What is the claims process for health insurance?

Medical contingencies can take place at any time. That’s why it’s always a good idea to buy health insurance. So once you have the best health insurance, what do you do next? If you are ever faced with a medical contingency, in order to have your medical expenses taken care of by your insurance provider, you will have to make a claim. But how do you go about it? Not to worry, we can help! It’s important to know what the claims process is before you buy health insurance so that you are well-informed when you do have to make a claim. Here’s what the process is like for health insurance. 

There are two types of claims that can be made for online health insurance – one is the Cashless Claim and the other is the Reimbursement Claim. 

Cashless Claim:

If you or the insured are hospitalized in a network hospital or nursing home, with a cashless claim, you won’t have to foot the bill. Your insurance provider will directly settle your medical expenses with the hospital – all you have to do is provide the details of your online health insurance policy, and you will be spared the burden of paying all those hefty medical bills. 

Under the cashless claim, the process might differ depending on whether the hospitalisation is planned or an emergency. The claims process for both is as follows:

Planned Hospitalisation:

  • If hospital admission is planned, the claim should be made 48 hours in advance.
  • Your policy details should be provided along with government-issued proof of identities, like a driver’s license or Aadhar card. 
  • The claim is validated by the hospital and then sent to your insurance provider
  • Once the claim is reviewed and confirmed by your insurance provider, your medical expenses will be settled by them. 

Emergency Hospitalisation:

  • In the case of emergency hospitalisation in any network hospitals or nursing homes, the claim should be made within 48 hours of hospitalisation. 
  • Much like the process for planned hospitalisation, you should provide your policy details along with a government-issued proof of identity. 
  • Once the claim is validated by the hospital and confirmed by your insurance provider, your medical costs will be covered. 

Reimbursement Claim:

In case you get admitted to a hospital that is outside your insurance provider’s network hospitals – it doesn’t necessarily mean that you will have to bear the medical expenses yourself. In such instances, you can file a reimbursement claim

Under a reimbursement claim, you will have to pay for the medical expenses at the hospital (either network or non-network), after which your insurance provider will reimburse you for the amount paid. The claims process is as follows:

  • Notify your insurance provider within 48 hours of hospitalisation in-network or non-network hospitals
  • Submit the claim along with all the required documents.
  • Settle your medical bills directly with the hospital after hospitalisation.
  • Once your claim is reviewed and confirmed by your insurance provider, you will be reimbursed for the amount spent.