How to Claim Your Senior Citizen Health Insurance Plan

A Health Insurance policy can be claimed through two different modes - cashless and reimbursement. If a person is getting treatment in a network hospital of the insurance company, he will enjoy the benefits of cashless treatment. While a person is getting treated at a non-network hospital of the insurance company, he will need to submit a reimbursement form and will get a claim through reimbursement mode.

Steps to Claim Health Insurance for Senior Citizens Through Cashless Mode

A cashless insurance claim can be made easily within 24 hrs of admission to the hospital for the required treatment, you just need to follow a procedure and submit the required documents. Steps that one should follow to make a cashless insurance claim are mentioned below. 

1. Inform the Insurance Company

You would need to contact the mediclaim department of the hospital and provide them with the required details regarding the insurance policy.

2. Share Your Policy Details

They would then ask you to show your mediclaim card provided by the insurance company, which has your details such as policy number, policyholder name, etc.

3. Complete TPA Formalities

Then, the hospital authorities would complete the TPA formalities from their side.

4. Appointment of Surveyor

After receiving the form and the documents, the company will then appoint a surveyor to refer to the case of the panel doctors. (As the case may be)

5. Claim Settlement

Within 24 hours of filing the claim and submitting the required documents, your claim would be settled.

Steps to Claim Health Insurance for Senior Citizens through Reimbursement Mode

Health insurance can be claimed within 3-4 weeks through reimbursement mode, you are just required to follow a certain procedure and submit the required documents. Read these steps mentioned below to know about the procedure in detail.

1. Notify Your Insurer After Hospitalisation

Within 24 hours of the hospitalisation, you would need to notify the insurance company about the hospitalisation, the disease you are getting treated for, and the other required details regarding hospitalisation.

2. Collect the Health Insurance Claim Form

The company will then provide you with the health claim form or the reimbursement form. If the company doesn't provide it by itself, you can download it through the website.

3. Fill and Sign the Claim Form

Then you would need to fill the form with the required details such as the expenses incurred on the treatment and for hospitalisation and duly sign it.

4. Submit the Claim Form to the TPA or the Insurer

After filling the form with the required and correct details and attaching the required documents with it you would need to submit the form to either TPA(Third Party Administrator) or directly to the Insurance Company.

5. Submit All Other Required Documents

With the Reimbursement form, you would need to submit the documents mentioned below.

• Doctor's Prescription- You are required to submit the doctor's prescription with the form so that the company would know the treatment done and expenses incurred were valid and prescribed by the doctor.
• Medical Report- You are required to submit medical reports and pathological reports too as proof.
• Chemist Bills- Health Insurance claims through reimbursement mode provide coverage for medication expenses too, so you are required to submit chemist bills too for calculation of expenses for reimbursement purposes.
• Doctor's and Surgeon's Receipts- You would also require to submit doctors' and surgeon's receipts. It would also be required for the company to calculate the total expenses incurred for reimbursement purposes.
• Certificate of admission- You are required to submit the certificate of admission in the hospital for treatment as proof.
• Certificate of Discharge- You are required to submit the certificate of discharge too as proof. It has details such as the date and time of discharge from the hospital.

6. Appointment of Surveyor

After receiving the form and the documents, the company will then appoint a surveyor to refer to the case of the panel doctors. (As the case may be)

7. Take Follow-up

After submitting all the documents, you should make a follow-up with the insurance company regarding the claim settlement.

8. Claim Settlement

After completing all the formalities, the company will settle the claim within 2-3 weeks and you would receive the reimbursed amount.

Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.