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Here Are the Documents Required At The Time Of Health Insurance Claim


By purchasing health insurance, you have already completed an essential step to secure yourself and your family financially. At the time of crisis, the insurance company would help you evade any financial hardships by providing the appropriate medical health insurance benefit.

At the time of purchase, you have the option to choose the Mediclaim policy claim payment mode: whether as cashless or as reimbursement. Whatever option you might have selected, there is specific documentation that you need to provide at the time of filing the claim. Here’s a list of documents that you need to furnish at the time of filing the claim settlement-

For Cashless Claims

In a cashless claim, hospital directly settles bills with the insurer, and you don’t need to do much as your hospital will handle the process of submitting relevant documents.

However, you can ensure that all the paperwork is done a day before the discharge.

For fast claim, settlement follow these steps-

Claim Notification

To initiate your claim process, you can contact your health insurance company via calling on the toll-free number, dropping an E-mail, or log in to their official website and can notify them with necessary details like-illness or any injury-

  • Policy number
  • Name of the insured
  • Name of covered person/insured member making the claim
  • Contact details
  • Nature of the disease
  • Hospital’s address and name
  • Medical hospital’s contact information
  • Hospitalisation date

Your claim notification will be answered within 48 hours by your medical insurance company. They will dispatch claim form as soon they will receive claim notification. You must provide the following documents at the time of claim-

For Planned Hospitalisation

In this type of hospitalisation, insured already knows that he/she will be hospitalised so, they accordingly apply for cashless request in advance. After TPAs approval of the initial amount, the insured can get admitted. Here are the documents required to apply for planned hospitalisation-

  • Select hospital from the network list
  • Carry any ID proof, Address proof, TPA card ID
  • Photocopy of the policy
  • Fill pre-authorization form

TPA checks the documents, and if the ailment is covered under the policy’s terms and conditions, it will approve the pre-authorized amount.

For Emergency Hospitalisation

In this case, the insured is rushed to the hospital from the network list, and insured attendee must provide all the above-mentioned documents.

For Reimbursement Claim

In reimbursement claim, you must pay the bills to the hospital, and later it is reimbursed by your insurer. Make sure you provide following documents to get reimbursement amount-

  • Claim acknowledgement number
  • Fill and send the claim form
  • Discharge summary
  • Diagnostic tests and reports
  • Treatment charges
  • Doctor’s prescription
  • You must cancel the cheque and fill up an ECS (electronic clearance service), so, that insurer can transfer money in your account.

Submitting the Right Documents is Crucial for Faster Claim Disbursal

Your health insurance policy for reimbursement claim also covers pre-hospitalization and post-hospitalisation expenses. Pre- and post-hospitalisation bills can be sent within 15 days from the end of the post-hospitalisation period as specified in your policy. Your health insurer will settle the claim within 30 days from the date of submission of the above documents. If all the documents are right, you will be received a payment within 21 days of submission of documents.

Overall, you need to provide the right set of documents at the time of filing your health insurance claim, so that you may have no hiccups while undergoing medical treatment.

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