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Documents Required to file Health Insurance Claim

When the time comes to use your insurance, it is best that you know all about the process and required documents for filing a claim beforehand. An injury or any medical emergency can leave you in a state of panic, and the last thing you want is to get your health insurance claim rejected. But if you already know all about it, you can have a seamless experience while filing a health insurance claim.

What is a health insurance claim?

A health insurance claim is the request the policyholder makes to their respective insurer asking them to provide them with the financial services that are covered in their health insurance policy. The process of filing a claim is simple, but where you may find difficulty is accumulating all the health insurance claim documents and putting them together.

To help you get through this process quickly, here’s a checklist of all the documents you need to file a health insurance claim.

1. Claim form

As soon as you need to file a claim, you have to fill out the claim form, which is nowadays easily available on the website of almost every insurance company.

2. Medical certificate

A medical certificate is needed to file a claim. It is a statement issued by an authorised doctor or hospital that describes the status of your health.

3. Diagnosis report

A diagnostic report can include blood tests, urine tests, x-rays, sonography, etc. of the patient. This has to be included in your set of documents to file a claim.

4. ID proof

Any valid identification of the patient is required. It can be a pan card, an Aadhar card, a driving license, or a passport. You can check this beforehand with your insurer or stay prepared with all the options to avoid any hassle.

5. Discharge Card

A discharge card for the patient needs to be attached with the other documents. It gives information about the patient, the cause of their hospitalization, and proof of their release.

6. Prescriptions and bills

Stack all the prescriptions and bills that were issued throughout the medical process together. It would be better if you arranged them in date order.

7. FIR

In the event of an accident, it is mandatory that you file an FIR first and then abide by the process of law. Make sure to submit a copy of it to your insurer as well.

There are two ways for you to file a claim

• Cashless claim

Under a cashless medical claim, you do not have to pay for the treatment upfront because your insurer takes care of it for you. But to get the benefits of a cashless claim, you have to get your treatment done at one of the network hospitals listed with the insurance company.

A cashless claim can be filed for both planned and unplanned treatment. In the case of the former, the time limit to file a claim is 4 days, and if you require unplanned treatment like hospitalisation in the event of any severe accident, you need to file the claim within 24 hours.

When you file a cashless claim, your insurer sends an authorization letter to the hospital after checking your eligibility and coverage.

• Reimbursement claim

If you file a reimbursement claim, you will have to make the payment upfront and then file the claim with your insurance company. This is applicable when the policy holder is treated in a non-network hospital. When you file the claim, make sure to submit all the above mentioned documents to your insurer. You have to file a claim within 7 to 15 days of your discharge.

Depending on the type of claim you raise, the health insurance claim documents may differ. But you can always check that with your insurance company at the time of buying the policy. Make sure to always keep your original documents safe and make more than one copy of each.

If you do not file the claim within the given deadline the insurer can reject your claim on technical grounds. Hence, know the time limit beforehand so you can enjoy the benefits offered by your insurer.

To safeguard yourself and your family from any future medical emergency choose a health insurance plan with Kotak General Insurance and fulfil all your insurance needs.

Related Blogs
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What Is A Health Insurance Claim Settlement Ratio
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Why Claim Ratio is Important When Buying Health Insurance

Disclaimer: The content provided is for education and informational purpose only, none of the information contained in our blog amounts to any form of opinion or advice. Please go through policy related documents carefully or consult an expert before making any insurance-related decisions.


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