Documents Required To File A Health Insurance Claim

The claim settlement process of a health insurance policy is one of the crucial steps. The policyholder must be aware of the claiming process as it is the key to avail all the benefits of the purchased policy.  Without knowing the terms and conditions included within your policy, you cannot avail yourself of the benefits. Claim settlement procedure should be made clear and understandable by the insurer to its policyholders. 

There are two broad ways to make a claim: the cashless claim process and the reimbursement claim process. Cashless claims can be made only when a policyholder is admitted to a network hospital of the insurer. While reimbursement claims can be made in any condition, as the medical expenses are transferred to the policyholder’s account. 

Documents Required To Claim A Health Insurance Policy 

The claim settlement process of your health insurance policy becomes more smooth and hassle-free when proper documents are produced by you to the insurer. On successful verification of those documents, the claim for your health insurance policy is approved. Following is the list of documents that you might require while claiming your health insurance policy: 

• Filled Claim Form

You have to submit a duly signed and carefully filled claim form available online on the insurance company’s website or collected from the hospital desk. The details in the form should be correct and verified. This form is used to initiate your claim settlement process with the insurer. You can either fill it before hospitalization in case of planned treatment, else it can be submitted as soon as possible post an emergency. 

• Medical Certificate 

A proper medical certificate authorized by the hospital and issued by the doctor should be attached with your other claim settlement documents.

• Diagnosis Reports 

All your medical reports like diagnosis reports, blood test reports, etc. must be collected and attached with the policy-related documents to avail the full benefits of your purchased health insurance policy. In case of a reimbursement claim settlement process, you are required to submit these reports as valid proof of your hospitalization and treatment. 

• Valid ID Proof 

As mentioned in the policy documents, you must attach the necessary identity proofs like Aadhar card, driving license, pan card, ration card, etc. You must attach a copy of these documents. 

• Discharge Documents 

Along with the claim documents, you must submit your discharge card or related documents collected from the hospital authorities. 

• Medical Bills 

Prescriptions, receipts, or any other medical bills which cover your expenses incurred during the treatment must be collected and attached with the claim documents. 

• Copy of FIR

A copy of the FIR report must be attached with the claim documents in case of an accident. If the bodily injuries are because of an accident, you must file an FIR to claim your purchased health insurance policy. 

The Process To Claim Your Health Insurance Policy 

You can follow the below-mentioned steps to claim your health insurance policy, in case of an emergency: 

• You must inform the insurer about your hospitalization as soon as possible to give the insurer enough time for processing your request. In case of planned hospitalization, you must inform in advance. 
• After informing, you must duly sign and fill the claim settlement form and attach all the required documents with it to get the sum assured for your treatment.
• Once your documents are verified, your medical dues will be cleared by the insurer directly with the hospital. 
• However, if you seek a reimbursement claim, you must pay for the treatment, and later the amount spent will be compensated in your bank account. 

Conclusion 

You must submit all the documents carefully and make sure that the information provided within them is correct and valid. You can confirm the list of documents required from your insurer and submit them accordingly. 

Also Read: How To Register A Complaint Against Health Insurance Claim

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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.