How To Fill A Health Insurance Claim Form?

Why would one consider buying a health insurance policy? Obviously, to stay financially protected if some health issue arises. 

Now, it’s a fact that nobody wants a situation that leads to filing a claim. Right? 

But what if any condition arises where you need to make a health insurance claim? In such a scenario, you have to understand  the process that’ll help get your claim reimbursed for your medical expenses. However, the health insurance claim process may vary from insurer to insurer, but one thing that will remain the same is filing a health insurance claim form. 

This guide will walk you through the process of how to file a health insurance claim form. 

How To Fill A Health Insurance Claim Form?

Filing a health insurance claim form is easy if you follow the below steps. 

1. Get The Claim Form

First, download the claim form from the insurer’s official website or visit their nearest branch to get the form in person. 

Pro Tip: Before you start filling out the form, read the instructions carefully to avoid any mistakes.

2. Fill in Your Personal Details

Generally, a claim form includes two parts: Part A &  Part B. Part A is the section that needs to be filled out by the policyholder, while Part B is for the hospital. 

Start filling out Part A with your full name, policy number, and contact details as per the policy documents. Further, mention details about 

• Hospitalisation (name and address of the hospital where you received treatment), 
• Claim (details of the treatment expenses claimed, the treatment you received, and the dates of admission and discharge)
• Enclosed bills (Original bills and receipts from the hospital, pharmacy, and diagnostic centres.)
• Bank a/c details 

(Make sure there are no discrepancies in the mentioned information)

3. Attach Supporting Documents

Attach the necessary documents to support your claim, like

• Doctor’s Prescription
• Treatment Summary
• Hospital Discharge Summary
• Bills and Receipts
• Other Reports

4. Sign and Submit the Form

After double-checking all the information, sign the form in the designated areas. Then, submit it along with the supporting documents to the insurance company. 

Do not forget to keep a copy of the filled claim form and all submitted documents for your records.

If your health insurance policy is bought via InsuranceDekho, connect with our relationship manager at +91-7551196989 if you need any assistance while filling out the claim form.  We will also help you in collating all the required documents which are required for making a claim.

Types of Health Insurance Claims in India

A policyholder is given two options for health insurance claim settlement, i.e., Cashless Claim Settlement & Reimbursement Claim Settlement. Read on to find out the difference between them. 

1. Cashless Claim Settlement

Every health insurance company has a network of hospitals. 

If the policyholder gets treatment at one of those hospitals, the insurer will directly pay the hospital bills to the network hospital. This means you can get the treatment without paying without paying out of pocket. All you need to do is inform the insurer before getting admitted (for planned treatments) or as soon as possible in emergencies. 

This is what we call cashless claim settlement! 

2. Reimbursement Claim Settlement

Reimbursement claim settlement proves to be of great help when you are getting treated at a hospital which is not on the list of the insurer’s network hospitals. 

Here, you have to pay for all the medical expenses upfront. Then, the health insurance company will reimburse you for the claim amount. 

In a nutshell, 

Cashless claims involve direct payment between the insurer and the hospital. But with reimbursement claims, you pay first and get reimbursed later.

Common Mistakes To Avoid While Filling A Health Insurance Claim Form

Below are some of the common mistakes that an individual must avoid while filing a health insurance claim form. 

• Providing incorrect details about the policy, name, bank a/c, hospitalisation expenses, and others. 
• Forgetting to attach necessary documents, such as hospital bills, receipts, doctor’s prescriptions, and treatment summaries.
• There is a certain deadline for submitting the claim form. If you miss that deadline, the claim settlement might take longer. 
• Failing to get pre-authorization for treatments that require it, especially for cashless claims. Also, this might result in claim denial.  
• As already stated above, different insurers have different claim settlement processes. If the procedure is not followed accordingly, it will result in delays in settlement or rejection of claims. 
• Sending original documents without keeping copies for your records. 
• Making errors on the form and then using correction fluid or overwriting to fix them. It’s better to fill out a new form rather than make corrections. 
• Not following up with the insurance company to check the status of your claim. 

What To Do In Case of Claim Denial

Reports suggest that 43% of policyholders who filed a health insurance claim in the last three years struggled with getting it processed. 

In case your claim is also denied, here’s what you can do! 

The insurance company will send you a denial letter stating the reason why they have rejected your claim. Carefully review that letter, and if you think the claim has been rejected for the wrong reason, you can appeal it. 

To do so, check the insurer’s official website, the denial letter, or the policy document to learn the procedure for filing an appeal. Explain to the insurer why your claim should be approved. Include any extra documents and corrected information.

Still, if your appeal is rejected, contact the insurance ombudsman for help. You can also consider legal advice if you think the claim was unfairly denied and the ombudsman can’t help. 

Follow up Process

Filing a health insurance claim is not enough; it's also important to keep track of how long the insurance company will take for a final settlement. Below is the typical follow-up process that you can follow. 

• Check your insurer’s website or app to track the claim status of your claim. Most insurance companies have an online portal where you can see all the updates.
• You can also call the customer support team or insurance aggregator from which you have bought the policy. 
• If the insurance company asks for more information or documents, provide them as soon as possible. This helps avoid delays in processing your claim.

Conclusion

Filing a health insurance claim might seem complicated, but it doesn't have to be. By understanding the process, avoiding common mistakes, and knowing what to do if your claim is denied, you can experience a hassle-free claim settlement process. 

Also Read: 

HDFC Ergo Health Insurance Plan: Easy Steps To Renew Your Policy

Does Cataract Surgery Come Under Health Insurance And The Cost Of Surgery In India?

Frequently Asked Questions (FAQs) 

Ques 1. How long does it take to process a health insurance claim? 

Ans. The exact timeline for a health insurance claim settlement depends on various aspects, like claim type, insurance company, and more. Sometimes, the claims are settled within a few hours (in the case of cashless claims), but it might also take 15 to 20 days. 

Ques 2. Where can I get a health insurance claim form?

Ans. You can download the claim form from the insurer’s official website or visit their nearest branch to get a physical copy.

Ques 3. What documents do I need to submit with the health insurance claim form?

Ans. Documents such as the 

• Doctor's prescription, 
• Treatment summary, 
• Hospital discharge summary, 
• Original bills and receipts and 
• Other medical reports (as requested by the insurer) must be submitted with the health insurance claim form for a smooth claim settlement process. 

Ques 4. What should I do if I am facing difficulties filing the claim form? 

Ans. In such a scenario, you can seek help from the insurance company’s customer support team. They will help you out with all your queries. 

Ques 5. How do I submit the claim form?

Ans. After filling out and signing the claim form, submit it along with the supporting documents to your insurance company. Make sure you do this within the specified timeline.