Most people understand the importance of health coverage and choose an insurance plan based on their requirements. While researching about health plans, people usually see the inclusions and exclusions, hospital network, riders, and premium.
An often overlooked aspect is the claim procedure, and you may find yourself confused if you need to file one.
What is a health insurance claim?
An online health insurance claim is a request to avail of the benefits as per the policy’s terms and conditions. It may either be a reimbursement or cashless claim. In the former, the insurer reimburses the expenses incurred, while in the case of the latter they directly settle the bill with the hospital.
When can you file a claim?
Most mediclaim plans require a minimum hospitalization of 24 hours to allow you to file a claim. However, several insurers offer cover for daycare procedures listed in the policy document. Ensure you read the various details mentioned in the policy, such as waiting period, co-pay and deductibles, limitations, and room rent cap when you buy the policy to avoid any trouble at the time of filing a claim.
Types of claims
1. Reimbursement claim
If you seek treatment from a non-network hospital or in case of emergency hospitalization, you may have to settle the expenses. You may later claim reimbursement of these costs from your insurer. You will need to submit documents like claim form, hospital invoice, and discharge papers, among other details to receive the reimbursement claim amount.
2. Cashless claim
When you opt for treatment in a network hospital, you may avail of the cashless health insurance benefit. You may use your health insurance identification card and provide the cashless hospitalization request form. Alternatively, you can submit this form online to reduce the approval time. Once your request is approved, the insurer will directly pay the hospitalization-related expenses.
Pros and cons of reimbursement and cashless claims
· You may seek treatment from any hospital of your choiceif you choose a reimbursement claim
· You need not worry about having the cash to meet the hospitalization expenses with a cashless claim
· You have to furnish several supporting documents if you opt for a reimbursement claim; moreover, the approval may take longer as compared to a cashless claim
Every medical insurance provider offers you the option to select either one of the claim procedures. You can decide on a suitable claim procedure as per your requirements and convenience. Irrespective of which type you finalize on, clearly understand the mediclaim terms to avoid any surprises.
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