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Health Insurance

Hospitalisation and treatment for you and your family, cashless at network hospitals and by reimbursement elsewhere.

Also calledMediclaim · Family Floater · Individual Health Policy

File/Claims library/Health, life and accident/Illness, hospital and life

First thing, todayFor a planned admission, get pre-authorisation before you go in. For an emergency, tell the insurer within the time the policy sets.

Three deadlines
  • Tell the insurer now, not after the assessment.
  • Pre-authorisation, or intimation before a planned admission, and within the hours the policy allows after an emergency one.
  • Every document within the time the insurer asks for it.
An itemised hospital bill, an authorisation form and a health card
An itemised hospital bill, an authorisation form and a health card. An illustration.

When you would claim

  • Hospitalisation for illness or injury
  • Day-care treatment on the policy's list
  • Pre-hospitalisation and post-hospitalisation expenses
  • Treatment at a hospital outside the network
  • A claim under a top-up or super top-up above the base policy

What insurers most often rely on

  • A waiting period still running for that condition or that treatment
  • Non-disclosure of something that existed before the policy began
  • Room rent above the limit, which proportions the whole bill and not only the room
  • Non-payable items such as consumables and administrative charges
  • Late intimation of an emergency admission

Most are answered by the treating doctor in a paragraph, once somebody asks for the right paragraph.

The documents

ask the hospital on the day

9 items. A hospital will hand you most of them on the day if you ask at the desk, and take three weeks over them if you ask in a month. Ask on the day.

  • Claim form signed by the policyholder and by the hospital
  • Discharge summary with the diagnosis and the line of treatment
  • The itemised hospital bill, with the payment receipts
  • Investigation reports, prescriptions and pharmacy bills
  • The pre-authorisation, where it was cashless
  • Identity proof and the policy card
  • Cancelled cheque and bank details in the insured's name, for the NEFT payment
  • Details of any other insurance covering the same treatment
  • The amount claimed after whatever the hospital has already deducted, with the reason given for each deduction
Admission to dischargeThree dates and the gap between them is most of what a health insurer queries. Note the hour of the emergency admission too: several wordings count in hours, not days.

Next

What the first day looks like

There is no playbook for this and there will not be one, because the first day is short. Tell the insurer or the TPA inside the hours the policy allows, keep every original the hospital gives you, and do not let a discharge happen before the pre-authorisation query has been answered in writing.

Call 92514 56334

Read the sub-limits

The sum insured is rarely what decides a health claim. The room-rent cap is, because exceeding it proportions the whole bill and not only the room; and after that the disease-wise sub-limits, the co-pay and the list of non-payables do the rest.

Filed under: Health, life and accident · Illness, hospital and life

Claims that sit next to this one

the same person, a different trigger

Critical Illness

a lump sum instead of a hospital bill

Group Health

the cover an employer buys

Personal Accident

injury rather than illness

Hospital bill cut, or a policy nobody will explain to you? Report a loss or call 92514 56334.