What do you need to know about claim procedure?

Having an efficient agent/broker who understands health and health insurance would be key in getting valid and correct claims documents to reach your TPA in time.

Call the TPA (Third Party Administrator) immediately you know about the hospitalisation schedule and within 24 hours of admission to hospital if it’s an emergency hospitalisation.

• Also write a mail or send a fax to the TPA or the health insurance company informing them about the hospitalization within the aforesaid time frame (this is because many health insurance companies recognize written communication only. You will also have a record of having provided the intimation.)
• The TPA or Health Insurance Company will provide you the intimation number through mail or sms but if they don’t, you must call them up and ask for the claim intimation number. This number is important for you to establish that your claim is duly intimated and is a helpful identity later in getting your claim processed and settled, so make sure you receive it.

For Documents Submission:

• Fill in the claim form provided in the company website or available with your Agent or Broker with details like your complete name, age, gender,  date of hospitalization, date of discharge, name of the hospital/nursing home, name of the medical practitioner, etc.
• Attach all the necessary claim documents (mentioned in policy wordings in the Claims Notice section) with the claim form and send it to the TPA or the Health insurance Company as mentioned in the policy within 7 days of from date of discharge, and get the same duly acknowledged with the time and date of receipt.

To read more see Health Insurance Claim Documents Submitted beyond 7 days rejected!