5 days ago

Best Practices for Filing Health Insurance Claims in India

Health insurance helps pay some of the costs of medical treatment.

Before an emergency, learn what your policy covers and what it excludes.

Cashless treatment lets the insurer pay eligible costs directly to a network hospital.

With reimbursement, you pay first and ask the insurer to repay eligible costs later.

Some policies require you to pay part of every claim through co-payment.

Keep all medical papers and bills safe because the insurer may need them.

Check room limits, waiting periods and items that are not covered.

Tell the insurer quickly about planned or emergency hospitalisation and review the final bill before leaving.

Key facts

Claim routes: Cashless claims are settled directly with eligible network hospitals; reimbursement claims require the policyholder to pay first and claim later.
Co-payment example: With a 20% co-payment on an admissible claim of ₹1 lakh, the policyholder pays ₹20,000 and the insurer pays ₹80,000.
Pre-authorisation: For cashless treatment, provide medical records, proposed treatment details and estimated costs before the procedure where possible.
Important limits: Room-rent limits, waiting periods, disease-specific caps and exclusions can reduce the amount payable.
Non-medical expenses: Registration charges, admission kits, personal convenience items and certain consumables may not be covered.
Documents: Keep prescriptions, consultation notes, diagnostic reports, bills, claim forms, discharge summaries and other treatment records organised.
Notification: Notify the insurer or third-party administrator promptly for planned hospitalisation and within the prescribed timeline for emergencies.

thehindubusinessline.com · 5 days ago