Today, having a family health insurance policy has become a need of the hour. The right insurance acts as a safety net in time of need and provides one with peace of mind. But buying the right healthcare insurance cannot help one avail of its benefits. One must have an idea of how to file a claim to avail of these benefits.
Having a clear idea of the filing process will come in handy in the time of need. Thus, this article will provide in-depth knowledge of the claim filing process. So let’s get started.
What is Claim Settlement Process?
The method insurance firms use to evaluate and handle insurance claims submitted by policyholders is the claim settlement process. Depending on the type of claim, it requires confirming the claim’s legitimacy, assessing the policy coverage, and then paying the claim amount to the insured or the healthcare provider.
What are the Kinds of Claim Settlement?
The best family health insurance plan in India offers two types of claim settlement. They are as follows:
1. Cashless Claim Settlement
In this claim settlement process, the insured person can receive medical care at network hospitals without paying upfront. The insurer pays the hospital directly for the qualifying medical costs. In this process, it is important that the insured person informs the insurer two days before if it is planned and if it is an emergency, then the insurer should be notified within 24 hours.
2. Reimbursement Claim Settlement
For hospital services outside of a network, the insured pays the associated medical expenses before submitting them to the insurer for reimbursement. According to the policy’s provisions, the insurer examines the invoices and reimburses the applicable amount. In this type of settlement, the insured does not need to consult a hospital connected with the insurer. The insured may visit any hospital and claim reimbursement after paying the bills.
What are the Necessary Documents to File a Claim?
The best family health insurance plan in India usually requires the following documents to be submitted by the insured:
- Claim form containing accurate information.
- Original prescriptions, receipts, and medical bills.
- Medical reports and the discharge summary.
- KYC records for the policyholder and the members who are insured.
- If it is a case of death, the post-mortem reports.
- A copy of the FIR, if filed.
- Valid ID proof
- Original consultation notes by the doctor.
- Reports of the tests conducted.
- Reports and bills of the surgeon.
How to File a Family Floater Healthcare Insurance Claim?
The best family health insurance plans in India offer two different kinds of claim settlement. They are:
Cashless Claim Settlement
Step 1: Notify the Company
Notify the insurance company when a medical emergency occurs. This has to be done immediately so that no details can be fabricated.
Step 2: Getting Treatment
In cashless claim settlement, the insured does not need to deposit anything beforehand; hence, the insured gets the required treatment, and the bill is generated afterwards for all the expenses.
Step 3: Pre-Authorisation
The hospital is required to send the insurer a pre-authorisation request. The hospital does it to get confirmation from the insurer about the payments and the bill.
Step 4: Payment
The insured is not supposed to make any kind of payment to the hospital. The bills are directly sent to the insurer, and it is their responsibility to pay for them.
Reimbursement Claim Settlement
Step 1: Fill the Form
After getting the treatment and paying the bills, the insured has to fill out the form for reimbursement.
Step 2: Submission of the form
The form, along with the supporting documents, is then submitted to the insurer. The insurer will then check if the documents attached are complete or not. They may also ask for more documents if needed.
Step 3: Investigation
Following the submission of the claim, the insurer checks the paperwork, validates the claim, and may contact the hospital.
Step 4: Reimbursement
After investigation, either the form is accepted or rejected. When it is accepted, the insurer calculates the amount that needs to be reimbursed and the amount is transferred to the insured’s bank account.
Conclusion
The best family health insurance plan in India acts as a safeguard, ensuring that the policyholder and their family’s health remains a top concern without putting pressure on the finances. Family health insurance plans India provide a significant solution for dependable healthcare coverage by providing comprehensive coverage, cost-effectiveness, and the convenience of a single policy for the entire family.
If one is interested in getting a family health insurance plan in India, then consider Niva Bupa the best health insurance company. It is one of the leading companies with a good claim settlement ratio. They offer prompt customer support and a swift claim settlement process.
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