Health insurance is a basic necessity for everyone as it is essential to safeguard your finances during medical emergencies and get you quick access to quality healthcare above all. To have a smooth experience with your health insurance plan, however, you have to ensure you know the claim process and all the details regarding it.
This article will discuss how the health insurance claim process itself is getting simpler and what you can do to ensure your claim process is hassle-free.
How Claim Processing is Getting Simpler in India?
Insurance companies like ACKO General Insurance are using app-based claim intimation and tracking, AI-enabled claim processing, WhatsApp intimation, and digital documentation to make their claim processing system faster and more efficient.
On top of that, the government is launching The National Health Claim Exchange (NHCX). It is a portal that will process claims across healthcare institutes across the country. It will primarily bring 50 insurers under the same umbrella and contain all the information these companies will need and speed up the discharge approvals and pre-authorisation times.
NHCX, a part of Ayushman Bharat Digital Mission (ABDM), is a step towards interoperability which will lead to democratisation of insurance and lower the premiums.
What are the Types of Health Insurance Claims?
Generally, there are two types of health insurance claims available for an individual. They are:
1. Cashless Health Insurance
While availing of a cashless mediclaim you need not worry about keeping track of invoices and bills for submission. If you have the Cashless Health Card with you you can file a cashless mediclaim at any network hospital.
2. Reimbursement Claims
If you choose any healthcare centre which is not among the network hospitals for emergency or pre-planned treatment you have to file a reimbursement claim. In this scenario, you have to initially bear the total expense and file a reimbursement claim later with all the necessary bills and so on.
How to Simplify Your Health Insurance Claim Process?
For a policyholder, it is important to have a streamlined process of health insurance claims as there are chances you can miss during times of medical emergency. Become aware of the following things to keep your claim process simple:
1. Go Through Policy Documents Carefully
This is the most common and safe tip to pass around in any scenario, but it is not the going through or the reading of policy documents that is most important. It is important to understand the terms and conditions clearly. For example, you should have a very good idea about the terms below:
● Waiting Period
● Sub-limits
● Co-Payment
● Exclusions
If you do not have a solid understanding of such terms you can easily form misconceptions and get unwelcoming surprises while claiming reimbursement. You can try consulting an insurance expert to get a lucid understanding.
2. Pay Attention to the Documentation
Although you will find most insurance providers have a minimal paperwork approach, they often ask for certain documents like approval letters, doctor’s prescriptions, pre-authorisation, and FIR. Therefore, you should make sure to keep all medicine bills, and original receipts of pre and post-hospitalisation safe.
The following documents are essential for filing a reimbursement claim:
● Health insurance claim form
● Doctor’s prescription advising hospitalisation
● Diagnosis and treatment procedure details with original reports, bills and receipts
● Discharge summary and fitness certificate
To make this work simple you should make a dedicated file and keep the policy papers, health card, ID proofs, and such relevant documents. You should also inform your immediate family members about this file so that during emergencies they can easily access it.
3. Inform Your Insurer Ahead of Time
This is a crucial step you can take to ensure that your claim process will go well. If you have already planned a hospitalisation your insurer may benefit from knowing it 3 to 4 days prior to admission.
If you are in a medical emergency it is important to let the insurer know within the first 24 hours of the admission. Even if you opt for a reimbursement claim you should keep the insurer notified by any channel you find convenient. For example, you can write, call, or contact them through their app.
4. Be Honest With Your Insurer
This is a serious matter as it can lead to the rejection of claims when it finally matters. Trying to hide crucial information to save a few rupees on the premiums may result in far greater losses in the future.
The Bottom Line
This is everything you can do to make your health insurance claim seamless. You should know that the government of India and the insurance providers themselves are constantly innovating their systems to minimise the drag and give you a smoother insurance claim experience. Moreover, if you plan on getting some tax benefits from your health insurance policy, the Section 80D deduction is for you. So, along with getting an easy claim process, health insurance also helps you get tax deductions, making it a win-win situation for all.
So, why wait anymore? To know more about different health insurance schemes at affordable and attractive premiums, contact ACKO today!
