A Health Insurance Policy contributes when the policyholder is admitted to the hospital or when the insured is faced with a medical emergency that costs lumpsum money. A Health Insurance Claim is stated to arise at that time if the medical bills are reimbursed by the Health Insurance Plan. A Health Insurance Claim reimburses the insured for medical expenses incurred in the event of a medical emergency.

Whenever a policyholder gets treatment at a networked hospital, the claim is settled without the use of cash. If the medical procedures are received at a networked hospital, the Insurance Company pays the hospital immediately. When the insured pays for his or her own medical bills and then receives reimbursement from the Insurance Company, this is known as a Reimbursement Claim.

For cashless Health Insurance Claim

Health Insurance Reimbursement Process

The methods to obtaining a cashless claim settlement are outlined below:

  1. If you're planning on getting treatment, let your Insurance Company know ahead of time. At least 3 to 4 days' notice should be given before being admitted to the hospital. Filling out and submitting a pre-authorization paperwork to the Insurance Company is required.
  2. If a medical emergency occurs and the policyholder is admitted to the hospital, the Insurance Company should be notified immediately, and the pre-authorization paperwork should be presented within 24 hours of admission.
  3. The Insurance Company evaluates the request based on the pre-authorization form and permits cashless claim payments once the form is filed.
  4. The insured can then receive the necessary treatments without having to pay the medical fees.
  5. The Insurance Company should get all medical bills, reports, and other medical documentation.
  6. Original written documentation of such charges should also be presented to the Insurance Company if there are other expenses that are being covered.

For reimbursement Health Insurance Claim

The steps to getting pre-paid claim settlement are outlined below:

  1. The policyholder must be hospitalized that is not affiliated with the Insurance Company to get treatment there.
  2. The insured should keep all of the official medical reports and invoices. Medical expenditures should also be footed by the insured.
  3. The policyholder should get a Discharge Certificate from the hospital where treatment was received after being discharged.
  4. The Insurance Company should subsequently receive this Discharge Certificate, along with a properly completed Claim Form, original medical reports and bills, and any pertinent papers that the Insurance Company demands.
  5. Afterwards, the Insurance Company must examine the claim, the supporting documentation, and the additional costs. Thereafter, the payments would be refunded.

Bereavement and illness can take a toll on your physical, mental, and financial well-being. Insurance Companies must be totally dedicated to being there for you in your time of need by facilitating a faster, easier, and more efficient claims settlement.

Disclaimer: HDFC Sales Private Limited, Registered office: 4th Floor, Wing-A, HDFC House, 165-166, Backbay Reclamation, H.T. Parekh Marg, Churchgate, Mumbai – 400020. CIN: U65920MH2004PTC144182; Toll Free: 1800 266 3345; Email: customercare@hdfcsales.com; Website: www.hdfcsales.com; IRDAI Reg. No. CA0080; AMFI Reg. No. 39103;