What To Do When You Need to File a Mediclaim Policy Claim
Making a claim is as important as buying the policy. Properly following the claim process ensures that you receive the necessary support and desired results. However, the procedure might seem confusing at first. But don’t worry!
This article will guide you through the mediclaim policy claim procedureand help you get a truly satisfactory experience from your claim.
What is a Mediclaim?
A mediclaim plan is a health insurance policy that covers medical expenses incurred by an individual during a specified period. It provides financial protection by reimbursing such expenses. The insurance company can also directly pay for medical treatments, hospitalisation, surgeries, and other related costs.
How Does Mediclaim Work?
Mediclaim policies operate on the principle of risk-sharing. When you purchase a mediclaim plan, you transfer the financial risk of medical expenses to the insurance company.
In case of hospitalisation or any other medical treatment, you can file a claim to request reimbursement or direct payment by the insurance provider. The policy terms and conditions define the coverage limits, eligible medical expenses, waiting periods, and other essential details.
What are the Necessary Documents to File a Claim?
When filing a mediclaim claim, you must provide specific documents to support your claim. The exact requirements may vary depending on the insurance company and the nature of the claim.
However, here are some standard documents you will likely need:
1. Claim Form
Each insurance company provides a claim form. You must accurately complete it with all the required information.
2. Medical Records
These include medical certificates, prescriptions, bills, discharge summaries, diagnostic reports, and other relevant documents validating your medical treatment.
3. ID Proof
You need to submit a copy of your identification documents. It can be your passport, driver’s licence, etc.
4. Policy Documents
Your mediclaim plan documents contain essential information about your coverage and terms. You should always keep them handy and use them as proof wherever required.
5. Any Additional Documents
Other documents may be required depending on the nature of your claim. These could include police reports (in case of accidents), death certificates (for a claim related to the demise of the insured), or any other documents specific to your claim.
What is the Process to File a Claim?
Filing a mediclaim claim involves the following steps:
Step 1: Inform the Insurance Company
Contact your insurance provider immediately to notify them about the hospitalisation or treatment.
Step 2: Complete the Claim Form
Fill out the claim form accurately and provide all necessary details, such as policy number, patient details, treating doctor’s information, and details of the hospital or medical facility.
Step 3: Attach Supporting Documents
Collect all the required documents mentioned earlier and attach them to the claim form.
Step 4: Submit the claim
Send the completed claim form and supporting documents to the designated address specified by your insurance company.
Step 5: Follow-up
Keep track of your claim’s progress and respond promptly to any requests for additional information from the insurance company.
Step 6: Claim Settlement
Once your claim is processed and approved, the insurance company will either reimburse you for the medical expenses or directly settle the bill with the hospital.
What are the Things to Keep in Mind While Filing a Mediclaim?
When filing a mediclaim claim, consider the following:
1. Timely Notification
Inform the insurance company about the claim as soon as possible to avoid any delays or complications.
2. Accurate Information
Fill out the claim form with accurate and detailed information to prevent misunderstandings or rejections.
3. Complete Documentation
Ensure you have all the necessary documents ready and provide them in a timely manner.
4. Adhere to Timelines
Be aware of the claim filing deadlines specified in your policy and submit your claim within the stipulated time frame.
5. Review Policy Terms
Familiarise yourself with the mediclaim policy claim rules. You can do this by reading the terms and conditions thoroughly. It will help you understand your coverage limits, waiting periods, and exclusions.
Conclusion
Filing a mediclaim claim can be a smooth and hassle-free process if you follow the necessary steps and provide the required documents accurately. It is also necessary to look at the claim ratio of mediclaim policy before purchasing one.
The higher the ratio, the better the policy is. Niva Bupa, the best health insurance company, has a claim settlement ratio of 96%, and it settles 99.99% of its claims within 3 months. So, make an informed decision and choose Niva Bupa’s mediclaim plan for you and your family.
