Be Aware of how to approach your health insurance claims

It is important for you to get a fundamental understanding of how to approach claims process in order that you don’t get stuck during claims process

Most probably, you can get stuck in health insurance claims process when you or your loved ones are hospitalised due to illnesses.

Our intent here is to give an account of high-level requirements during the process of health insurance claims for your benefit, in order that you get the fundamental understanding of how to approach the claims process.

Cashless Claims

There are three major follow ups in cashless claims,

  1. Choose a Network Hospital – Cashless claims are possible only in hospitals that are in the Network list of your health Insurer
  2. Approach the hospital’s Insurance Desk – All hospitals have an Insurance Processing Desk
  3. Discharge Procedure at the Hospital – Coordinate for early completion of discharge formalities.

Choose a Network Hospital

Find out your best choice of hospital, which falls in the network list of your health insurance company. Normally, people seek the recommendation of the physician who diagnosed them of the ailment and referred to a hospital where the physician may know the specialist.

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Why you should take the time while buying insurance..

..a fair comparison of premium vs coverage/benefits is important before you decide to buy.

You have to understand how insurance is fundamentally designed to serve you before you buy. You will also know why and how a fair comparison of premium vs coverage/benefits is important before you decide to buy.

The structure of insurance as a contract lies on three strong pillars,

  1. A Promise – The Insurer promises to cover your losses due to unforeseen events as specified in the Insurance policy. For example, covering cost of hospitalisation due to specified illnesses in a health insurance policy or covering the cost of accidental repair in your car insurance policy.
  2. Unforeseen Events – The promise holds good only for those events or group of events, which are specified/named in the insurance policy. It is normally called as a set of benefits or coverage clearly spelt out in the insurance policy.
  3. Terms and Conditions – And the Promise will be honored subject to a list of terms and conditions mentioned in the insurance policy. The standard terms, conditions and exclusions (those which are not covered) will be detailed in the ‘Policy Wording’.
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What if a network hospital denies ‘cashless’ treatment facility..

The insurance broker plays the expert coordinator to resolve it.

There are many instances hospitals will deny ‘cashless facility’ even though the insurance company has a tie-up with them. While there can be various reasons behind the denial of cashless facility, a customer who is at the door step of healthcare and insurance service providers should not be put to difficulty.

In such a situation, what is the best choice for the customer?

In these distress situations, the best choice for him/her is to depend on an expert coordinator who will support them from their side, ie., their insurance broker. The customer should, at this stage and always during claims, should rely on the claim support services of a responsible and committed insurance broker.

Whatever may be the reason for the hospital to deny ‘cashless’, even with tie-up in place, the insurance broker coordinates as the customers’ representative between the TPA/Insurer and the hospital for the resolution specific to the customer’s request of ‘cashless’ treatment.

What happens when you exceed the room rent limit of your health insurance?

If the room rent limit is not sufficient in your health insurance policy, it will cost you more on claims in the form of proportionate deduction..

Room rent limit is a very important factor while choosing your health insurance policy. A lot about this factor has been written widely by a lot of people. So, we are writing down the gist of important things a customer should consider about room rent limit while purchasing a health insurance policy.

Room Rent usually includes the rent, nursing charges and the fees related to the Resident Medical Officer (RMO).

Room Rent limits are imposed in three different ways,

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10 reasons why you will need an expert on your side for Insurance

Insurance Brokers are experts on the side of the customer, advising while buying insurance and assisting for faster settlement of claims.

Insurance Brokers across the globe are called Independent Intermediaries, meaning, they do not represent any specific Insurance company like Insurance Agents, but they represent the policyholder or the customer.

In other words, Insurance Brokers are experts on the side of the customer, advising the customer while buying insurance and assisting for faster settlement of claims.

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COVID Insurance – Is it good to have one?

Considering certain facts will prompt us buying it as an additional cover.

COVID Insurance is a low cost niche cover introduced by few insurers specific to corona virus infection. It is a fixed benefit policy, where a lump sum amount is paid if you are diagnosed positive to COVID.

Fixed Benefit: The benefit amount varies from Rs.21,000 to Rs.2,00,000 based on the respective insurers’ plans.

Other Benefits*: Each insurer extends additional benefits unique to each other.  Following are the types of additional benefits:

  • Daily Cash for 10 days. Double for ICU
  • You can choose to add your family members
  • Covers job loss during the quarantine period of 15 days
  • Health assistance and ambulance aid
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Exclusions and Waiting Period in Health Insurance

While buying health insurance policy for the first time, all the insurers exclude coverage of certain diseases for a specified period of time from the date of inception of the policy.

It is imperative for any insurance buyer to know the details of coverage extended by various insurers before buying.

Two of the most important terms of health insurance are Exclusions and Waiting periods.

While buying health insurance policy for the first time, all the insurers exclude coverage of certain diseases for a specified period of time from the date of inception of the policy. Those are called exclusions and the period of exclusion of coverage is called waiting period.

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