Published On : Fri, Feb 19th, 2021

Health Insurance Claims Process & List of Documents Required


With the growing importance of healthcare, it has become necessary to have a facility to take care of unexpected medical needs. Health insurance is the perfect safety net that everyone should consider in their financial plan.


Given the varied choices you have, you can select a suitable medical insurance policy. But it doesn’t end there. Once you make a choice of your insurance plan, you must be informed of the process to raise a claim. This article lists down the process of how to make a medical insurance claim and the documents you need.


What is the process to make a health insurance claim?

Health insurance claims are broadly categorised into cashless and reimbursement mode. Cashless health insurance, as the name suggests, is where you are not required to pay upfront for the treatments costs. The only requirement to make a cashless claim is that the treatment needs to be sought at a network hospital. This cashless treatment can either be planned or a sudden medical exigency.


For a planned treatment, inform the insurance company in advance about the treatment. You also need to provide a letter from your medical professional. This will get you a pre-authorization from your insurer which should be submitted to the network hospital at the time of treatment. For an emergency hospitalisation, you need to provide your health insurance identity card at the network hospital. Once you fill out the necessary forms, the insurance company shall provide the authorisation to the hospital after verification of eligibility and policy coverage.


Reimbursement claims are processed differently than a cashless one. All types of health insurance claims can be made in this manner. You need to provide proof of evidence of the treatment. The insurer will analyse the eligibility of your expenditure under the policy and make the payment. In case of rejection, the insurer will provide a reason for rejection in its explanatory letter.


What are the documents that are required at the time of raising an insurance claim?

Application form: The first and foremost document is the application form for your insurance claim. This form must be completely filled and should indicate all the necessary details.


Medical certificate: Next, you need to furnish a medical certificate issued by the doctor as well as the hospital where treatment is sought.


Diagnosis report: Along with these documents, a diagnosis report is required that indicates the health issue for which treatment was sought.


Identity proof: The patient’s identity proof is required to confirm whether he/she is a beneficiary of the insurance policy.


Discharge card: Discharge card is another document that is required to be submitted along with the above-mentioned documents.


Medical bills: Insurers also demand you to submit medical bills. This makes paying claims a hassle-free process since the validity of the expenditure can be evaluated before making the payment.


These are handy documents that will help you avail a smooth insurance claim pay-out. As complicated it might seem, it isn’t when you have the right set of documents and you follow the claim process thoroughly. Although you may not make claims that often, it is best to stay aware of it if you are required to file one.