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How to Make Claim on a Health Insurance Policy

18 July 2012, Wednesday

Formalities for a health insurance claim

You can make a claim under a Health insurance policy in two ways :

  • On a Cashless basis and
  • A Reimbursement Claim

On a Cashless basis :

For a claim on cashless basis, your treatment must be only at a network hospital of the Third Party Administrator (TPA) who is servicing your policy. You have to seek authorisation for availing the treatment on a cashless basis as per procedures laid down and in the prescribed form. Please read the policy document as soon as you receive it to familiarise yourself with the process rather than wait for a claim to arise.

Claims on reimbursement basis :

Read the clause relating to claims in your policy document as soon as you receive it to ensure that you understand the procedure and the documents required for making a claim on reimbursement basis. When a claim arises you should inform the insurance company as per procedures required. After hospitalisation, you have to ensure that you obtain and keep ready documents such as claim form, discharge summary, prescriptions and bills that you should submit for a claim.

Source: Insurance Regulatory and Development Authority

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