The BuyT Desk
Health insurance is necessary to protect self and family in times of medical emergencies. It is a worthwhile investment to provide the best medical care for your family. Also, it saves you against the burden of high medical expenses. Before selecting a health insurance plan, few considerations are the insurance amount, additional riders, the premium, and credibility of the insurance company. You have heard repeatedly to read the terms and conditions carefully before buying an insurance policy. Among all the considerations, do pay attention to the claim process of the insurance.
Cashless Claim Settlement
If you wish to opt for this settlement, you can avail of medical treatment only in the hospitals, on the panel of the insurer. In such a case, before choosing your health insurance policy, ensure that the insurer has a long list of hospitals on its panel. You may avail cashless claims for a planned or unplanned hospitalization.
In the case of a planned treatment in the hospital, the insurer has to be informed a minimum of 4 days in advance. After submission of the cashless claim request form with the insurer, he will check the coverage and eligibility as per your policy. He will inform you and the hospital about this information. You have to display the health insurance card and insurer’s confirmation letter at the hospital on the day of treatment. The insurer will pay the medical dues to the hospital directly.
In the case of an unplanned treatment in the hospital, you can go to only a hospital empanelled by the insurer. You must carry the health insurance card to the hospital. The hospital will forward the cashless claim request form to the insurer. Upon receiving an Authorization letter from the insurer about your policy’s coverage and eligibility, the hospital will demand medical dues from the insurer who shall clear them. If the insurer rejects the claim, a letter is sent to the policyholder.
Reimbursement claim settlement
Under this claim settlement, you can opt for any hospital of your choice. The hospital doesn’t have to be empanelled with the insurer. After the hospitalization, you have to submit the claim request form along with the requisite documents to the insurer. The documents required (in original) are discharge summary, original hospital bills, doctor’s prescription, cash memo from pharmacy, investigation report, and medical certificate from the doctor. Upon evaluation of the claim against the policy’s coverage, the insurer pays the policyholder. However, the claim can also be rejected.
Cashless claim settlement is relatively new in comparison to reimbursement claim settlement. In cashless claim settlement, you do not pay the medical expenses upfront instead; your insurer settles the claim directly with the hospital. On the other hand, in reimbursement claim settlement, you pay for the medical treatment to the hospital and send discharge summary and other medical bills to your insurer for settlement, via post. A cashless claim is more convenient than a reimbursement claim. In cashless claim settlement, you can leave the worry of medical expenses and focus completely on your family member’s health. However, you have to pay the medical expenses from your pocket and later claim it from the insurer. In a time of distress, arranging for a huge sum of money adds to your woes.
