4 Things to Remember For a Smooth Claim Process

We all are aware of how important a smooth claim settlement process is, in health insurance. And to ensure a smooth process you must be aware of the terms and conditions under your policy. This keeps you informed, thereby making the most of your health insurance policy. To understand these terms and conditions in detail, that might help you enjoy a hassle-free claim process, read below: 

1. Hospitalisation of at Least 24 Hours is Required

To avoid any discrepancy at the time of claim, you must know that health insurance plans cover you for medical expenses if the hospitalisation is for at least 24 hours. So, if you go to a doctor for a tetanus shot, then the health insurance company will not reimburse you for the same. However, there are several health insurance companies that cover you for daycare procedures that do not require hospitalisation for at least 24 hours. Some daycare procedures include balloon sinuplasty, radiotherapy, chemotherapy, etc.  

Must Read: How To Check Health Insurance Claim Status?

2. Limits on Specific Procedures

Some health insurance plans come with limits on certain procedures such as maximum rent for the room that you can avail treatment in, etc. One may think that they can avail treatment in a room of higher room rent and pay the difference at the hospital. But you should always contact your insurance company before doing that as the insurer may treat room upgradation as a partially payable claim. So, it is not recommended to alter policy terms and conditions. 
 

3. Waiting Periods for Specific Diseases

Health insurance claims are not admissible during the waiting period. So, you must be aware of the waiting periods under your policy including the initial waiting period, waiting period for pre-existing illnesses, and waiting period for specific illnesses. To know these waiting periods, you can refer to your health insurance policy document.  

One of the reasons that people face issue at the time of claim settlement is because they do not state pre-existing conditions at the time of policy purchase. This mainly happens when the customers allow agents to fill proposal forms on their behalf, or when they do not take the application process seriously. 

4. Co-Payments And Exclusions 

The next thing that you should consider is limiting conditions such as co-payments, exclusions, etc. Co-payment is when the insurance company and insured pay expenses partially towards a claim. To avoid any issue at the time of claim settlement, you must go through the policy document to check if there is any co-payment clause in it. Similarly, you must be aware of the expenses that your policy does not cover. 

Takeaway

You should not worry about claim rejection if you are well informed about the claim settlement process as well as inclusions and exclusions under your health insurance policy. Also, keeping yourself informed by reading the policy document thoroughly helps you fight any unjust call made by the claim settlement team. 

Also Read: How To Make A Cashless Health Insurance Claim?

Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.