Ever since the pandemic, the necessity to protect our health has been more apparent than before. It has increased public awareness of the fact that illness, accidents, natural catastrophes, and other unexpected events can occur at any time and without warning. When we are confronted with these unanticipated events, it not only affects our mental well-being but also financially draining. Opting for health insurance is therefore beneficial in such scenarios and prevents a medical emergency from resulting in a financial crisis.
Depending on the plan chosen, comprehensive and adequate health insurance can cover both pre and post-hospitalization bills, ambulance fees, costs connected with severe diseases, and a variety of additional expenses. The claims process is the most important aspect of any insurance coverage for every consumer. As a result, understanding the claims procedure is just as vital as purchasing insurance. Being well-informed helps make the claims process run more smoothly and without any hassle.
A thorough understanding of insurance is usually beneficial for a smooth claims settlement.
Here's a brief rundown of things to keep in mind while filing for any claims.
Things not to miss:
- It is important that you notify your insurer / appointed TPA after a medical emergency. In case of planned hospitalizations, intimations can be given in advance for planning cashless.
- Intimations can be provided over phone, e-mail, SMS, apps, and other platforms made available by the insurer / TPA.
- Upon intimation, you will receive a claim number. This is an important link for you to submit/pursue your claim in future
- Filling up the claim form completely with the right information is important. You need to give all the relevant facts asked for in the form. All necessary supporting information should be provided
- All original copies of receipts and bills should be submitted and, a copy of the claim form and the receipts should be kept for records
- Ensure that all the medical investigation reports and consulting papers are submitted in original. Insurers can be requested to return the papers; in case you require them for long-term / repetitive treatments
- It is necessary to always follow the claims procedure mentioned in the policy documents
- Claim form and the papers should be submitted to the right entity. It should be submitted to the TPA in case the policy is serviced through them, or to the insurer in case of direct servicing. In many cases, Insurance Agents/Brokers facilitate the collection and submission of documents
- Most insurers ask for identity proof, KYC documents, and account details (with Bank/ISFC Codes) for facilitating the remittance of claim proceeds. In some cases, a copy of the canceled cheque is also required
Things to avoid:
- Delay in intimation of claim
- Providing incorrect, incomplete, or misleading information in the claim form
- Submission of the claim form through a third party not recognized by the insurer
- Leaving important sections of the form blank
With sound planning and preparation, filing a health insurance claim can be quick and simple. Following the methods indicated above can guarantee that the insurance claim is completed quickly, resulting in quicker reimbursement when required the most.
Mr. Atul Deshpande, Head – Claims, Digital and Projects, SBI General Insurance.