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Policyholders can make health insurance claims either through cashless or reimbursement mode. Some hospitals do not offer cashless hospitalisation facility. In this case, the policyholder has to pay all dues to the hospital and then submit a claim to the insurer.
Intimation
In a planned hospitalisation, a policyholder intimates insurers about the forthcoming claim. In emergency hospitalisation, claim intimation must be sent to the insurance company or TPA within 24 hours.
Documents collected at the hospital
Before leaving the hospital, it is important to collect the discharge summary, copy of investigation reports, bills, prescriptions and pharmacy receipts.
Form
Policyholders need to fill up prescribed reimbursement claim forms. Some sections need to be filled by the hospital and signed by the doctor who treated the patient. The form can be downloaded from the insurer or TPA’s website.
Bank details
At the time of submission of the claim, one should submit a fresh bank mandate with the policyholder’s bank account details and IFSC. A cancelled cheque may be required to be submitted.
Submission
Claim form with documents like a copy of the policy, discharge summary, medical bills and investigation reports should be submitted to TPA. The claim must be submitted right after discharge.
Process
On receipt and scrutiny of papers, the insurer may call for other documents for processing the claim, or intimate the reasons for repudiation of the claim.
Points to note
Retain old health insurance papers, as copies of these may be required when making reimbursement claims. The policyholder must keep copies of all claim papers for maintaining his medical records.
Courtesy : Centre for Investment Education and Learning (CIEL). Contributions by Girija Gadre, Arti Bhargava and Labdhi Mehta .