Health insurance is that kind of insurance that covers the policyholder’s medical expenses. The primary purpose of a health insurance policy is to provide or settle the claim of the policyholder for all claims related to hospitalisation.
Insurance claims can be made in two forms – cashless and reimbursement. Cashless claims are available at networked hospitals, i.e. hospitals tied-up with the insurance company. On the other hand, if you choose non-networked hospitals, cashless claims would not be available. In such cases, you must pay the hospital’s fees and be reimbursed for the expenses by filing a claim with the insurer.
Health insurance claim filing is a specific process which you should follow to get a quick settlement. There are certain things which you should keep in mind and have at your disposal when filing a health insurance claim, be it cashless or reimbursement. However, each type of claim might have a different requirement.
Top 6 Necessary Documents for Filing a Health Insurance Claim
1. Pre-authorization form
A pre-authorization form is mandatory for cashless claims. This is the basis on which claims are settled on a cashless health insurance plan basis. This is like a pre-approval for the claim settlement. This is not needed in a reimbursement claim.
The pre-authorization form is available either with the Third Party Administrator of the insurance company or at the TPA desk of the hospital. This pre-authorization form should be filled and submitted with the insurance company on time.
Timelines: In case of planned hospitalisation, the form should be submitted at least 3-4 days before being hospitalised and after the initial approval from the insurance company comes in, the cashless procedure for health insurance claim can begin. However, in the case of an emergency hospitalisation, the pre-authorization form should be submitted within 24 hours of hospitalisation.
2. Policy bond
The policy bond forms the basis of the health insurance contract and might be needed by the health insurance company at the time of claim. So, keep the policy bond within reach so that it can be submitted with the claim documents.
3. Duly filled and signed claim form
A claim form is needed to make a claim in your health insurance policy. In order to obtain a health insurance claim form, you must contact the insurance company or obtain a copy of the same from their website. The claim form will also provide further guidance as to what specific details are needed from the doctors or healthcare facility.
It is therefore advisable to read it carefully before filling the form. Fill the form correctly and sign it before submitting it with the insurance company. The claim form should contain the Claim Intimation Sequence Number or Reference Number which is provided by the insurance company when you inform the company of your health insurance claim.
Along with the reference number, the following details should be filled correctly in the claim form -
- Policy Number
- Name of Patient
- Name of the policyholder
- Contact number of the policyholder
- Relationship of caller with the Patient or policyholder
- Date of Admission
- Reason for Admission
- Name of Doctor
- Hospital Name
- Address of hospital with landmark, city and state
4. Health card
For getting your claims settled on a cashless basis, the Health Card along with the patient’s KYC documents need to be presented at the time of hospitalisation in a networked hospital. The health card is issued with your health insurance policy and it contains a unique member identification number which helps the insurance company identify the insured.
5. Medical and other documents
For cashless hospitalization, the documents are usually submitted by the hospital. However, only for your reference, the list is mentioned below.
- Doctor’s prescription for admission in the hospital
- All original Bills and Investigation reports
- Discharge Summary
- All prescriptions of attending doctors
- Original invoice from pharmacies
- In case of accident, FIR or Medico Legal Certificate (MLC)
Copies of above-mentioned documents should be retained for future reference. You can even refer to the insurance company’s official website for the appropriate documents needed to be gathered and submitted for their claims.
For all cashless hospitalization, the documents are submitted to the insurance company in original and a certified true copy of the same would be provided to you, in case of further claims.
6. Bank details
However, for Reimbursement Claims of Health Insurance Plans, bank details of the policyholder needs to be mentioned. This is not necessary in a cashless claim.
In the case of a non-networked hospital, where you cover the bills from your own wallet and are subsequently reimbursed by the insurance company, you should provide your bank account details with the IFSC code. In fact, to ensure that payment is reimbursed smoothly, you must submit a cancelled cheque too. Only when your bank details are provided can the insurance company reimburse you for the claim amount that you incurred.
After you gather all of the above-mentioned things, you should contact the health insurance provider to check with them that everything is accurate and to ask them if anything else is needed. Please ensure that the claim form is submitted on time so that the claim is not delayed. If you follow the correct claim procedure and keep the above-mentioned things handy, your health insurance claim would be settled easily and quickly.
