I retired from a job with the Andhra Pradesh State government. I am entitled to government health insurance cover for myself and my spouse. Last year, due to inadequacy of government payment, I purchased a Care Health Insurance policy covering both of us. Can you explain the procedure for making a claim on the policy?
G RAGHAVA REDDY
Unlike in the past , the claim-filing process in health insurance is hassle-free these days.
If it is a planned hospitalisation, insurers require the insured to intimate them in advance (at least 48 to 72 hours before admission). In case of emergency hospitalisation, intimation should be done within 24 hours of admission. You can reach the insurance company on the toll-free number available on the company website or through email (for Care Insurance it is firstname.lastname@example.org ).
If the insured is are getting treated in a non-network hospital, you will not be able to avail of cashless service and need to to get the expenses reimbursed.
In case of a reimbursement claim, keep all your documents safe. Post- discharge, you will have to submit the documents, including doctor prescriptions, original bills and receipts, copies of all diagnostic reports and discharge papers, to the insurance company. This has to be done immediately after your discharge ; most insurers give a 15–30-day window for document submission. You also need to submit the claim form that can be downloaded from the company website; (available under the ‘claims’ section) with all the required information such as the policy number, details of the hospital and particulars of the procedure given by the hospital.
You can submit these documents online as well. Most insurers, including Care Health Insurance, have provisions for online submission. For this, first register yourself on the website with your customer ID . Insurance companies also give the option of submitting the documents directly at their office or by post. Note that after submitting all the required documents, it may take 30-40 days for claims to be settled.
If you get treated in a network hospital, you can avail of the cashless claim. On admission, you approach the insurance/TPA desk at the hospital. You will have to show your ID card (given by the insurer at the time of issuance of the policy). After the verification, you will get the ‘pre-authorisation’ form (can also be downloaded from the insurer’s website).
You fill the personal details and submit the form. Other details will be filled by the insurance desk and will be sent to the insurance company. After the form is reviewed, the insurer will provide guarantee to payment of the bill amount, subject to the sum insured.