Life-style diseases, stress, increasing medical cost – healthcare has become an expensive proposition; especially when medical intervention becomes necessary. Health insurance is no longer merely an employee incentive or tax-saving measure, it has become a need. Hence, insurance companies have gradually expanded into specialised products such as critical illness insurance plans for life-threatening ailments. But the extended claim settlement process often discourages many consumers from buying a health insurance.
Health insurance claim settlements need not be a stressful and frustrating experience however. A little planning and adherence to a few dos and don’ts can make the entire process simpler and faster. Here’s what all you should do
While purchasing the policy:
Provide complete and correct information
Ask about exclusions, limits, sub-limits, etc
Read the fine print
Disclose pre-existing medical conditions
While filing claims:
Claims can be made under cashless arrangement or by way of reimbursement. The insurance company/ third party administrator (TPA) must be informed if it’s cashless, and only the insurance company needs to be informed if it’s via reimbursement.
In emergency cases, Insurance Company should be intimated within 24 hours of hospitalisation
If the procedure is planned in advance, complete the relevant paperwork/ formalities 3-4 days in advance
Most insurers insist on a 48 hours advance intimation to complete the pre-authorization process. Keep your health card & Any Govt ID proof ready and handy. Remember that the cashless facility works only in network hospitals (hospitals that are on the insurers pre-approved list)
Ensure the pre-authorization form/ cashless request form is complete and correct and signed by the attending doctor
Provide OPD consultation papers for planned hospitalisation
Furnish all bills, prescriptions, consultation receipts, medical reports, letter from doctor advising hospitalization, stamped hospital bills and receipts etc.
Settle all expenses if the process is not cashless and get the receipts. Do note that even for a cashless claim, there might be some expenses that will need to be borne by you. You need to settle those
If treatment is availed at a non-network hospital, details of the hospital, including registration number, number of doctors, nurses, beds, etc, must be obtained on the official letterhead of the hospital
Ensure complete and correct information in claim settlement forms. The form should be submitted within the time frame stipulated in the policy. All original hospital bills/ receipts should be duly stamped and signed by the hospital.
In General:
Ensure timely payment of premiums so that the policy does not lapse
Give fresh bank mandate for reimbursement, if necessary
Maintain a complete medical record, including copies related to old insurance, prior claims made, if any
Keep insurer updated of relevant developments in your life
What you should not do?
Don’t hide any information related to your health condition as it can hamper your claim settlement
Don’t opt for facilities or rooms that exceed your approved upper limit
Don’t delay reporting and submitting relevant documents to the insurance company/ third party administrator
Don’t forget to seek extension of time to submit evidence, if required
Don’t forget to renew your policy on time
Don’t make false or questionable claims
With a little foresight and planning, making a health insurance claim can be simple and effortless. More so, when you opt for a medical insurance company like HDFC ERGO which has partnered with a wide network of hospitals and also has a dedicated claim settlement team in place, guiding and assisting you, ensuring a hassle-free, quick claim settlement.
Disclaimer: All information in this article has been provided by HDFC Ergo and NDTV is not responsible for the accuracy and completeness of the same.