Individual Health Insurance Claim Process

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If an individual wants to purchase an Individual Health Insurance Plan, then they must also know about its claim process from the beginning. The family members could carry on the claim process in case the insured is unwell. For the claim process of Health Insurance Plans for Individuals, usually two methods are followed:

Individual Health Insurance Claim Process

1)     Cashless Claim Process: 

In cashless claim facility for Health Insurance Plans for Individuals, the insured must be treated in the network hospital which would be conveyed while purchasing the Individual health plan. They need to present an e-card, health insurance plan details, and any physical proof documents, etc. After approval, the insured could avail the cashless claim treatment. Also, approval would be provided only if the injury or the disease is covered under the Individual health plan. After the patient is discharged, the hospital provides all the medical bills to the health insurance company. After evaluation, the company does the payment to the hospital.

2)     Reimbursement Claim Facility:

The second type of claim process in Health Insurance Plans for Individuals is reimbursement facility. As the name suggests, the health insurance company provides reimbursement up to the sum assured for the amount which was already paid by the individual during times of accidents or mentioned illness. This facility is provided by Health Insurance Plans for Individuals for treatment not falling under the network hospitals. Here, the insured will have to bear the initial cost of treatment, then after treatment, they will have to submit all the medical bills to the Individual health insurance company for settlement of claims. If the treatment is not covered, then the claim could be rejected.  

Below documents must be kept in hand opting for this claim process:

i)   Claim form which is duly filled

ii)   Medical Certificate or form which is signed by the treating doctor.

iii)   Medical Certificate or form which is duly signed by the physician

iv)    Patient’s Discharge summary or original card, given by the hospital.

v)   Prescription, cash memos from pharmacies or hospital.

vi)   Original Bills and receipts

vii)   Reports of Investigation

viii)  FIR or Medico Legal Certificate, in case of an accident

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