Keep your documents ready for claiming Health Insurance Policy

About Health Insurance Policy

A policy which does not offer the facility of cashless claim is known as Health Insurance Policy. In this policy, the insurer is required to clear the hospital bills directly on the undergoing medical treatment. The same rule is applied when an individual is covered in cashless benefit but has been treated in the hospital. Even the rule is also applied when a cashless request is turned down by TPA (Third party administrator).

In such event, the person will have to settle the hospital bills and then claim the reimbursement from the insurer.

Reimbursement Claim form:

You will have to fill and submit the reimbursement claim form for overall processing to the Insurance company. If your claims are processed in the house, they are sent to TPA (Third party administrator).

This form is generally available with TPA and the insurer and can be downloaded from different websites.

Accompany your form with Documents:

The duly filled form should be accompanied with necessary documents. While claiming Health Insurance, you must submit important documents like original hospital bills, doctor’s note for investigation, tests, bills etc.

Processing period:

The health insurance claim is processed only after the documents and form are received. It generally takes about 15-21 days for verification of claim, processing and determining the eligibility. Afterwards, the reimbursement Cheque is then sent to the customer.

Important points to note:

• Insurance company may ask you to submit intimation of the hospital admission within the specified period of time.
• The insurer will describe the period after discharge in which the reimbursement claim has to be submitted.
• The company has the power to deny the claim wholly or partially.

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