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When your health deteriorates, it becomes a traumatic situation for both the patient as well as for the family members. In such a case, your health insurance policy comes to the fore as a great support. However, it is important that the claim reimbursement process should be effortless so that the policyholder can receive the required financial support soon.
Most insurance companies aim to make their claim settlement process smooth and easy. But there is a particular procedure that has to be followed. Hence, it needs a policyholder to be transparent as well as patient with the insurer while raising a reimbursement claim.
Here are 5 must-know things about reimbursement claims that you must educate yourself about in case of a health policy.
If you go by the dictionary meaning, Reimbursement means a compensation that is paid by someone for expenses already done. Under the health insurance policy, reimbursement claims implies that the insured clears all the hospital bills on their own first and later can raise claim for compensation from the insurer by filing the health insurance claim letter for reimbursement.
We know that in the case of a cashless health insurance claim process the hospital bill is directly settled by the insurance company. However, in case of reimbursement claim, the policyholder has to make the effort to raise the claim from the insurer. So, the insured has to arrange for documents, fill application forms, do follow ups, etc.
Under the reimbursement claim process, the policyholder is required to arrange all the bills received from the hospital and other important documents on their own to raise the claim process. There might also be a Third-Party Administrator (TPA) who would assist in document submission. However, it depends on the claim settlement policy of the insurance company.
Another point to note in reimbursement claims is that each claim of reimbursement goes through great scrutiny done by the TPA or the insurer. Since, reimbursement claim is not cashless, such detailed verification becomes necessary for the insurer.
A reimbursement claim process goes through all the above-mentioned steps and procedures; hence it is more time consuming than the cashless claim. And that is the reason why one has to be very patient while applying for such claims and must cooperate with the concerned authority throughout the process.
This is the most essential part of buying a health insurance policy. To select a reliable insurer requires one to be judicious so that the person can make a better buying decision. If you are looking for a smooth process of claim settlement, you must buy the health insurance policy from a trustworthy insurer with a good CSR or Claim Settlement Ratio.
Further, if you have trouble or unsatisfactory experience of claim settlement with your insurer, you can avail the facility of portability and switch insurer at the time of policy renewal. While looking for a good insurer, always consider the CSR of the company. Also, check customer reviews online to know if the particular insurer is credible. Try to research and be educated about the insurer by visiting the official portal of the company before buying the plan.
You may also compare policies to check their price differences by using the health insurance premium calculator. The health insurance premium calculator is a simple online tool where you have to submit some data to see the premium charged for a particular health plan. This way, you can look for different combinations to seek the desired premium and to make a decisive decision.
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Below are the documents required:
Medi assist reimbursement claim form duly filled and signed
Valid identity proof
Prescriptions by doctor for treatment
Prescription by doctor for diagnostic tests, medicines etc.
Ambulance receipt etc.
These are claims in which the insured pays the hospital bills on their own first and later raises a claim for the bill from the insurance company.
In most cases, the time limit for making a claim is within 90 days from the date of discharge from the hospital. However, some claims can be counted from the date mentioned on the bill.
Get admitted to any network or non-network hospital
Inform the Oriental Insurance Company about the hospitalisation at the earliest
Download the reimbursement claim form from their website
Fill the required details to file the form
At the time of discharge, pay the hospital bills on your own
Collect all original bills, documents, and reports and keep safely
Sign the documents before sending them to the TPA together with the claim form
The TPA investigates the documents
If everything is fine, the insurer settles the claim
The payment is made in the name of the insured
Open the app of ECHS Beneficiaries
Now click on “Card Status”
Once the page opens, submit your registered mobile number and ECHS smart card application number.
You will be able to check the ECHS 64 KB card status
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