Health Insurance 101 views March 13, 2021

According to news reports, India finds itself in the unwanted list of nations with most diabetes patients. Out of every six diabetes patients globally, one comes from India. To get the proper treatment for this chronic disease and considering the complications involved in it, individuals should have health insurance if they are diabetic or become so later. Health insurance companies like HDFC Ergo, Star Health and Care Health understand this need and provide some specialized plans for diabetes. But the process to claim the diabetes cover in a health insurance plan remains one of the talking points among people.

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With a health insurance plan, individuals can get coverage against a wide range of diabetes-related expenses such as diagnostic tests, in-patient treatments, organ donor expenses, doctor’s consultation fees, medical wellness programs, expenses on medicines, etc. There are three popular plans with diabetes cover – HDFC Ergo Energy Health, Star Health Diabetes Safe and Care Freedom Plan.

In this article, we are going to discuss the claim processes for diabetes cover in all these specialized health insurance plans. It will help you understand them better and make the right decision. Keep reading to know more!

How to Get Claim for Star Health Diabetes Safe Insurance Policy?

Star Health Diabetes Safe insurance plan is a specialized policy for people affected by diabetes as they can get protection against expenses incurred during their treatment. With sum insured options up to INR 10 lakh, you can choose between Plan A and Plan B according to your convenience. There is no waiting period under Plan A while there is a 12-month waiting period with Plan B. So, you can get a claim for diabetes cover right from the commencement of the policy on choosing Plan A while with Plan B, you need to wait for 12 months before getting any claim.

Coming to the process of getting the claim for diabetes cover, you can choose between Cashless and Reimbursement methods to get the claim for diabetes cover. Star Health has around 9,900 network hospitals across India where you can get cashless treatment, while you can enjoy the reimbursement facility at both network and non-network hospitals if you intimate about the claim within 24 hours of hospitalization.

Cashless Method – With the cashless method, you only need to intimate about the hospitalization via call or email. After hospitalization, the network hospital will submit the pre-admission investigation paper and doctor’s consultation paper to Star Health. After discharge, the hospital will directly settle the bill with the company. However, you may need to bear all the expenses towards non-payable items.

Reimbursement Method – With this claim method for diabetes cover in the Star Health Diabetes Safe plan, you need to pay the bills for your treatment in the hospital. Collect all the original documents related to treatment and the incurred expenses. Submit them within 15 days of getting discharged. After receiving your documents, Star Health will settle the claim as per the terms and conditions of the policy.

How to Get Claim for Care Freedom Plan?

Care Freedom Plan is another specialized option for people affected by diabetes, high blood pressure, and high body mass index (BMI). This plan also provides two options – Plan 1 and Plan 2 with the sum insured up to INR 10 lakh. Under this plan, the waiting period for pre-existing conditions stands at 2 years. So, you can get any claim related to diabetes-related expenses after 24 months from the commencement of the policy.

Care Health Insurance also provides Cashless and Reimbursement methods to claim the diabetes cover under Freedom Plan. With a claim settlement ratio of 92.30% and more than 15,500 cashless healthcare providers, you can trust this plan when it comes to getting a hassle-free claim.

For the Cashless method, you should intimate within 24 hours in case of emergency hospitalization and 48 hours in case of pre-planned hospitalization. After the hospitalization, fill the cashless pre-authorization form available at the hospital insurance/TPA desk and send it to Care Health through Fax. In case you don’t find the approval, you will need to bear the expenses from your pocket, and you may file the reimbursement claim later. With this method, you will need to submit the claim form along with the required documents as per the terms and conditions of the Freedom Plan. The company will assess them and approve your claim by reimbursing the expenses to your bank account.

How to Get Claim for HDFC Ergo Energy Health Plan?

If you want coverage against expenses incurred towards the treatment of diabetes and hypertension right from Day 1 of your policy, the HDFC Ergo Energy health plan could be the right choice. However, for other pre-existing diseases, individuals will need to wait for 24 months from the policy inception date to get any claim. With this plan, you can also choose from Silver and Gold plan options according to your convenience. Some of its top features are 182 daycare procedures coverage, HbA1C benefit up to INR 750 per policy year, personalized health coach, organ donor expenses, etc.

HDFC Ergo provides a hassle-free claim process for diabetes under the Energy Health plan. There are two methods from which you can choose – Cashless claim at more than 10,000 network hospitals and Reimbursement at non-network hospitals. You can understand more about them below.

Cashless Claim Process – In this process, you need to get hospitalized in one of the nearest network hospitals. Here, you will get cashless hospitalization by showing your health card and a valid ID. Now the network hospital will send the cashless request to the HDFC Ergo with the pre-authorization form. At the time of discharge, HDFC Ergo will settle the claim, and you will receive an update via SMS or email at every stage of the claim process on your registered mobile number or email ID.

Reimbursement Claim Process – With this process, you can get the required treatment at the nearest hospital even if it is not on the list of network hospitals. After getting discharged, you will need to submit all the soft copies of your bills and documents on the online registration module provided by HDFC Ergo. You can also send the documents along with the claim form via email. After this, HDFC Ergo will assess all the documents. You will get updates throughout the claim process. After receiving the complete documents, your claim for diabetes cover will be processed and you will get the payment via NEFT within 7 days from the time the last document is received. The maximum time can be up to 30 days in case your claim needs further verification.

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