Steps to Fill Health Insurance Claim Form | Filling Health Insurance Claim Form


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Updated on Aug 25, 2023

The health insurance policies come with numerous features and advantages that policyholders can receive as part of the health plan. These features can be availed by the insurance policyholder at the time of claim settlement. However, most of the health plans are available with a waiting period within which no claim can be made.  A policyholder can make claims in two ways – through cashless claims or through reimbursement claims.

For both the claims, there is a procedure that needs to be followed. For that the insured can get the medi assist claim form first and other documents required with it, which he/she needs to submit to the insurer. Once the verification is done properly, the health insurer approves the claim and the insured gets the amount.

In this blog, we are looking at the various details and steps that need to be followed to fill a health insurance claim form.

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How To Fill a Health Insurance Claim Form?

To start with, get a hard copy of the mediassist claim form that needs to be filled and submitted for filing your health insurance claim. The form is generally available at the hospital desk of the network hospital. Further, it is also available at the website of the insurer and you can get a print out of the same.

The next step is to fill the form accurately with the required details. Once done, you can submit the form after signing it duly together with the documents mentioned in the form.

Here are some basic details required for the insured to know prior to filing your claim form:

  • You must know the member number or the insurance group number prior to filling the form.
  • You must also know the name of the insured individual, the one who holds the policy.
  • Also, you should know coinsurance available under the plan.
  • You should also know the treatment that the insured has undergone or the reason for the hospital visit like accident, illness etc

Steps To Follow to Fill Health Insurance Claim Form

Below are the quick steps that you need to follow to fill the mediassist claim form of your health insurance:

1. Procure relevant documents:

For cashless claims the details of the treatment documents that need to be attached are ID proof of insured, copy of FIR (in case of accident) and so on. On the other hand, in case of reimbursement claims, the papers that need to be attached along with the claim form are receipt of bills received from the hospital, the medical consultation documents, medicine bills, and so on.
Thus, it is important to keep the required documents in place so that you can submit the documents as per requirement of your policy.

2. Fill the Claim Form Properly:

Once you have a hard copy of the claim form, start filling important details like your name, policy number, and so on. You can get the hard copy of the claim form from the portal of the insurer or from the hospital helpdesk. The insured must fill the claim form Part A on their own, whereas the claim form Part B is filled by the hospital.

3. Take Copies:

Once you procure all the required documents and the claim form that is duly signed, you are required to have copies of all the necessary documents so that you can use them to re-file your claim if you lose any document.

4. Review And Send the Documents:

Finally, you need to cross check all the documents to check if you have entered the details correctly. Now, you need to send the papers to your insurer and wait for them to get verified and processed. Once these processes are done, you can get approval of the claim amount from the insurer.

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Different Types of Health Insurance Claim Settlement Procedures

There are two key types of procedure to settle claims of health insurance policies. They are;

1. Process of Cashless Claim Settlement 

Cashless claim process is used to make a claim when the treatment is done at a network hospital via cashless mode.  Insurance companies provide cashless treatment facilities in their network hospitals. The insurers tie up with different hospitals to provide this facility to the insurance policy holder. An insured person can avail this facility by getting admitted in a network hospital and by showing the ID proof of the policyholder. This ID proof is provided by the insurer and the insured should show it at the insurance helpdesk of the hospital to initiate the cashless treatment claim.

2. Process of Reimbursement Claim Settlement 

Under the reimbursement claim settlement policy, the insured can receive treatment at any hospital of their choice. Here, once the treatment is done and the policyholder is discharged from the hospital, he/she is required to pay all the hospital bills for the treatment. Later, the insured can file for the reimbursement claim by submitting the discharge papers to the insurer. The insurer compensates the amount as per the policy terms and conditions and it reaches the bank account of the insured.

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It is very important to fill the IRDA claim form for claim settlement with great care. You must provide precise details in the form because if there is any issue in the form or if the data doesn’t match, the insurer might nullify the form and reject the claim. So, be very careful to provide accurate details so that there is no chance of facing rejection on the claim you made. You may check the claim form Part A filled sample to get better guidance.

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FAQs: Health Insurance Claim Form

What is the time limit for filing a health insurance claim?

This often needs to be completed within 90 days, starting from the date of hospital discharge. However, in some circumstances, claims may begin to accrue as of the date shown on the bill.

What is the purpose of claim form in insurance?

An ordinary printed form used to submit claims is called a claim form. Normally, payment will happen ten days after the claim form and all necessary paperwork have been received and approved.

Can I claim from 2 health insurance policies?

Yes, you are allowed under the IRDAI to submit claims for the same medical emergency or treatment to two different insurance providers. However, if you want to do so, you must inform the insurance providers of any current health insurance plans you may already have from other providers.

What is the limit on a claim?

It is the highest amount of claims your insurer will settle during the course of your policy period, which is often a year. The amount paid out for each claim you submit while your policy is in force is capped by per claim restrictions.

What happens if you file too many claims?

The insurance provider decides not to renew the coverage after receiving repeated insurance claims. Your rate will probably increase even if you switch to a new motor insurer because your new insurer might see you as a larger risk for an accident.

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Apr 19, 2022
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PayBima is an Indian insurance aggregator on a mission to make insurance simple for people. PayBima is the Digital arm of the already established and trusted Mahindra Insurance Brokers Ltd., a reputed name in the insurance broking industry with 17 years of experience. PayBima promises you the easy-to-access online platform to buy insurance policies, and also extend their unrelented assistance with all your policy related queries and services.

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