What is the Time Limit for Filing a Health Insurance Claim?

Health Insurance helps people get financial protection in case a medical crisis happens. Considering the rising cost of treatment these days, it is necessary to have health insurance to prevent your savings from getting exhausted. Health insurance companies provide coverage for different expenses related to your treatment if you raise a claim (cashless or reimbursement) within a definite time frame. Time limit is one of the crucial aspects that people should keep in mind when raising a claim for their health insurance plan.

Imagine a situation where you do everything right to protect your finances in a medical emergency (comparing different plans, choosing the suitable one, paying the premium amount, etc.) but miss the last necessary step of filing the claim within a time limit. This could lead to the rejection of your claim. So, it is necessary to know the same while filing a health insurance claim.

On this page, we will discuss the time limit for filing a successful health insurance claim so that you can get the treatment without any worry about rejection. Let’s start!

Why Do Health Insurance Companies Fix a Time Limit for Filing Health Insurance Claims?

Health insurance companies follow a strict time limit regarding health insurance claims due to some making fraudulent claim requests. Through a time limit, insurers try to mitigate the fraud claims as such people will find it hard to mislead or falsify the claim-related information. Apart from this, a definite time limit helps companies synchronize the claim process, allowing policyholders to get their claim amount faster.

Let’s now understand the time limit for different types of claim processes.

Time Limit for Filing a Cashless Claim in Case of a Planned Hospitalization

Policyholders don’t need to pay any bills if they get treatment at a network hospital of the respective health insurance company. The insurer will settle the bill directly with the network hospital. In case of planned treatment, you must intimate/inform your insurer at least 2 to 4 days before the scheduled hospitalization. Within this duration, the network hospital will send the pre-authorization form to the insurer to smoothen the overall cashless claim process.

Note: Do remember that the time limit for filing a claim in case of a planned hospitalization may vary from one insurer to another.

Time Limit for Filing a Cashless Claim in case of an Emergency Hospitalization

Medical emergencies can come without any prior warning. In case you need emergency hospitalization, it wouldn’t be possible to inform your insurer 3 or 4 days before the hospitalization. So, the time limit for filing a cashless claim in an emergency hospitalization is fixed within 24 hours of getting hospitalized in a network hospital. The insurer may reject your claim if you fail to inform about the hospitalization within this time limit in case of emergency hospitalization.

Time Limit for Filing a Reimbursement Claim

In case your cashless claim gets rejected at the network hospital, or you are getting treatment in a non-network hospital, you can file a reimbursement claim after getting discharged. With this method, you will need to pay the bills by yourself, and the insurer will reimburse the overall claim amount according to the terms and conditions of your health insurance plan.

You should file a reimbursement claim within 7 to 15 days after getting discharged from the hospital. To file a successful reimbursement claim, you will need to submit the following documents along with a duly filled claim form.

1. Final Hospital bill and payment receipts
2. The breakup of the hospital bill
3. Original Discharge summary
4. Operation theatre notes (if any)
5. Indoor case papers
6. Investigative reports (X-ray, Blood reports, etc.)
7. Certificate from treating medical practitioner
8. Ambulance receipts
9. Medical reports and prescriptions
10. Medicine bills
11. First Information Report (FIR) and Medico-legal certificate in case of an accident
12. NEFT details for payment

Time Limit for Filing a Health Insurance Claim in case of Post-Hospitalization Claim

Health insurance companies also provide coverage against the post-hospitalization expenses on your treatment. The time limit for filing your post-hospitalization claim stands within 15 days after completion of 60 or 90 days (depending on your health insurance policy) from the date of discharge from a network or non-network hospital.

The Bottomline

You can see the importance of filing your health insurance claim within a stipulated time limit. Now you only need to remember the time limits for filing different health insurance claims to get the claim amount.