Health Insurance Claims

A health insurance plan comes into effect when the insured is hospitalized or when the insured faces a medical contingency and incurs cost. At that time, if the hospitalisation or the medical expenses are covered by the health insurance plan, a health insurance claim is said to occur. Under a health insurance claim, the insurance company pays the medical expenses which incur in case of any medical contingency.


Types of Health Insurance Claim

Providing healthcare service when needed is the true utility of a health insurance plan. To ensure timely and easy settlement of all the medical expenses, one needs to initiate the health insurance claim process. There are two ways to claim a health insurance policy:

Cashless claims

Cashless settlement of health insurance claims occurs when the insured seeks treatment in a networked hospital. A networked hospital is one which is tied-up with the insurance company. Since treatments are taken at a networked hospital, the insurance company settles the hospital bills directly with the hospital. You, therefore, do not have to take the burden of paying for the medical expenses yourself.

Here are the steps involved in availing a cashless claim settlement

  • If you are seeking a planned treatment, inform the insurance company beforehand. Intimation should be given at least 3 to 4 days prior to being hospitalized. A pre-authorization form needs to be filled in and submitted to the insurance company. This form acts as a claim notification. In case of planned hospitalization, the form should be filled in and submitted 3 to 4 days in advance.

  • If there is a medical emergency and the insured is being hospitalised under an emergency situation, the insurance company should be informed and the pre-authorisation form should be submitted within 24 hours of hospitalisation.

  • Once the pre-authorisation form is submitted, the insurance company assesses the claim based on the form and allows cashless claim settlements.

  • The insured can then avail the required treatments without paying the medical bills incurred.

  • All medical bills, medical reports and other medical documents should be submitted to the insurance company.

  • If there are other expenses which are being covered, original documented proofs of such expenses should also be submitted with the insurance company.


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