When buying a new health policy, the area of concern for the most is perhaps ‘claim settlement’. While we supposedly refer to the process as complicated but with proper awareness, claim settlement in health insurance can be made smooth and hassle-free.
Why Do You Need a Go Claim Settlement in Health Insurance in India
When buying a new health policy, the area of concern for the most is perhaps ‘claim settlement’. While we supposedly refer to the process as complicated but with proper awareness, claim settlement in health insurance can be made smooth and hassle-free.
Why Do You Need a Good Health Insurance Policy?
Nowadays, with the remarkable increase in the expenses associated with medical procedures and treatments, investing in real health insurance plans has become a necessity. To enjoy the monetary respite and peace of mind, especially in times of need, you have to have a medical insurance cover for you and your loved ones.
What Should You Consider Before Purchasing Health Insurance?
It is quite obvious that you will be doubtful about whether the insurer or the private company would settle your claim or not. To help you understand let us first discuss three important insurance claim ratios:
- Claim Settlement Ratio for Health Insurance: It implies the claim solving capability of the company. The ratio would be high when the majority of the claims are solved. The ratio is calculated as (Number of Claims Settled)/(Number of Claims Reported + Number of Claims Outstanding at the Start of the Year – Number of Claims Outstanding at the End of the Year)
- Claim repudiation ratio: It gives you an idea about the percentage of claims rejected by the health insurance company. It is calculated as (Number of Claims Rejected/Total Number of Claims){ed162fdde9fdc472551df9f31f04601345edf7e4eff6ea93114402690d8fa616}
- Claim pending ratio: It tells you about the claims that are neither approved nor rejected. It is calculated as (Outstanding Claims/Total Claims){ed162fdde9fdc472551df9f31f04601345edf7e4eff6ea93114402690d8fa616}
Meaning of Claim Settlement and How Does the Data Help?
The claim ratio data gives you a clear insight into the history of the insurance company’s claim handling process. Although new insurers would naturally have low ratios, claims data helps you in analysing companies that have been in business for the same period.
If you have already invested in a valuable health insurance policy, you need to be familiar with all the aspects of claim settlement for easy dealings.
Claim Settlement Types
Cashless Claims
In the case of a planned hospitalisation, you can select a cashless settlement. Make sure you follow these steps for a hassle-free process.
- Check whether the health condition is covered according to the terms and conditions of the policy. Also, track a hospital included in the network of the insurer before going ahead with cashless hospitalisation
- Inform the insurance company that you want a cashless claim on your policy. Fill the Pre-Authorisation Form during admission and submit it to the TPA counter
- Submit documents such as the Cashless Card given by your insurance company and some documents for identity at the TPA counter
- The original hospitalisation documents will be kept by the insurer once you receive the cashless approval. Therefore, keep a copy of the documents for your records
- Check the pre-post hospitalisation cover in the health insurance plan. Retain all the medical reports, prescriptions and bills to claim expenses
Reimbursement Claims
Some policies do not offer cashless claim facility. In such cases compensation claims can be made in the following ways:
- You need to inform the insurer by submitting the duly filled claim form offered by the company within 30 days after discharge from the hospital
- Submit all the original medicine bills, hospital bills, and reports duly signed and stamped
- The Discharge Summary issued by the hospital after your discharge has to be given to the company
- The follow-up prescription, showing that you are fit after hospitalisation, has to be given in the original. You need to submit the bills within three to four months after discharge for post-hospitalisation expenses
- For future reference, you must retain copies of all the documents submitted
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