ideal health insurance policy & claim

When Should I Lodge a Health Insurance Claim?

4th October 2019 6min read 429 views

Now that you've picked the ideal health insurance policy for your needs, you might find yourself thinking that you're quite invincible. But, life can be unpredictable and we can never really rule out a trip to the hospital. When either you or somebody that you love is recovering in a hospital room, the claims process is probably the last thing on your mind. Sadly, this could mean that you could lose out on your claim altogether. Typically, your health policy will require you to lodge your claim within a specified time period. If you don't, you will end up looking after all the treatment costs.

Luckily for you, we've come up with a helpful guide on when you can lodge your claim to avoid missing the deadline. Before we get into the nitty-gritty details, let's first understand why insurance policies have these limitations.

So, what exactly is a time limit?

The time limit refers to the predetermined time frame during which your insurance provider has asked you to make a claim. Typically, there are different time limits for cashless claims and reimbursement claims.

Why is this limit necessary?

The time limit helps insurance providers manage their claim settlement operations. It could also prevent certain individuals from taking advantage of the system and making fraudulent claims.

What's the time limit for a cashless claim?

For non-emergency situations, you should let your insurance provider know that you'll be heading to the hospital at least 3 days in advance. This will help smoothen out the claims process and allows your insurance provider to contact both their Third Party Administrator (TPA) as well as the network hospital where you're getting your treatment.

In an emergency situation, you should notify your insurance provider within 24 hours of being hospitalised.

What's the time limit for reimbursement claims?

These claims work a little differently since you will have to pay all the medical bills first and then claim the amount from your insurance provider. This means that you don't have to let your insurance provider know about any treatment before being hospitalised. However, you will have to remember to lodge your claim within 7 to 15 days from the day you're discharged.

Can I claim for post-hospitalisation treatment?

This changes from one policy to the next. If your policy does cover post-hospitalisation expenses, you'll have to check how long this is valid for. Some policies cover expenses for only 30 days after hospitalisation, while others cover up to 60 days. Either way, you will have to lodge the claim within 15 days from the end of the 30 or 60 day period – whichever bracket your policy falls under.

What papers do I need?

Irrespective of whether you're lodging a cashless or reimbursement claim, you will have to furnish a few documents with your claim request. Your insurance provider will want to have a look at your:

  • Detailed claim application
  • Discharge card
  • Hospital bills
  • Doctor's reports
  • Prescription details

Now that you know when to lodge your health insurance claims, you can rest easy knowing that your medical bills will be taken care of.

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