{"id":598,"date":"2020-10-07T13:07:28","date_gmt":"2020-10-07T13:07:28","guid":{"rendered":"http:\/\/blog.insurancesamadhan.com\/?p=598"},"modified":"2020-10-07T13:07:29","modified_gmt":"2020-10-07T13:07:29","slug":"how-to-claim-health-insurance-in-india","status":"publish","type":"post","link":"http:\/\/www.insurancesamadhan.com\/blog\/how-to-claim-health-insurance-in-india\/","title":{"rendered":"How to Claim Health Insurance in India | Documents Required for Health Claim"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_76 counter-hierarchy ez-toc-counter ez-toc-grey ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">Table of Contents<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"http:\/\/www.insurancesamadhan.com\/blog\/how-to-claim-health-insurance-in-india\/#What_is_a_Cashless_Claim_in_Health_Insurance\" >What is a Cashless Claim in Health Insurance?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"http:\/\/www.insurancesamadhan.com\/blog\/how-to-claim-health-insurance-in-india\/#The_4_step_for_cashless_claim_resolution\" >The 4 step for cashless claim resolution<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"http:\/\/www.insurancesamadhan.com\/blog\/how-to-claim-health-insurance-in-india\/#What_is_the_Reimbursement_Claim_in_Health_Insurance\" >What is the Reimbursement Claim in Health Insurance?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"http:\/\/www.insurancesamadhan.com\/blog\/how-to-claim-health-insurance-in-india\/#The_6_Step_Process_of_Reimbursement_Claim\" >The 6 Step Process of Reimbursement Claim<\/a><\/li><\/ul><\/nav><\/div>\n\n<p>Just like all right things in the world don\u2019t come easy, Insurance policies too come with certain problems. Insurance policies are hard to understand for a layman or someone who does not have any expertise in &nbsp;Insurance, &nbsp;and this difficulty magnifies when you have to lodge an&nbsp;<a href=\"https:\/\/www.insurancesamadhan.com\/blog\/what-to-do-when-cashless-insurance-claim-is-rejected\/\">insurance claims<\/a>. However, due &nbsp;to inadequate information, incomplete documentation or discrepancies in claim process, you don\u2019t want &nbsp;to face a claim rejection. Therefore, it is crucial to &nbsp;understand the claim process, how it works and &nbsp;what documents you need &nbsp;so as to get maximum pay-out. &nbsp;To help you sail through the process, we have laid &nbsp;down everything &nbsp;you need to &nbsp;know about &nbsp;how the claim &nbsp;process works.<\/p>\n\n\n\n<p><strong>There are two ways to claim health insurance<\/strong><\/p>\n\n\n\n<ol class=\"wp-block-list\"><li>Cashless<\/li><li>Reimbursement<\/li><\/ol>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"What_is_a_Cashless_Claim_in_Health_Insurance\"><\/span>What is a Cashless Claim in Health Insurance?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p>A cashless claim is when the policyholder does not have to pay anything out &nbsp;of his pocket, according &nbsp;to the terms and conditions of the policy, the entire bill is directly cleared &nbsp;by the insurance company. A cashless claim can be lodged for both, planned or unplanned medical emergency.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_4_step_for_cashless_claim_resolution\"><\/span>The 4 step for cashless claim resolution<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p><strong>1. Pre-authorisation<\/strong><\/p>\n\n\n\n<p>In this process, the&nbsp;<a href=\"https:\/\/www.insurancesamadhan.com\/blog\/how-insurance-samadhan-help-covid-patients-in-settling-insurance-claims\/\">insurance company<\/a>&nbsp;verifies &nbsp;the policyholder\u2019s eligibility to claim. When the policyholder presents the insurance policy card and an official identity card to the hospital, pre-authorisation process is initiated.<\/p>\n\n\n\n<p>After verification of eligibility and hospital needs and the line of treatment is established, is when the cashless claim process begins.<\/p>\n\n\n\n<p><strong>2. Enhancement While Admission<\/strong><\/p>\n\n\n\n<p>Although the line of treatment and needs of hospital were established during pre-authorisation process, however if due to foreseen &nbsp;or unforeseen circumstances &nbsp;the hospital realises that the treatment expenditure maybe higher than previously established expected cost. The hospital needs to send out a new expected figure and this process is called the enhancement while admission.<\/p>\n\n\n\n<p><strong>3. Queries in Cashless Admission<\/strong><\/p>\n\n\n\n<p>If during admission, any discrepancies are found, the insurance company raises queries to hospital which is &nbsp;required to be resolved within 24-hours framework. In order to resolve the query, the hospital may need to provide additional supporting documents. Once the query is addressed, the insurer company reassess the claim. &nbsp;<\/p>\n\n\n\n<p>However, if the hospital is unable to resolve the query then pre-authorisation is rejected and the policyholder is informed to lodge a medial claim via reimbursement.<\/p>\n\n\n\n<p><strong>4. Cashless Discharge<\/strong><\/p>\n\n\n\n<p>If the query has been resolved and the insurance company has &nbsp;verified and established all requiring data in line with the terms and conditions of the policy, the insurance company is then required to settle the payment directly. &nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"What_is_the_Reimbursement_Claim_in_Health_Insurance\"><\/span>What is the Reimbursement Claim in Health Insurance?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p>The reimbursement claim can be opted when treatment is undertaken in a non-network hospital or if cashless facility is not available at the hospital, the policy holder has to pay for the treatment from his own pocket and then later, claim reimbursement for the same.<\/p>\n\n\n\n<p>A reimbursement claim is lodged only after the discharge process, therefore the policyholder needs to make sure that he\/she has collected all necessary documents and kept a copy of every receipt provided by the hospital.<\/p>\n\n\n\n<p>The company will then assess the claim in accordance to the term and conditions and after verification, accept\/reject the claim.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_6_Step_Process_of_Reimbursement_Claim\"><\/span>The 6 Step Process of Reimbursement Claim<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ol class=\"wp-block-list\"><li><strong>Contact the Insurer Company:-<\/strong>&nbsp;First things first, the policyholder is required to inform the insurance company, ideally within 24 hours of the admission in case of a medical emergency. On the contrary, if it\u2019s a pre-planned hospitalisation then the insured needs to inform the company at least 3 to 4 days prior. &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;<\/li><li><strong>Ensure to collect all relevant documents :-&nbsp;<\/strong>The burden of presenting all relevant documents for claim approval lies on the policyholder, therefore he\/sheis required to collect all the original medical documents and itemized bills and submit them to the insurance company in the order mentioned in the&nbsp;<a href=\"https:\/\/www.insurancesamadhan.com\/blog\/importance-of-nomination-in-a-life-insurance-policy\/\">insurance policy<\/a>.<\/li><\/ol>\n\n\n\n<p><strong>These documents include &#8211;<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Copy of Gov. Id Proof with Insurance card<\/li><li>Original Hospital Discharge Summary<\/li><li>Original Itemized Bills<\/li><li>Hospital Bill &amp; Breakup<\/li><li>Original Investigation Reports<\/li><li>Original Pharmacy Bills<\/li><li>Original Prescriptions<\/li><li>Copy of FIR\/Medico-Legal Certificate (only in case of accidental injury)<\/li><li>Original Cancelled Cheque<\/li><\/ul>\n\n\n\n<p><strong>3. Getting the Documents Reviewed by an Expert Agency like Insurance Samadhan<\/strong><\/p>\n\n\n\n<p>We, at Insurance Samadhan have a bench a professionals who are expert at their work and therefore can verify all documents for you. This is primarily recommended because the insurance company suspects the state of fortuity of occurrence of amoral hazard and cross-verifies every minute detail. Therefore, to save your claim from being rejected, we recommend to get your documents verified.<\/p>\n\n\n\n<p><strong>4. Lodging and Submittingthe Claim Form:-&nbsp;<\/strong>The policyholder can either lodge a claim form by hand, online or via an expert at Insurance Samadhan to ensure that the whole process is error and hassle free. Our experts will ensure that you receive guidance at every step and get maximum pay-out faster. Once all documents are verified and uploaded, the claim can be submitted.<\/p>\n\n\n\n<p><strong>5. Claim Tracking and Query:-<\/strong>&nbsp;&nbsp;You can track a reimbursement claim via call or through the online portal of the company. If after claim submission, any query is raised by the insurance company then the policyholder is required to resolve the query ideally within 2-3 days.<\/p>\n\n\n\n<p>The policyholder can approach our experts for assistance or advice on resolving the query. Insurance Samadhan is the most trusted platform for resolving Insurance complaints in India. We will overtake the entire process and put you at ease. With our growing family of over 10,000 happy customers, we commit to solving all your insurance related issues.<\/p>\n\n\n\n<p><strong>Claim Approval and Settlement<\/strong><\/p>\n\n\n\n<p>Once claim is assessed, all documents are verified and queries are resolved, the insurer company approves and settles the payment made by the policyholder by reimbursing all costs incurred by the insured.<\/p>\n\n\n\n<p><center><a href=\"https:\/\/www.insurancesamadhan.com\/register?utm_source=google&#038;utm_medium=organic&#038;utm_campaign=blog_banner&#038;utm_content=http%3A%2F%2Fbit.ly%2F2kuc159\"\/><img decoding=\"async\" src=\"https:\/\/www.insurancesamadhan.com\/assets\/img\/contact.png\" alt=\"Get Resolutions for Insurance Complaints\"\/><\/a><\/center><\/p>\n\n\n\n<p>If you&#8217;re having any kind of problem while filing for Health Insurance Claim please reach out us to below given details.<\/p>\n\n\n\n<p>To reach us at InsuranceSamadhan.com \u2013<\/p>\n\n\n\n<p>Call us at \u2013 844 844 0626<\/p>\n\n\n\n<p>Mail us at \u2013&nbsp;<a href=\"mailto:corporate@insurancesamadhan.com\">corporate@insurancesamadhan.com<\/a><\/p>\n\n\n\n<p>Register your insurance complaint&nbsp;<a href=\"https:\/\/www.insurancesamadhan.com\/register?utm_source=google&amp;utm_medium=organic&amp;utm_campaign=blog\">here<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Just like all right things in the world don\u2019t come easy, Insurance policies too come with certain problems. Insurance policies are hard to understand for a layman or someone who does not have any expertise in &nbsp;Insurance, &nbsp;and this difficulty&hellip; <a href=\"http:\/\/www.insurancesamadhan.com\/blog\/how-to-claim-health-insurance-in-india\/\" class=\"more-link\">Continue Reading <span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":3,"featured_media":599,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_uag_custom_page_level_css":"","footnotes":""},"categories":[1],"tags":[],"class_list":["post-598","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.8 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>How to Claim Health Insurance in India | Documentation of Health Insurance<\/title>\n<meta name=\"description\" content=\"How to Claim Health Insurance in India: In this article we have explained step to step method to file a Mediclaim in India. 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