Health Insurance Claim: A medical insurance scheme that fully covers the hospital expenses and does not eat into your savings is the right one and comes in handy in case of a medical emergency.
Health Insurance Claim: A medical emergency can prove to be a stressful and extremely distressing problem for the patients as well as their families. Hence it is important to have the right health insurance plan to provide financial support during such unforeseen situations. With a good medical insurance plan, you will not have to dip into your savings to pay for hospital bills. While buying a health insurance scheme, it is important to understand the settlement process of the benefits offered and the claim settlement process of the insurer. This knowledge will help you in taking an informed decision and will ensure that you are fully protected in case of any medical emergency.
There are two types of health insurance claims – cashless and reimbursement claims. Through cashless health insurance, the insurer can directly settle the hospital bills as per your health insurance plan. Such claims can be received only in network hospitals for the treatment of those diseases which are provided by the insurance company. This simply means that you will not have to pay the hospital bill yourself first. On the other hand, through reimbursement, later the claim will have to be filed with the insurance provider for reimbursement. After this, the insurance company will reimburse the cost of treatment according to your medical insurance plan, ie will pay you.
However, if you get treated in a non-network hospital, reimbursement claims can be filed. To claim medical reimbursement, you have to fill the medical reimbursement form and provide all the hospital bills and necessary documents along with it. Apart from this, it is also important that you have knowledge about medical reimbursement income tax rules in case of any complaint.
It is also important to know that while network hospitals provide cashless claims for the treatment of patients, non-network hospitals also provide you coverage through reimbursement claims. If you want to know more about the medical reimbursement process, here you will get all the information about it. Know what important information you should have-
Know the Medical Reimbursement Rules – Here’s a Simple Process
During any medical emergency, if you want medical attention from the insurer’s network hospitals, you will have to proceed with the reimbursement claim process. However, if you get treatment under network coverage hospital, then you can choose the option of cashless claim. If you keep in mind some of the facts and rules mentioned here, then you will find it easy in the claim settlement process.
To make it easier for you, we have put together an exhaustive list that will help you get claim settlement as per the medical reimbursement rules. These rules will ease the process for you and ensure that you get full coverage in case of any medical emergency.
Learn more about the Medical Reimbursement Process
Medical reimbursement is the process that is given in lieu of the medical expenses that have already been incurred. Simply put, first you will have to bear the hospital expenses yourself and the insurer will reimburse you at a later date.
You will have to submit the required documents for reimbursement. This is an important aspect that you need to keep in mind during the medical reimbursement process. Through this you will understand which documents you need to collect and you will not face any delay.
Crucial Stage in the Medical Reimbursement Process – Leading the Way
In the cashless claim process, the insurer directly settles the bill with the hospitals, but in order to get the money back in the reimbursement plan, it is necessary that you have to take the initiative and start the claim settlement process. If there is any doubt regarding this, you can discuss it with the insurer.
Being a policyholder, you have to take steps to get the money back from the insurer. In order to file a reimbursement claim, it is important that you keep all the bills and documents used during the treatment. By taking initiative and being systematic, you will be able to enjoy a simple, easy and hassle-free reimbursement process.
Documents Required for Medical Reimbursement – What You Need to Know
Before starting the claim settlement process, you need to collect all the documents as per the medical reimbursement rules, which include hospital bills and other related documents. For a hassle-free medical reimbursement process, you must keep the documents handy and produce even the smallest proof of payment.
You will need to communicate with the third party administration in the process of submitting documents as per the policy with the insurer. It is also important that you keep the photographs of the required documents and because sometimes along with the submission of the documents, they may also ask for duplicate copies. Through this, you can expedite the medical reimbursement process and avoid delay in it.
Scrutiny of documents
Third party administrators and insurers analyze hospital bills and all documents closely, so it is important that you check them beforehand. Since they directly connect with the hospital and the claim is not cashless, they have to ensure that the claim is genuine and then they have to ensure the correctness of all the documents. Check before submitting the bill to the TPA or Insurer. Even a small difference can be enough to reject your claim, so check them all before submitting.
Understand the long process of medical claim reimbursement
Due to the verification process involved, it may take time to reach you. Therefore, you should assume that it will take more time for you to get this claim as compared to the cashless process. You need to have some patience and cooperation with TPA or insurer for a smooth process. If they ask any question or query, then it should also be answered on time. You need to submit all the documents on time, in the right manner and it is also important that you have a cordial relationship with your TPA or Insurer.
Documents required to get medical reimbursement money
To get medical reimbursement money, before raising the claim, you have to do all the documents together- Here you are telling about the list of those necessary documents-
- Duly filled and signed medical reimbursement form
- Photocopy of your insurer policy or policy card
- Medical certificate signed by a doctor
- All pathology reports including X-rays
- Hospital bills and original receipts
- hospital discharge card
- any kind of pharmacy bill
- Investigative Reports (if any)
- If there is an accident claim, then copy of FIR or MLC
- Credit card settlement with NEFT details
- Duly filled KYC form if the claim is more than Rs 1 lakh
- You must have the originals of all these documents.
Important things to keep in mind- Understand the claim rules and choose the right insurer
To get medical reimbursement, you need to choose the right insurer and for the right process, you should do a little research about the insurer. Their claim settlement process should be understood and queries, if any, should be answered before purchasing the policy. At the same time, it is also very important to know the rules of medical reimbursement and cashless.
Buying health insurance online with Tata AIG is a very easy process, it is efficient as well as quick. Tata AIG has a pan-India network of over 7000 cashless hospitals to facilitate hassle-free cashless claim settlement. Their claim settlement ratio or ratio is 94.21 percent, which is the figure for the year 2020-21. This is proof that you can take care of the health of your loved ones through this and Tata AIG can provide you the best treatment.
