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How to File Health Insurance Claims?

There are two ways in which insurance claim settlement can be done. It can either be done on a cashless basis or a reimbursement basis. Visit now to know more about it.

  • Nov 22, 2021

Investing in a health insurance policy is important for a multitude of reasons. However, while purchasing the policy, you must have been asked to look at the health insurance claim settlement ratio for any insurance company you are thinking of investing in. The health insurance claim settlement ratio refers to the number of claims that have been settled or met by the insurer as opposed to the number of claims filed.

The journey of having a health plan does not end at simply purchasing it and paying the premiums. Of course, these are important aspects, but the whole purpose lies in the reimbursement or claim to be settled for you. Therefore, it becomes important to consider the health insurance claim settlement ratio before you purchase an insurance plan so that you do not face unnecessary hurdles when the time comes.

Insurance claim settlement might seem like an overwhelming process if there is a loss in the family, or when you are tending to your loved ones who are going through critical medical issues. However, you can ensure that everything goes smoothly in terms of settlement claims by providing the right documents. Every health insurance policy has a series of specifications that need to be looked into when you buy a health plan - whether online or offline. To make this process easier for you, let us look at some of the general procedures.

There are two ways in which insurance claim settlement can be done. It can either be done on a cashless basis or a reimbursement basis.

Cashless Basis

Insurance settlement claim for a health plan can be made on a cashless basis when you or your loved ones take services from a network hospital (any hospital the health insurance policy lists). Settlement claims under the cashless settlement are usually made directly between the hospital and the insurer.

If you seek treatment that you have prior notice for, for example - a surgery - you can let your insurance provider know about the same. This is to be done typically 4-7 days prior to the procedure so that the insurance company can provide you with an approval letter. Post this, the insurer will generate an identification card for you along with the approval letter, Aadhar card, cashless claim forms, and any other document required to be shown at the network hospital.

Once your treatment is done, you can leave the bills with the hospital which is then sent to the insurance company for settlement claims. In case of an emergency, the settlement claims can be made by giving the hospital a copy of your health plan. They will get in touch with the company and get the details along with the approval letter.

Reimbursement basis

Claim insurance settlement under this can only be done once the person is discharged and it must be done within 7 days of being discharged from the hospital. Reimbursement is when you make the expenditure from your pocket and then are paid back for it by the health insurance policy provider.

You can do that by getting the claim form or death claim form from the company either by visiting it physically or downloading it from their website online. This claim form/death claim form must be filled out and sent to the insurance company along with all the copies of medicines bills, hospital services availed, etc.

You must ensure that any treatment for which you file an insurance claim settlement is part of your policy. While this may seem like too much work, it is a rather simple process if you have all the documents required already in place. Having prior knowledge of filing claims always comes in handy as it makes the process much smoother!

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Ref. No. KLI/22-23/E-BB/2435


- A Consumer Education Initiative series by Kotak Life

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