Tips to File Reimbursement Claims
Tips to file reimbursement claims

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Tips to File Reimbursement Claims

Max Bupa

02 November 2020

What is a Reimbursement Claim?


As part of any health insurance plan in India, the insurer offers the option of cashless claims or a reimbursement claim as a benefit. A cashless claim can be filed while receiving treatment at a hospital approved by the health insurance plan or Mediclaim policy in advance. On the other hand, a reimbursement claim can be filed once the treatment has been received at a hospital outside of the network of those associated with the insurance company. In this method, the hospital bills and all expenses borne from the treatment received are paid by the policyholder and then upon filing a reimbursement claim the expenses are covered by the insurer.


While choosing a Mediclaim policy, it is important to keep a few pointers in mind, which could prove to be useful:


1. The policyholder’s health:


Ensure that while choosing a Mediclaim plan, your insurer is aware of any pre-existing and current health conditions.


2. Annual renewal:


A Mediclaim policy typically needs to be renewed every year, ensure that you do this for the safety of yourself and those that fall within the policy. Some plans may also cease to exist after a certain age, which is why one must be careful in opting for special senior citizen plans if needed.


3. Premiums change with age:


The older you get, the higher the premium to pay will be as you get more susceptible to certain kinds of illnesses and injuries with age.


4. The fine print:


Always read the clauses mentioned in your Mediclaim policy to ensure that it fits the needs of you and your family.


Tips to file Reimbursement Claims


Although it may seem like a complicated task, filing a reimbursement claim for your Mediclaim policy is easy so long as you keep the following things in mind:


1. Planned Treatment:


In case the treatment has been planned in advance, ensure that the insurance company is given notice at least forty-eight hours in advance if not more. This may vary depending on the Mediclaim policy one has opted for.


2. Emergency treatment: 


In case of treatment that is required urgently due to an emergency, ensure that the health insurance company has been given notice within twenty-four hours from when the individual was hospitalised. Once again, this may vary from one Mediclaim policy to another. Ideally, notify the provider at the earliest.


3. Reimbursements:


Begin the treatment as needed after intimating the insurance company and make the required payments while ensuring all hospital bills and transactions are recorded. Collect any reports and bills from the beginning of the treatment to the end including the original notes from the initial consultation. Always keep valid ID proof on hand.


4. Required forms:


You can ask the insurance company to email the same or download it from their official portal. All the forms and documents should be attested with the patient’s signature and name along with the details of the cost of the procedure, document, and serial numbers. The form should be signed by the main policyholder as well as by the consultant for the treatment. And finally, the documents should have the hospital seal on them. After attaching a copy of your health card to the documents and policy form, they can be sent across to the insurance company as instructed.


The middle class in India is estimated to increase by a CAGR of close to 7% by 2021. The rising incomes will also lead to great exposure to risks and lifestyle diseases and a demand for quality healthcare. At the same time, medical costs are rising at twice the rate of inflation in the country. A Mediclaim policy is an inexpensive alternative to traditional health insurance plans. It is important to read the documents carefully before choosing your plan, to ensure the safety of you and your family for any possible health concerns that could arise in the future.


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