All You Need To Know About Reimbursement Claims In Health Insurance

Claiming for reimbursement of mediclaim insurance would be tedious if you are doing it for the first time. How to get the reimbursement claim form? How to submit it? What documents are required? Within how many days should the form be submitted? A lot of questions may boggle your mind when it comes to filing a reimbursement claim after getting discharged from the hospital. However, you should not worry. Just read this article and you will get the solutions on how to file a reimbursement claim.

What Is The Meaning Of ‘Reimbursement Claims’?

In health insurance, if an insured person receives hospitalisation services from a facility i.e, hospital which is not in the list of empanelled network providers; then the individual has to file an official application to their health insurance companies. This is done in order to claim reimbursement on the medical expenses incurred. This application, seeking reimbursement on the coverage of the medical bills is known as Reimbursement Claim.

How to File a Reimbursement Claim?

Following the steps given below can assist you in filing your reimbursement claim:

Step 1: Informing Insurance Provider

Firstly, you need to intimate your health insurance company or the TPA (Third party administrator) about the hospitalisation which could be planned or an emergency one. For planned hospitalisation, you are required to inform the insurer or TPA at least 48 hrs prior whereas for emergency hospitalisation services, please inform within 48 hrs of getting admitted.

Step 2: Availing Medical Treatment

You can smoothly avail the treatment services during hospitalisation at the hospital and recover.

Step 3: Bill Payment 

Next step is the complete transaction of medical expenses which will later be reimbursed by your insurer. 

Step 4: Collecting Documentation 

It is absolutely essential that all the bills, receipts, doctor’s prescription, diagnostic x rays/ reports etc are carefully collected by the insured person to submit to the insurer along with the claim form. 

Step 5: Submission Of Claim Form

You need to then proceed to the step of filling up the claim form obtained from your health insurance company. This form is available both offline and online through your insurer.

Step 6: Document Submission

Then, you may move ahead with the submission process after collection of the requisite documents as well as the claim form. The insurance company will review all the papers, check into the need of missing details or documents if any and as per their coverage benefits offered under your purchased health insurance plan and as mentioned in your policy document; they shall notify you within 30 days whether the claim has been accepted or denied 

Step 7: Payment Of Claim

If accepted, the claim amount shall be duly paid to you by the insurance company. 

Eligibility Criteria for Employee Reimbursement Claim Process

The Reimbursement Claim eligibility criteria is mentioned below:

• An employee must have spent the money only on medical treatment expenses.
• The treatment amount must have been spent on the employee or their family members including spouse, children, parents or siblings, and other dependents.
• The employer must reimburse the specified amount, which is not more than Rs. 15,000 in a financial year.

Please note that the tax exemption is available only on the actual expenses on medical bills that an employee has spent. The bills could be the ones received from any of the pharmacies or treatment taken in public or private hospitals and clinics.

Documents needed for Reimbursement Claim Submission

You need the following documents in hand to file for reimbursement claim:

• Health Card Copy
• Hospital Discharge Summary (Original)
• Duly filled claim form
• Investigation Reports( like scans, X-rays, blood report, etc)
• Case receipts from hospitals or chemists
• If an accident happens, then FIR or medico-legal certificate(MLC)
• Doctor’s Consultation papers and pre-admission investigations
• Copy of KYC documents
• Contact Info, NEFT details
• Invoices of pharmacy supported by respective prescriptions.

Key Things About an Employee Medical Reimbursement

Every employee looking forward to claiming medical reimbursement should note a few points including: 

1. A medical reimbursement claim cannot be made for the previous financial year. 

2. There does not exist any kind of maximum limit regarding reimbursements related to medical expenses undergone at hospitals that are maintained by the employer. The same applies to medical expenses undergone at hospitals approved under health schemes by the Central Government or Government authorities.

3. There is a big difference between medical reimbursement and medical allowance as a part of the salary. While allowance is a fixed amount, medical reimbursement is a feature under which the employee’s medical expenses are reimbursed by the employer.

4. Mediclaim policy premium is not considered as medical expenditure. It is not taken into consideration for income tax exemption, but it can be considered for tax deduction on a separate basis under Section 80D of the Income Tax Act. 

Customer Care Assistance For Reimbursement Claims By InsuranceDekho

We at InsuranceDekho are forever committed to serving all individuals seeking any type of support and assistance on queries or doubts related to Insurance. If you too wish to file your reimbursement claim, please connect with our policy experts and customer care staff team who’re available 24*7. Do visit our website: www.insurancedekho.com | Call on toll - free number 7551196989 | Just drop an Email at support@insurancedekho.com

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In case of any doubt or query, feel free to call InsuranceDekho. Our experts are ready to help you.

FAQs 

Ques 1. What’s the difference between cashless claims and reimbursement claims?

Ans. Every insurance company has its empanelled list of ‘network hospitals’ from which an insured can avail medical treatment and services. So, if a patient gets hospitalised in a network hospital, he/she can file for cashless claim post discharge but if its a non network facility, then the insured would have to proceed with reimbursement claim on the medical expenses incurred post hospitalisation.

Ques 2. How long does it take for the reimbursement claim to get processed? 

Ans. Once documentation is received, verified and processed by the insurance provider, it usually takes 30 days for the claim process to get completed. 

Ques 3. Is the reimbursement amount on medical insurance taxable?

Ans. No, the health insurance amount of reimbursement claims is non taxable.