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Caring for aging parents means ensuring they receive the best healthcare without financial stress. Having a Parents Health Insurance policy makes medical expenses more manageable. However, many people find the claims process complicated and time-consuming.
Missing required documents or not following the correct steps can lead to claim rejection or delays. Following the right process ensures claims are settled quickly, helping your parents get timely medical care.
Types of Health Insurance Claims
Understanding the two types of Health Insurance claims can help choose the right process and avoid unnecessary delays.
1. Cashless Claims
A cashless claim allows the policyholder to receive treatment at a network hospital without paying medical bills upfront. The insurance provider directly settles the bill with the hospital. This option is convenient and reduces financial burden during emergencies.
2. Reimbursement Claims
In a reimbursement claim, the policyholder pays the hospital bills first and then submits documents for reimbursement. This process is necessary when treatment is done at a non-network hospital. To avoid claim rejection, all original bills, prescriptions, and reports must be submitted correctly.
Steps to File a Cashless Claim
Filing a cashless claim is easy when treatment is planned in advance or during emergencies at a network hospital.
1. Before Hospitalisation
Check if the hospital is part of the Health Insurance provider’s network. If it is a planned treatment, notify the insurance provider at least 48 hours before admission. For emergencies, inform them within 24 hours of hospitalisation.
2. During Hospitalisation
Visit the hospital’s insurance desk and present the Parents Health Insurance card along with a valid photo ID. Fill out the pre-authorisation form and submit it for approval. The hospital will send the request to the insurer for verification.
3. After Treatment
Once the insurer approves the claim, the bill will be settled directly with the hospital. The policyholder only needs to pay any expenses not covered under the policy, such as consumables or non-medical charges.
Steps to File a Reimbursement Claim
A reimbursement claim requires the policyholder to pay the hospital bill first and later submit a claim for repayment.
1. During Hospitalisation
Keep all medical reports, prescriptions, discharge summaries, and hospital bills safe. Ensure each document has the correct details, as errors can cause claim delays.
2. After Discharge
Inform the insurer about the hospitalisation and submit a duly filled claim form. Attach all necessary documents, including original bills, receipts, test reports, and discharge summaries.
3. Claim Processing
The insurer verifies the submitted documents and processes the claim within a few working days. The approved amount is credited to the policyholder’s registered bank account. To speed up the process, ensure all documents are correctly submitted.
Essential Documents for a Smooth Claim Process
Submitting complete and accurate documents ensures faster claim processing. Here are the necessary documents:
- Duly filled claim form
- Original discharge summary from the hospital
- Detailed hospital bills with payment receipts
- Doctor’s prescriptions and treatment advice
- Diagnostic reports (X-rays, MRI, blood tests, etc.)
- KYC documents of the policyholder
- Canceled cheque or bank details for reimbursement
Tips to Avoid Claim Rejection
A rejected claim can cause financial difficulties, especially during medical emergencies. Following these tips can prevent unnecessary delays.
1. Check Policy Coverage
Read the Parents Health Insurance policy carefully to understand what is covered and what is excluded. Some treatments, pre-existing conditions, and waiting periods may affect claim approval.
2. Inform the Insurer on Time
Late claim intimation can lead to rejection. Always inform the Health Insurance provider within the specified time frame to ensure smooth processing.
3. Submit Correct and Complete Documents
Incorrect or incomplete documents are a common reason for claim rejection. Double-check all forms, receipts, and medical reports before submission.
4. Use Network Hospitals for Cashless Benefits
Cashless claims are hassle-free when using a network hospital. Before admission, verify whether the hospital is part of the insurer’s network.
Conclusion
Filing a Parents Health Insurance claim does not have to be stressful. Knowing the difference between cashless and reimbursement claims helps in choosing the right process. Keeping all documents organised and informing the insurer on time can prevent delays.
A well-managed claim process ensures parents get the medical care they need without unnecessary financial stress. By following these steps, policyholders can navigate the Health Insurance claim process smoothly and confidently.
*Standard T&C Apply
Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.
Claims are subject to terms and conditions set forth under the Health Insurance policy.
