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Health Insurance 1458 views March 11, 2021
Health insurance claims can be made via cashless and reimbursement methods. But the first one applies to network hospitals only. In case any of the network hospitals of the insurer remains far away from your location, you will most likely go to non-network hospitals and pay for the expenses there. But with the reimbursement method, you can get back all the payment you do towards the treatment. So how is the reimbursement of health insurance processed? In reimbursement first, you need to pay the hospital bills from your pocket and get that reimbursed from the insurer. When the insurer approves your claim request, you need to fill up a reimbursement claim form and submit the same along with some documents to the company’s branch office. You can download the reimbursement claim form from the company’s official website or visit any nearby branch office and collect the same. Let’s know more about the documents required for reimbursement of health insurance in this post below.
Table of Contents
Under the reimbursement claim form, you need to fill in the following details –
The insurer requires the original hospital discharge summary because it contains the following information –
The hospital final bill contains the detailed breakup of room rent, nursing and other services expenses such as –
You need to submit all the investigation reports of the diagnostic tests of the injury or illness for which you have been admitted to the hospital. This includes – X-ray, blood tests, urine tests, ultrasound, etc.
The insured needs to submit the implant sticker/invoice in case of self-purchase of implants for – Cataract, Heart surgeries, AbdominalSurgeries, Knee replacement surgeries, etc. For this, vendor invoice and payment receipt shall also be required.
If the insured person has any pre-existing condition and has been treated for the same, they also need to submit the investigation reports for the previous treatment for reimbursement of health insurance.
MLC or FIR is mandatory for accidents, burns, suicide, poisoning and other injury cases. And if you haven’t done MLC or FIR, in such cases, the same should be given in writing by the hospital authority.
Provide your NEFT details such as bank account number, IFSC code, bank name, bank branch name to the insurer, so the insurer can reimburse health insurance claims.
Note– The insurer may ask for additional documents as well if the claim demands further investigation