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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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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Room Rent Limit – Why and how it is important

The limit imposed on the coverage of boarding expenses or room rent, along with nursing fees of the hospital is called room rent limit in health insurance.

The limit imposed on the coverage of boarding expenses or room rent, along with nursing fees of the hospital is called room rent limit in health insurance. The limit is expressed as an absolute amount or as a percentage of Sum Insured or by the category of room. For instance,

  • If the allowed room rent limit in your health plan is ₹5,000, your plan would cover your boarding expenses up to ₹5,000.
  • If the limit is expressed as 2% of the Sum Insured and the chosen Sum Insured is ₹5 Lakhs, your plan would cover your boarding expenses up to ₹10,000.
  • If the limit is expressed by the category of room as Single Private room, then your highest eligible category is Single Private Room.

Suppose you choose a room rent that exceeds the limit, then all the other charges related to the treatment will be settled by the Insurance company on the same proportion. For example, if your room rent limit is 3000 and you opt for a room rent of 4000, then if your overall claim is 1,00,000, the insurance company will pay only 75,000 considering the ratio in with the room rent limit was exceeded. This is called the proportionate deduction under the terms and conditions of the policy.

No Claim Bonus (NCB)

No Claim Bonus (NCB) is the benefit accrued to an insured for not making any claims during the previous policy period.

No Claim Bonus (NCB) is the benefit accrued to an insured for not making any claims during the previous policy period.  As per current norms in India, the discount ranges from 20% on the Own Damage premium (and not on Liability premium) and progressively increases Year on Year of no claim to a maximum of 50%.

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