How to Make a Health Insurance Claim?
What are Claims in Health Insurance?
A health insurance claim is submitted by the policyholder so that the insurance company can verify that they are eligible for compensation of the treatment costs. How insurance claims work is that the policyholder is either directly reimbursed or the company pays for the medical bills, depending on the process followed. The main aim of the claim is that the policyholder is provided financial support. An advantage of being a medical insurance policyholder is that one gets to claim tax deduction up to 25,000 Rs on insurance premiums.
Types of Health Insurance Claims
Generally, there are two types of claims in health insurance, first one is cashless claim. If you decide to follow this method, then the insurance company directly settles the payment for services with the hospital. The policyholder should go to a hospital associated with the insurance agency and after being admitted, produce the cashless health card provided by the agency. Usually, majority of insurance companies approve of cashless claims within three hours of the patient being admitted.
The health insurance claim process is different for planned admission and emergency admission. For planned admission, one should inform the third-party administrator (TPA) three days before getting admitted, fill cashless form at the hospital, submit form and other relevant documents to the TPA for inspection. Information such as name of patient, diagnosis, hospital details, treating doctor details, date of hospitalization and expected discharge should be covered. After the insurance company approves the claim, please note that attendant fees and food expenses are not included in the reimbursement. In case of emergency admission, inform the company 24 hours before and the TPA, fill the cashless form at the hospital and get it certified by a doctor. Then send all the medical records to the TPA, if it is approved the expenses will be settled directly. If there is any error with the documents, TPA will revert back within four hours of submission. In case the treatment is not included in the policy, a rejection letter will be sent to the hospital in two hours. However, please note that rejection of cashless claim does not mean that you can’t apply for the reimbursement claim instead.
The second kind of claim in health insurance is reimbursement claim. If you opt for this method, then initially you must pay for the medical bills and then file a claim for reimbursement. Remember to produce all the bills and any related records such as prescriptions and treatment costs. All the necessary documents should be sent to the insurance company within 30 days from date of discharge. If there is any inconsistency with the documents then the company will notify within 7 days.
Royal Sundaram Health Insurance
Royal Sundaram offers two detailed health insurance policies: Lifeline and Family Plus. Lifeline is for individuals and can also be extended to one’s family. Family Plus plan is specifically designed couples planning to start their family and has benefits such as maternity leave and no claim bonus. One should avail Royal Sundaram health insurance because it covers pre and post hospitalization expenses, ambulance charges and health-care checkups. It also includes in-person AYUSH treatment which is alternative medicinal treatments such as Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy. These services are not expensive, effective and do not have long-term side effects. Therefore, Royal Sundaram is one of the best choices for medical insurance, be it for an individual or the entire family.
