To claim on your health insurance, a minimum of 24 hour hospitalization is mandatory.
When you receive the policy documents, please refer the policy wordings for the terms and conditions related to your plan including the process to follow in case of claims.
Every insurance company has set certain time frames to follow in case of various processes. Ensure to follow them to avoid any surprises.
Be aware what’s covered and what’s not in your health insurance plan. More than what’s covered, it’s important to pay close attention to what’s not.
Share a copy of your policy documents, health card and contact details of the insurance company/TPA with your family, friends along with the process to follow in case you are in no position to follow the procedure yourself.
Keep an eye on the waiting periods for claiming on your insurance policy.
Last but not the least, ensure you maintain a proper file with all the prescriptions, medical bills, etc. for easy availability.
Why Coverfox Should Be Your Ideal Choice?
Coverfox, being an IRDAI certified broker, is well equipped to handle all your queries and concerns regarding claiming on your health insurance policy. We can be your ultimate choice with the below services on offer:
Claim Intimation: We can intimate the claim to the insurance company on your behalf saving a lot of your valuable time and efforts.
Documents Pick-Up: We can arrange to pick up all your claim related documents from your home/office as per your convenience.
Documents Scrutiny: We have dedicated and qualified Claims Team who thoroughly scrutinize your documents for correctness or any missing information before submitting them to the insurance company/TPA. This saves a lot of your time in back and forth coordination with the insurance company/TPA. The team can also provide a rough estimation of the claim amount that you can expect to get compensated for.
Follow-Up and Status Update: We understand your anxiety when it comes to claiming on your health insurance. Therefore, we keep you posted with all the updates related to your claim assuring complete peace of mind. Similarly, we follow up with the insurance company/TPA for the timely disbursement of the claim amount.
Dispute Resolution: At last, we will be there for you at the most crucial time – when you really need us. In case you are not satisfied with the outcome of your request, we will raise the same with the insurance company and if required, also help you dealing with it through grievance cell.
Frequently Asked Questions
I have just bought a health insurance plan. Am I entitled for the cashless treatment?
Every health insurance plan entitles for the cashless treatment provided you seek it in a hospital that is within the network of the insurance company. As mentioned earlier, a minimum of 24 hours of hospitalization is mandatory to claim on your health insurance.
What if the insurance company deny my request for cashless treatment?
As per the IRDAI guidelines, no insurer can deny your valid claim. Hence, if your request for the cashless treatment is denied due to valid reasons, you can still pay towards the treatment and all related expenses through your own pocket and then raise the request for reimbursement. If your claim request is within the scope of coverage as per the policy terms and conditions, it cannot be rejected.
What are the charges/expenses that are not covered in the health insurance?
There are certain expenses that are not covered in any health insurance plan such as administrative charge, services charge, expenses related to laundry, extra bed, toiletries, diapers, syringes, telephone charges, etc. For detailed information on what’s not covered by your insurance company, please refer the policy wordings.
Is there any waiting period to claim on my health insurance?
Typically, every health insurance policy is bundled with three types of waiting periods.
The initial waiting period: This specifies to an initial 30 days of waiting period where you cannot raise a claim on your health policy except in case of an accident.
Ailment specific waiting period: There are certain ailments that are covered by the health policy only after a certain waiting period such as two years. This list varies as per insurance company and is mentioned in the policy wordings.
Pre-existing Disease waiting period: Most insurance companies cover the pre-existing diseases after a waiting period of 3-4 years. Hence, if you have specified any illness as pre-existing during the time of policy purchase, the same will be covered only after the waiting period mentioned in your policy.