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Health Insurance

How to claim health insurance :

Making a claim on your health insurance is easy
if you have the paperwork in place. Heres how to go about it. 

Reimbursement Claims :

Intimate the TPA or insurer before hospitalisation. In case of an emergency, inform within 24 hours of admission.

Retain all prescriptions, bills and payment receipts of medicines and ancillary expenses.

Make sure the bills and receipts have the correct name and dates.

Take the discharge card while leaving the hospital.

Keep photocopies of all prescriptions, bills and the discharge card.

If treatment is to be continued at home, make sure this is prescribed by the doctor at the time of discharge.

Fill the claims form and submit along with original bills, discharge card and other documents.

While submitting the claims form physically, take a stamped receipt. If sending by post, use courier, speed post or registered post.

Cashless Claims: Emergency Hospitalisation

Show the identity card issued by the TPA or insurer at the hospital at the time of admission.

Inform the TPA or insurer within 24 hours of admission. You can call or send an e-mail. Make sure you get a claim intimation number.

Fill the authorisation form and submit it to the TPA or insurer. They will then send the authorisation letter to the hospital.

Some hospitals may ask for a 15-20% deposit depending on the TPA. This is refunded after deducting expenses not covered by the policy.

At the time of discharge, get photocopies of prescriptions, discharge card, bills and other documents.

Cashless Claims: Planned Hospitalisation

If hospitalisation is planned, intimate the TPA or insurer after fixing the schedule with the doctor. Do this 3-4 days before being hospitalised.

Note down your claim intimation number after you have informed the TPA or insurer about the hospitalisation.

Fill pre-authorisation form with details of the treatment needed and estimated cost. This form is provided with the policy document. It can also be downloaded.

After examining the details, the TPA or insurer will issue an authorisation letter for cashless treatment.

At the time of discharge, get photocopies of prescriptions, discharge card, bills and other documents. The hospital will give the originals to the TPA or insurer directly.


Pre- & Post-Hospitalisation Claims

After discharge, pre- and post-hospitalisation claims have to be filed separately.

If no further treatment is required after hospitalisation, these claims can be submitted along with the hospitalisation claim.

Insurance companies reimburse expenses incurred 30 days prior to and 60 days after the hospitalisation.

Domiciliary expenses include doctors fee, tests, nursing and medicines for up to 60 days after discharge.

Fill up the claim form and submit it along with the original bills and receipts to the TPA or the insurance company.

Retain photocopies of documents for your own reference.

Documents needed for claim submission

A copy of your health insurance policy.

TPA card.

The pre-authorisation claim form provided by the TPA or insurer.

Claim form along with the patients and the doctors signatures.

Discharge card.

Letter from the doctor who recommended hospitalisation.

All prescriptions for medicines and line of treatment.

Medical bills.

Hospital bills with invoice number, break-up of treatment expenses and proof of payment.

Medical reports, X-rays, blood test reports (signed by the doctor).

Hospital registration certificate.

Smart idea: Get the documents scanned and store them in digital format for ease of access.

Tips to avoid claim rejection

Check whether the hospital is on the insurance companys network.

In case you have more than one health cover, mention that in the claim form.

All bills (medicines, diagnostics and surgeries) must be accompanied by prescriptions.

In case of an emergency hospitalisation, make sure the doctor specifically prescribes admission.

Unless your policy covers daycare procedures, hospitalisation is covered only if the patient is admitted for at least 24 hours.

Source : ET



Understanding health insurance :

The term health insurance is a type of insurance which grants you cover against ever rising medical care costs or expenses, beginning from diseases to grave accidental injuries. Health insurance is a critical monetary product that is a must for every individual irrespective of his or her age, sex or religious specification. It aids you in obtaining the first class treatment without muddling your head much over the financial costs involved.


Benefits of health insurance

Our lives cannot be predicted; hence health insurance helps to make it secure and protected from handling mammoth financial hammering. It not only helps you in dealing with severe emergencies effectively, but it also beneficial in dealing with disability and custodial needs. 

Health insurance as a concept is new in India; however it is catching up speedily. Its responsiveness has been massive in the last couple of years. This is due to the response to the series of qualms, worries and suspicions people have observed in current times such as terror attacks and so on.

In brief, a health insurance is a contract signed between an individual and an insurance company.

One must note in advance, the amount and type of health care expenses that will be covered under a health plan. Based on the terms and condition of a health insurance policy, it covers major and at times all part of medical expenses which includes medications, nursing expenses and doctors consultation charges. Treatment can be obtained from any authorized hospital or medical organization across India. 

Health insurance in India can be purchased in two available formats: individual and group plans. In an individual policy, he or she is himself or herself the owner of the policy, whereas in group policy, the guarantor or the sponsor purchases the policy and the beneficiaries covered under it are labeled as its members. 


The need of health or medical insurance

Looking at the sky mounting expenses now a days, health insurance is a must. A simple appointment with your doctor is capable of shelling big bucks from your pocket, it is then that health insurance comes in handy. 

Convoluted medical treatment expenses combined along with modern sedentary lifestyle patterns could binge into your savings which for all obvious reasons is meant for your future. For peaceful, secure and healthy lives of you and your family, it is always advisable to buy a well suited health insurance plan. Right from the food we consume to the air we inhale to our daily stressful activities, having a right health insurance plan is imperative. 

At some time or the other, we all have met people who wonder that if they buy a Health insurance policy, it is certain for them to get ill. However, let us face the fact. We all need a health insurance plan in order to cover a small appendix operation cost which is more than Rs. 25,000, when compared to the year 2000, when it was close to just about Rs. 10,000. The cost of any sort of treatment is likely to shoot, without giving a prior notice to general public in advance.


Benefits of a health insurance plan

The benefits of a health insurance policy are multi fold. It not only aids you in getting a suitable treatment keeping your pocket under watch, but it also covers the signs of financial instabilities in the event of long, delayed illnesses. 

Benefits of a health insurance policy depend on two factors: the coverage it provides and the policy you choose. 


Lets explore some of the basic advantages that major health policies provide. 

1.    It aids in rendering a safe future by paying a fraction as your medical care costs, which is called as the premium. Depending upon the kind of policy you have opted for, it at times can cover the whole chunk of your medical costs.
2.    It helps in dealing with huge amount of monetary losses and danger of financial breakdown in the cases of costly medications and post-illness care.
3.    It unquestionably gives you a sense of security.
4.    Depending upon the type of widely available policy that you opt for, it aids in covering pre-hospitalization to post-hospitalization bills, for the period of 30 days and 60 days respectively.
5.    It helps in providing a financial security to the family members.
6.    It also takes care of custodial bills and disability. 
7.    One can also benefit from the tax benefits on the premium paid under section 80D of the Income Tax Act.
8.    Depending upon the type of policy you claim for, one can also avail discounts on insurance premium which is available on family packages.
9.    The premiums are considerably available at much cheaper costs for younger people.
10.    Domiciliary hospitalization can also be covered.


Source : prajnacapital


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