health insurance claims


How To Claim Health Insurance

28th July 2022 8min read 547 views

In today’s fast-paced, stressful world, lifestyle diseases are on the rise. Individuals suffer from multiple mental and physical ailments, including heart attacks, stroke and asthma on a regular basis. Having health insurance helps you deal with the cost of treatment in a good hospital. To get the most out of your medical claim policy, you need to understand the health insurance claim process.

Types of Claims in Health Insurance

There are two kinds of medical insurance claim requests that a policyholder can make:

Cashless Claims
Every health insurance company has a list of network hospitals where policyholders can get treatment and then file a cashless insurance claim. Here, you do not have to settle the entire bill upfront. Instead, the insurance company deals with the hospital directly.

Reimbursement Claims
Some individuals may receive treatment in another hospital. They have to settle the bill with the hospital and then file reimbursement health insurance claims.

Understanding the Cashless Claim Process

Planned Hospitalisation
When you know about a hospitalisation in advance, you can follow these steps to file healthcare claims:

  • Inform your insurance company at least five or seven days before the hospitalisation. You and the hospital both need to fill out pre-authorisation paperwork and submit it to the insurance company.
  • Your insurance company will send written communication approving the claim request.
  • Submit the approval letter and your insurance card to the hospital desk when you get admitted.

Emergency Hospitalisation
Sometimes, you may require immediate hospitalisation to deal with a health emergency. Here’s how to file an emergency hospitalisation claim:

  • Inform the insurance company within 24 hours of getting admitted. The hospital will fill in a cashless claim form with the relevant details about the medical procedure. For accident cases, you must attach the FIR or Medico Legal Certificate with your claim application.
  • Your insurance company studies the request and authorises the hospital. They will settle the claim with them directly.

Reimbursement Claims

Reimbursement claims often take longer than cashless ones and require policyholders to have enough money to settle the bills upfront. Here’s how reimbursement claims work:

  • Submit all the original medical bills, prescriptions, and hospital discharge summary with your claim request.
  • Allow the insurance company time to study your claim request and reimburse you for the covered medical expenses.

Having a health policy helps you deal with rising healthcare costs and medical emergencies. It’s best to purchase medical insurance when you’re young and in good health as you could get high coverage at affordable premiums. Visit the Edelweiss General Insurance website to browse the various plans available and find one that meets your needs. We have many add-ons that you can select to enhance your insurance coverage. You must renew health insurance plans every year to enjoy uninterrupted coverage and benefit from your no-claim bonus.

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