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Know Everything About Health Insurance Reimbursement Claim

24 June 2022, 10:06 AM

A medical insurance plan helps you to stay healthy by seeking treatment at the best hospital whenever there is a requirement. If you have a reimbursement health insurance plan, all you need to do is pay the hospital bill at the time of discharge and then get the amount reimbursed from the health insurance company. The process is quite simple and straightforward. However, you need to submit a few crucial documents to ensure the claim is paid to you smoothly. Read on to know more.

Documents Needed for Health Insurance Reimbursement

Take a look at the list of documents needed when making a reimbursement medical insurance claim:

  1. The claim form, duly filled and signed
  2. Cancelled cheque of the policyholder along with bank account details for NEFT
  3. Health card/Policy document
  4. The doctor’s advice for hospitalization, if treated in a network hospital
    For emergency hospitalization, the RMO’s (resident medical officer) advice for hospitalization
  5. The original hospital bill. If the original is not available (where a cashless claim has already been processed), then you need to submit the certified true copy of the original bill.
  6. All test reports and bills (in original) - Pre and post-hospitalization, as well as during hospitalization for expenses excluded from the final hospital bill
  7. Original copies of the consulting physicians’ prescription
  8. ID proof of policyholder and insured
  9. FIR Copy, in case of accidents

The Exact Procedure & Documents of Reimbursement Hospitalisation: Step by Step Like

  1. Documents
    • Claim Form - Fill the claim form very carefully. Tally the information with the information printed on your health card and policy bond. If there is any discrepancy, the claim may be rejected.
    • Financial Documents - Insured and policyholder’s KYC, bank details for NEFT with a copy of a cancelled cheque. The name on the cheque should be written in clear, block letters.
    • Hospitalisation Paperwork including the doctor’s advice for hospitalisation, all the bills in original, diagnostic test reports prior to and during hospitalisation, and also the discharge summary.
    • Pre and post Hospitalisation Documents such as ambulance bills, pharmacy bills, miscellaneous receipts and memos.
    • Best Practise - Create an Excel sheet of the expenses with detailed columns that has the amounts and dates. 
    • Number Each Document included in the Excel for quick and simple reference and categorise them as “pre-hospitalisation”, “Hospitalisation” and “post-hospitalisation”
  2. Things-to-note
    • You need to submit the original report of every diagnostic test that aided in treatment.
    • You must have the original doctor’s consultation records of every test and medicine taken by the policyholder.
    • In the Excel sheet you create, mention only the relevant expenses for which a claim is being made.
  3. Process
    • Filing up all relevant details in the form with signature.
    • Submitted the documents at the correct place. If sending by courier, keep the receipt of the courier company very carefully till the insurer receives the documents.
    • Always remember to keep an entire set of the submitted documents with yourself as well, so that if there are any issues later on, it will become easier for you to follow up with the health insurance company or the TPA.
  4. Second Claim  (portion already paid by cashless from another insurer)
    • Documents - Certified True Copy of all relevant documents to be submitted along with claim form, insured and policyholder’s KYC, policyholder’s bank details and cancelled cheque, an excel of the calculation for which claim is being made along with a covering letter.
    • Reimbursement ONLY as only 1 claim can be cashless according to the IRDA.

The Bottom Line

Keep the points mentioned above in mind and you will be able to get your medical bills reimbursed under your health insurance plan. The best health insurance companies in India work in ethical ways and do not hold back claims, if you have the correct documents and follow the correct protocol when making a health insurance claim. So be methodical and your bill amount will be duly reimbursed.

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