico-legal certificate (MLC)
  • Doctor’s consultation papers and pre-admission investigations
  • Copy of KYC documents
  • Contact Information and NEFT details


Reimbursement claim submission process

  • After your discharge, you need to submit all treatment-related documents to the TPA or your insurance company in the prescribed format for the reimbursement claim initiation.
  • Your insurance company will evaluate and scrutinize your claim. The company will verify all the documents and reports for approval of the claim.
  • Sometimes, they may ask for more documents to validate the claim.
  • After checking thoroughly, your claim may be accepted fully /partly or rejected. The insurance company will intimate the policyholder about the same.


Key Features and Benefits of Reimbursement Health Insurance

Many insurance companies are offering medical insurance reimbursement, which is nothing but an insurance plan with a reimbursement claim facility. The prime feature of the health insurance claim settlement option is that it offers flexibility while choosing a hospital for your treatment. Your chosen hospital need not be impaneled with your insurance company to avail of health insurance reimbursement benefits. Here are some salient benefits of a health insurance claim settlement.

  • You don’t need to find a network hospital during healthcare emergencies
  • While looking for urgent medical treatment, you don’t need to face any health insurance-related procedures
  • You can get admitted to any hospital (non-network hospital)
  • After the completion of your treatment, you can apply for reimbursement by submitting the bills and reports


What is covered in a health insurance reimbursement process?

Here are some benefits that are covered under a health insurance reimbursement plan

  • This insurance plan covers hospitalization expenses
  • It covers critical illnesses including stroke, cancer, paralysis, etc.
  • Covers the cost of transportation (ambulance cost) for the insured policyholder in case of a medical emergency
  • It covers pre-and post-hospitalization expenditures
  • Covers domiciliary treatment costs
  • This plan covers daycare treatment cost
  • Though this plan covers OPD treatment, still it has some terms and conditions that you need to meet


Points to remember

  • You should have an adequate idea about the claims clause in the policy document. This will help all policyholders to make a valid reimbursement claim with proper documents.
  • You need to submit all original medical bills and reports along with the claim form to initiate the claim process. But don’t forget to keep a copy of all submitted documents for the record.

This article gave you adequate knowledge of how to file medical insurance claim during the time of an emergency. Always consider the claim settlement process while purchasing a health insurance policy.

Buy Insurance - 18002101330