Now that you have purchased a health insurance policy it’s time to rejoice and take sigh of relief. Buying a suitable insurance policy helps insured need not worry about how he or she can manage adequate funds for treatments. This type of policy ensures that the outflow of such funds does not create a big hole in your wallet. When you or one of your family members fall ill, the very last thing you will concern about is how to pay for the medical treatment. And, health policy India fulfills the same purpose at really affordable rates.
But many a time due to the hassle and in the concerned frame of mind you tend to miss out the major aspect of policy claim. Policyholders can take advantage of insurance benefits only when they know how and when to claim their insurance. Although buying a health policy is as simple as a click on your mouse, the claiming process is really complicated. Relax! The article will guide you on how policyholders can avail the most of their health insurance policies:
- When to Claim
Generally, according to the standard parameters set, insurance can be claimed when the policyholder has been taken into a hospital for a period of at least 24 consecutive hours. There are exceptions in few cases such as ‘Day Care treatment’ for which a policy can be claimed even if the patient is admitted into a hospital for less than 24 hours. It includes chemotherapy, eye surgery, tonsillectomy, prostate surgery and ligament repair procedure among other processes and will be mentioned in a policy document, if applicable.
- What to Claim
This is the trickiest part of the policy. A regular Health insurance will cover the costs incurred during hospitalization like surgery and procedures, room charges and medical tests and so on. Also, it pays for some pre- and post-hospitalization expenses which are connected to the condition for which insured person is hospitalized. Policyholder can register a claim only for those conditions which are in a policy document. The companies strictly abide by the rules and regulation and will not entertain anything out of the agreement level and mentioned conditions. Therefore, it is advisable to read your health insurance policy carefully to know both the exclusions and coverage. All insurance companies in India provide plans along with a list of related expenses like ambulance, wheel chairs, or delivery charges etc. from the residential location to the hospital if not covered under your policy. Some plans even pay for treatment at home or domiciliary treatment under certain situations. However, you need to go through the policy where it clearly mentions if such expenses can be claimed or not.
- Claim Procedures
There are two ways to claim health insurance. Either you pay the amount at the counter and then apply for reimbursement of expenses or you avail cashless facility at the time of admission into the hospital. For cashless claims, policyholder must avail treatment at a network hospital. Request the hospital administration to fill in the claims cashless request form at the time of admission and then submit it to insurer. In case of reimbursement of expenses, insured must contact insurer regarding hospitalization charges. Policyholder will need to settle the medical bills at the time of discharge and later submit it to insurer along with diagnostic reports, prescriptions, discharge summary, other specified papers etc.
- Claim Rejection
Many times the major reason for claim rejection would be non-payments of your premiums on time, policy lapse or expiration and you being unaware of it. Sometimes, it does happen because of reasons like non-disclosure of health issues, lack of clarity with regard to the policy terms & conditions and misunderstandings of the procedure to be followed.