Health insurance claim settlement process - PolicyBoss

Health Insurance Claim Settlement Process ?

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WHAT IS A HEALTH INSURANCE CLAIM? A Health Insurance claim is a request made by policyholder to the health insurer to avail the services covered under the insurance policy.

TYPES OF CLAIM SETTLEMENT PROCESS CASHLESS

REIMBURSEMENT

CASHLESS CLAIM SETTLEMENT PROCESS There are two types of cashless claim settlement process.

01.

PRE-PLANNED HOSPITALIZATION

Recommended that you inform the health insurer 2-3 days prior to hospitalization Inform the Third Party Administrator (TPA) and submit the required documents Insurer investigates your documents and case and inform you about eligibility Insurer pays the bills as per approved claim amount

02.

EMERGENCY HOSPITALIZATION

Call up the insurer’s customer care and get details on nearest empanelled hospital Get hospitalized and submit your health insurance details to hospital authorities Hospital sends your claim request along with required documents to Third Party Administrator (TPA) of insurer TPA studies your case and upon approval, settles the bill amount with hospital

REIMBURSEMENT CLAIM SETTLEMENT PROCESS Get admitted in Hospital Pay the bills and collect the documents at the time of discharge Submit all the required documents and ďŹ lled application form to the Third Party Administrator (TPA) of insurer TPA investigates your claim As per amount of claim approved, reimbursement is made directly to your bank account

REQUIRED DOCUMENTS Duly filled in Claim Form Medical Certificate/Form signed by doctor Prescriptions/Cash Memos of pharmacies/Hospitals Investigation reports Original bills and reports Original Discharge summary/card FIR/Medico-Legal Certificate (in accidental cases)

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