How does the health insurance claim process work?

June 7, 2022

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health insurance claim process work

Every health insurance policyholder has one common question-’will I get coverage from day 1’? While the answer to this question is no, considering the waiting period clause, it is therefore important for a policyholder to understand how claims processing in health insurance works.

What is a health insurance claim?

Once you buy a health insurance policy, you get a specific amount of coverage up to which you can claim for hospitalization expenses. The specific amount is also known as the sum insured and is provided in exchange for the premium you pay. In case you get hospitalized, you can register a claim with the insurance company. On verification of the documents, the insurance company will then process the claim.

Claiming health insurance means claiming for the policy benefits which you are entitled to receive from the insurance company as per the policy terms and conditions.

Different types of health insurance claims/ Types of health insurance claims

Cashless claim:

Cashless claim is one of the easiest and hassle-free ways to claim health insurance. Under this type of claims process, the insurance company directly settles the bill with the hospital, and you don’t have to pay for the expenses. You only have to pay the admission fee and get treatment at the hospital that falls under the network of the insurance company.

Types of cashless claim

Planned hospitalization

This simply means that you have planned to undergo treatment at a hospital, and you are aware of the same.

Steps to follow in case of planned hospitalization

  • Sign a pre-authorization form available at the network hospital
  • Inform the insurance company about the hospitalization
  • The insurance company will notify the hospital and give you a confirmation letter which is valid for a period of seven days.

Emergency hospitalization

This refers to hospitalization that must be undertaken on an emergency basis.

Steps to follow in case of emergency hospitalization

  • Inform the insurance company within 24 hours of hospitalization
  • Submit documents like identity proof, address proof, photo ID, etc.
  • Fill in the cashless claim form
  • On submission of the documents, post verification, the hospital will receive an authorization from the insurance company
  • In case of approval, the entire cost of the treatment will be borne by the insurance company.

Reimbursement claim

This is a type of insurance claim where you must bear the cost of the treatment and the insurance company will later reimburse the bills.

Steps to file reimbursement claim

  • Duly filled claim form
  • Medical reports
  • Identity proof
  • Address proof
  • Medical certificate
  • Discharge documents
  • Medical certificate issued by the doctor
  • In the event of hospitalization due to accident, FIR copy

We hope by now you will be clear with both the types of claims process. In case of any query, you can write to us at XX to contact our Good Doctors Team. Onsurity’s Good Doctors Team takes care of the end-to-end claims’ assistance process, assisting you at every step. With Onsurity’s group health membership, you can get access to Good Doctors Team, and several other health and wellness benefits,

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