How To Make A Family Health Insurance Claim?

Medical technology has come a long way over the last few decades, but medical treatment costs have increased too. That's why having adequate health insurance has become the need of the hour. And people are understanding this factor and that's why you can see a gradual increase in customers buying health insurance policy but many people are still unaware of the benefits of such policy and how to claim them.

An insurance policy can be claimed through two modes either is cashless mode or reimbursement mode. If you opt for a network hospital of the insurance company then you can enjoy a cashless facility while if you opt for a non-network hospital of an insurance company you would be required to ask for a reimbursement by submitting a reimbursement form to the company.

Steps To Make A Cashless Family Health Insurance Claim

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. It is a hassle-free process. Steps that one should follow to make a cashless insurance claim are mentioned below.

• Step 1: Inform the Insurance Company

You wouldn't need to contact the insurance company directly, hospitals have separate mediclaim departments, you are required to contact them in the hospital itself they will then complete the process from their side.

• Step 2: Share Your Policy Details

You would be asked to show your mediclaim card provided by the insurance company, which has your details such as policy number, policyholder name etc.

• Step 3: Complete TPA Formalities

Then, the hospital authorities would complete the TPA (Third Party Administrator) formalities from their side.

• Step 4: Claim Settlement

Within 24 hours of filing the claim, the insurance company will give you notification of claim settlement.

Steps To Make A Reimbursement Family Health Insurance Claim

You would need to inform the insurance company about the treatment and expenses incurred and ask for a reimbursement by filing a reimbursement form and also submit the required documents which would contain the details of the patient and then they would know which member of the floater plan you are asking to claim for.

• Step 1: Inform Insurance Company after admission

The first thing you need to do after admission to the hospital is to inform the insurance company about the member of the floater plan admitted to the hospital for the required treatment.

• Step 2:Fill the Reimbursement Form

The insurance company will provide you with the reimbursement form and you will be asked to fill in the required details regarding the medical expenses incurred for which you are asking reimbursement.

• Step 3: Collect Original Reports and Bills

The hospital provides you with a file of all the original reports and bills of the patient with the stamp of the hospital you would need to submit this file along with the other documents. Make sure all the documents are stamped and have the registration number of the hospital then only they would be considered reliable. Also, do keep a xerox of the documents submitted with yourself as proof. Insurance companies would also need bills in order to evaluate the expenses incurred and reimburse accordingly.

• Step 4: Submit Discharge Summary

At the time of discharge, the hospital gives a discharge summary which has the information regarding admission and discharge of the patient and all the expenses incurred in between.

• Step 5: Submit Doctor’s Prescription

The insurance policy also covers medication expenses to a certain extent subject to the terms and conditions of the policy you are required to submit the doctor's prescription for that matter.

• Step 6: Submit Post Hospitalisation bills

In order to claim reimbursement for post hospitalisation expenses, you would need to submit post hospitalisation bills such as diagnostic tests bills, medication bills, check-up bills, etc.

• Step 7: Take a Follow-up

After submitting all the required documents and completing the procedure do keep a follow-up with the insurance company to check the status of your insurance claim.

• Step 8: Claim settlement

After completing the whole procedure, wait for two to three weeks, within 2-3 weeks the insurance company will settle your claim and give you the required reimbursement 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.