Every individual should take health insurance planning seriously in their life. It protects them from the financial burden of unforeseen events. A thorough and well-researched financial planning also enables them to compare the medical insurance plans available in the market and select the one that best meets their needs.
The best health insurance company in India provides a wide range of insurance plans to choose from. Thus, to get the best insurance plan, the individual must consider various factors such as waiting periods, pre-existing disease coverage, sum insured, and many others. They should choose an insurance company that has a high Claim Settlement Ratio (CSR). CSR indicates the number of successful claims the company has made during the financial year.
This blog will provide details regarding the do’s and don’ts of medical insurance claims.
What are the Mediclaim Insurance Claims?
An insurance claim is a request made by the policyholder to the insurance company for compensation for a loss covered under the insurance policy. Upon receiving the request, the insurance company reviews the policyholder's request and claim application to ensure that all documentation is accurate. They then approve the application and provide coverage for the loss. The best health insurance in India has a high claim settlement ratio.
Individuals must have the following documents for filing insurance claims in the best health insurance company in India:
Identity proof
Policy document
Medical reports of the illness
Hospitalisation papers, along with dates
Medicine bills
Policy document
Ambulance bills
How to File an Insurance Claim?
There are various types of insurance available in the market such as life insurance, motor insurance, fire insurance, marine insurance, and more. Filing an insurance claim can vary depending on the type of insurance plan.
Here’s how a policyholder can file mediclaim insurance claim :
Review the policy
The policyholder should be familiar with the medical insurance plans, terms, and conditions. This will allow them to understand what is covered by the policy. Reviewing the policy helps avoid confusion regarding the policy terms and conditions.
Notify the Insurance Provider
It is important to inform the insurance company about the loss as soon as possible. Some of the best health insurance in India have specific time frames for reporting claims. Hence, delaying in informing can result in the cancellation of the claim.
Gather Documentations
Depending upon the type of claim, the policyholder should collect all the essential documents, like medical bills, reports, prescriptions, etc., before filing the claim. They should always keep copies of these documents safe for future reference.
Fill Out the Form & Submit
Obtain the claim form from the office or download it online from the website. To avoid delays in claims processing, the policyholder should fill out the form completely and accurately.
After filling out the form, submit the application to the insurance company and wait for the approval.
Do’s and Don’ts to Successful Mediclaim Insurance Claims
When health insurance planning, policyholders should keep certain factors in mind. Successful mediclaim insurance claims involve careful preparation and adherence to procedures.
Here's a list of do's and don'ts for policyholders to ensure their claim goes smoothly:
Do’s
Understanding the policy is the first and foremost step that a policyholder should take. Before filing a claim, thoroughly read and understand the terms, conditions, and coverage details of the medical insurance plans.
Maintain records of all medical treatments, expenses, prescriptions, and hospital bills. This documentation is crucial for processing the claim.
It is essential to inform the best health insurance company in India about the hospitalisation within 24 hours in case of a medical emergency and before 48 hours in case of planned hospitalisation.
The policyholder must be honest and should share if they have any pre-existing condition before purchasing the medical insurance plans. This enables them to get the coverage and claim accordingly.
Getting treatment at network hospitals will give them the benefit of cashless claims, which can simplify the process.
Don’ts
Avoid delaying the claim process by informing late, as this can result in rejection or a reduction in claim amounts.
Ignoring policy exclusions or limits can result in denial of claims. Policyholders should ensure that their treatments fall within the policy’s coverage.
Choosing non-network hospitals, as they may incur out-of-pocket expenses.
Hiding information about pre-existing conditions, ongoing treatments, or other relevant details can lead to claim rejection.
Final Words
Medical insurance plans act as a shield to policyholders and provide them with financial protection. Individuals can choose insurance plans according to their needs and requirements. The plans provide comprehensive coverage to the policyholders by covering their pre- and post-hospitalisation expenses, medical bills, and other expenses related to blood tests. The policyholder can easily file claims by filing out a form online or offline, whatever suits them.
To help policyholders navigate the complexities of healthcare, Niva Bupa Health Insurance offers tailored insurance solutions that align with their needs. Discover how their plans can offer policyholders the financial security, smooth claims process, and the support they deserve.
