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Home Articles How to Make Claim on a health Insurance Policy?

How to Make Claim on a health Insurance Policy?

IndianMoney.com Research Team | Updated On Wednesday, July 18,2012, 07:52 PM

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How to Make Claim on a health Insurance Policy?

 

 

Formalities for a health insurance claim

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

  1. On a Cashless basis and
  2. 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 health insurance 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

See Also: Life Insurance Policies

Formalities for a death claim

When a person with a life insurance policy – called a life assured – dies, a claim intimation should be sent to the insurance company as early as possible. The assignee or nominee under the policy can do this. So can any close relative or the agent who handles the policy.

The claim intimation should contain information like the date, place and cause of death. The insurance agent has the duty to help the life assured’s family/ assignee to deal with the insurance company to fulfil the formalities for a claim.

The insurance company will respond to this intimation and will ask for the following documents:

  • Filled-up claim form (provided by the insurance company)
  • Certificate of death
  • Policy document
  • Deeds of assignments/ re-assignments if any
  • Legal evidence of title, if the policy is not assigned or nominated
  • Form of discharge executed and witnessed

Other documents such as medical attendant's certificate, hospital certificate, employer's certificate, police inquest report, post mortem report etc could be called for, as applicable.

Formalities for a maturity claim

Where a life insurance policy is maturing, the insurance company will usually send intimation to the policyholder along with a discharge voucher at least two to three months in advance of the date of maturity giving details like the maturity amount payable.

The policyholder has to sign the discharge voucher – which is like a receipt – have his signature witnessed and send it back to the insurance company along with the original policy bond to enable it to make the payment.

See Also: Claim Settlement Methods of Health Insurance

If the policy has been assigned in favour of any other person or entity – like a housing loan company – the claim amount will be paid only to the assignee who will give the discharge.

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IndianMoney.com Research Team

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