Health Insurance Making a Claim

When you need to make a claim, we're there for you

-> When to File a Health Insurance Claim Form

A health insurance claim is when you request reimbursement or direct payment for medical services obtained. The way to obtain benefits or payment is by submitting a health insurance claim via a form or request.

-> What will the insurance company pay in case of a claim

Once your claim is accepted, an insurance company will pay for all medical expenses related to the claim, as long as you have not exhausted the sum assured of the policy for the year. If your policy has co-pay or a deductible, you will need to pay that part. You may also need to pay some portion of the claim if your plan has limits, like a room rent limit.

Rest assured, on Acme Insurance you can clearly see how much your out of pocket will be for a claim, for each and every plan.

-> What Are the Options to File a Health Insurance Claim

There are two ways that you can file a health insurance claim.

  1. The first way and the most convenient is when your medical services provider can submit the claim directly to the insurance company through the network directly electronically.
  2. The other way is by filling in the health insurance claim form and sending in the paperwork yourself. If your health service provider is not in the network for your health insurance company and can not file the claim on your behalf, then you will have to file a health insurance claim form to request payment for the medical services obtained.

-> How to make a claim on cashless basis

For a claim on cashless basis, your treatment must be only at a network hospital of the Third Party Administrator (TPA) who is servicing your policy. You have to seek authorisation for availing the treatment on a cashless basis as per procedures laid down and in the prescribed form. Please read the policy document as soon as you receive it to familiarise yourself with the process rather than wait for a claim to arise.

-> How to make a claim for reimbursement basis

Read the clause relating to claims in your policy document as soon as you receive it to ensure that you understand the procedure and the documents required for making a claim on the reimbursement basis. When a claim arises you should inform the insurance company as per procedures required. After hospitalization, you have to ensure that you obtain and keep ready documents such as claim form, discharge summary, prescriptions and bills that you should submit a claim.

-> Why can my claim get rejected

Your claim may be rejected if,

    • you are claiming for something that is not covered by the plan, OR
    • you are claiming for a disease existing prior to your enrolment in the plan, which you did not disclose to the insurer.

Speak to our expert advisors to understand cover restrictions & disclosures.