How to Fill a Health Insurance Claim Form?

Posted on: Dec 12, 2023 | | Written by: None

How to Fill a Health Insurance Claim Form?

Publication date: December 12, 2023. EST READ TIME: 3 MIN

A health scare can happen to anyone at any time and cause immense mental and financial stress. However, if you are covered under health insurance, you can opt for timely treatment at a reputed healthcare centre without worrying about the bills. A health insurance policy can cover your hospital bills and other associated expenses and keep your savings intact. When there is a medical emergency, all you must do is notify the insurance provider about it and file a cashless or reimbursement claim with them. The claim filing process involves filling out the health insurance claim form and submitting the required documents. Read on to learn how to fill out the claim form correctly and file a health insurance claim.

Types of Health Insurance Claims

There are two categories of health insurance claims – cashless and reimbursement.

1. Cashless claim:

If you opt for a medical procedure at a network hospital of your insurance provider, you can file a cashless claim with them. In this case, the insurance company will settle your medical bills directly with the healthcare establishment, so you will not have to pay the same from your pocket.

2. Reimbursement claim:

If you choose a non-network hospital, you need to pay the bills from your pocket and then claim reimbursement for the expenses.

Before you file a cashless or reimbursement claim, you must notify the insurance provider about the same. You must also fill out the claim form correctly and submit it at the TPA desk of the hospital for verification. If you are filing a reimbursement claim, you must attach original bills and receipts with the claim form. The insurer will verify the same before reimbursing your healthcare expenses.

How to Fill Out a Health Insurance Claim Form?

Whether you choose a network or non-network hospital for a medical procedure, you must fill out the claim form of your insurance provider. You can download the form online or obtain it from the insurance company or TPA.

Once you have the claim form, here’s how you must fill it out:

1. A health insurance claim form has two sections, i.e., Part A and Part B. While Part A is to be filled out by the policyholder, Part B is for the hospital.

2. In Part A of the form, you must fill out your name, residential address, policy number, email ID, phone number, medical history, details of hospitalisation, etc.

3. Enter all the details correctly and review the form minutely before you submit it to the insurance company. Any incorrect or incomplete information can lead to health insurance claim rejection.

4. If you are filing a cashless claim, you must submit your cashless card along with the duly filled claim form at the hospital’s TPA desk. The insurer will verify your claim before settling your bills with the hospital.

5. For a reimbursement claim, you must submit the claim form, discharge summary, and the original bills and receipts to the insurance provider. The insurer will also need your medical certificate, ID proof, and any other documents related to the claim.

6. Collect everything, arrange them date-wise and submit them to the insurance provider. Since you have to submit original documents, remember to take their photocopies for your records.

Conclusion

Make sure you fill out the health insurance claim form correctly and completely to avoid the rejection of your claim. Also, remember to inform the insurance company about your medical procedure at least 48 to 72 hours in advance. For medical emergencies, you must inform the insurer within 24 hours of hospitalisation. Submit all bills and receipts with the claim form so the insurer can verify them and reimburse the expenses.

Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.

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