Uncertainties related to health are a part of life. And although you cannot prepare yourself for health uncertainties, you can certainly be financially prepared against the health risks using health insurance.

While buying health insurance is easy, claiming health insurance can get very complicated. Most policyholders do not know how to fill medical claim form and because of the incomplete information, they end up with a rejected claim. However, with the right advice and careful actions, you can get your claim settled and receive the maximum pay-out without much hassle.

So, here are 5 very important tips to help you make the health insurance claim process quick and hassle-free.

1. Send Timely Claim Intimation

In case of a reimbursement claim, intimation is the first step that must not be missed. It requires the policyholder to inform the insurer about the hospitalization of the patient, and hence, the forthcoming claim. An intimation can be sent via email, call or the website of your insurer and you must send an intimation.

• • 3-4 days prior to the admission of the patient in case of pre-planned hospitalization
  • Within 24 hours of admission of the patient in case of emergency hospitalization

If the insured fails to send a claim intimation, the insurance company will raise a query. However, with a valid justification, you can resolve the query.

2. Get Pre-Authorization

Pre-authorization is the process of establishing trust between the insured and the insurer. The hospital checks the eligibility of the claim before initiating a cashless claim by sending the pre-authorization form filled by the policyholder to the insurance company. To get a pre-authorization, the insured needs to present their original identity proof and the insurance policy card to the hospital.

However, the most critical step is to correctly fill the preauthorization form based on which your eligibility for a cashless claim is checked. Here are a few important things to keep in mind:

• • Do not use abbreviations while filling the form; the information in the fields must be clearly deciphered.

• • Seek claim assistance from a claim expert if the hospitalization is pre-planned.

• • Attach the documents required in the correct order as per the policy.
  • Justify your claim in preauthorization form by including:
    • • The reason for hospitalization or the diagnosis history
    • • The plan of treatment
    • • Number of days the patient will be hospitalized for
    • • Approximate cost estimation of the treatment
    • • Credentials of the doctor

3. Resolve Queries on Time

In case of reimbursement claim, if the insurance company finds any discrepancy in the documents or the medical case of the insured, it raises a query that needs to be acted upon by the insured. And, most of the claim settlement processes fail because the insured does not resolve the query raised by the insurance company in a timely manner.

The insurer sends 3 reminders to the policyholder. And if despite 3 consecutive reminders, they do not resolve the query, their claim is rejected. So, in addition to responding to the query quickly, here’s what you must do:

• • Track the claim settlement process by getting in touch with the insurance company or TPA (if associated) though call or website. This will help you resolve the query in case you somehow miss the reminder.
  • Represent your case clearly by presenting all the required documents in response to the query.

4. Establish Trust

Patients often make mistakes while filing a claim which cost them a great deal. And the reason behind this is carelessness. They assume that the absence of a single document must not impact the process if the insurance policy, anyway, has to cover the treatment cost. And this feeling of entitlement, in most cases, lead to claim rejection.

The health insurance claim process, however systematic, is influenced by the trust between the insured and the insurer. Which is why disclosing all the details during the claim settlement process is as important as disclosing pre-existing ailments while buying the policy. So, as a proof of honesty, you must submit all the original documents mentioned in the insurance policy and arrange them in the right order to reduce the risk of human error at the insurer’s end. The documents include:

• • Copy of Gov. Id Proof with Insurance card

• • Original Hospital Discharge Summary

• • Original Itemized Bills

• • Hospital Bill & Breakup

• • Original Investigation Reports

• • Original Pharmacy Bills

• • Original Prescriptions

• • Copy of FIR/Medico-Legal Certificate (only in case of accidental injury)
  • Original Cancelled Cheque

5. Contact a Claim Expert

The insurance policy certificate is a complex document which consists of terminologies that are almost impossible for a layman to understand. This is why policyholders end up making decisions with incomplete or incorrect information they have. Moreover, misunderstandings while filling a claim form and attaching the documents to submit a reimbursement claim request may lead to rejection of the claim or deduction in the claim amount. Hence, to avoid making a costly mistake, you can contact a claim expert who will –

• • Answer all the doubts you may have.

• • Prepare your claim form so that you don’t need to struggle.

• • Help you with online self-claim preparation.

• • Guide you step-by-step through the claim process.

• • Identify the right documents. Resolve the query raised by a TPA and help you submit a grievance.

These tips will not only make the claim process easier for you but will also help you ensure that you get the claim pay-out that you deserve.

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Buying Health Insurance plan is one of the tasks that should be in every person’s to-do list. But, buying an insurance plan is not as easy as buying groceries. Thousands of insurance providers offer thousands of insurance plans with different coverage amounts and policies. Buying an insurance plan in a hurry without getting completely acquainted with the plan can result in problems and unpleasant experiences at the time of the claim. Therefore, here are a few common mistakes that insurance applicants make and how to avoid them to have a smooth claim experience.

1. Under-Insuring Yourself

One of the most common mistakes made by Health Insurance applicants is to skimp on the coverage amount. People lower the premium amount, which in turn, lowers their coverage amount. If you think of doing do, you should always calculate whether the coverage amount will be sufficient in the long run or not. While choosing a cover amount, you should consider various factors like the number of members to be covered in your plan, the city you live in, family disease history, and current medical expenses. If you are on a limited budget, you may go for a top-up plan to supplement your cover but make sure you always select a high coverage amount.

2. Overlooking the Sub-Limits

While buying Health Insurance plans, people rarely bother to look at the applicable limits and sub-limits of the coverage policy. As a consequence of this mistake, you face a financial strain when your medical bills are presented in excess of the sub-limits. The people who have faced this condition before should be careful about these clauses in their insurance policy before buying it.

For those who are yet to purchase health insurance, you should always be aware of the limits and sub-limits that are associated with the coverage benefits. The most common form of sub-limits is the room rent sub-limit that is included in the inpatient hospitalization coverage. Sub-limits have an effect on the total hospitalization claim, and thus, you should always check the sub-limits before buying any health insurance plan. The best option is to buy plans that have high coverage limits and minimal or no sub-limits.

3. Not Considering the Exclusions

Nowadays, Health Insurance plans are highly comprehensive. But, all the insurance plans are not universal when it comes to coverage. There are a few conditions that are excluded from the extent of coverage in any plan. People who don’t properly study the insurance plan end up getting their claim rejected because the illness or treatment was not included in the plan. Therefore, you should equally prioritize the exclusions of ailments or treatments in an insurance plan. This helps you get a clear picture of what is covered and what is excluded in the plan. Having this knowledge enables you to make the right choice to buy a plan and also to make a claim accordingly.

4. Not Disclosing Your Previous Illnesses

Some people choose to hide their existing medical conditions or medical history. They fear that their application for the Health Insurance will be rejected or they have to pay higher premiums. This mistake is something you should avoid at all costs because if the insurer finds out that you intentionally tried to fraud the insurance company, your claim will be rejected in no time.

Therefore, you should never cheat with the insurance company. Insurance plans are contracts that are based on faith as it is based on the information you provide. It is essential to be truthful when you buy a health plan. Disclosing your medical history or past ailments might increase the cost of your premiums, but you will face no difficulties while receiving the claim as the insurance company was already aware of your condition and risks.

5. Copying the Insurance Policy of Your Friends or Family Members

This mistake is common. Do you drive the same car your friends drive? Do you wear the same clothes your relatives wear? Then why consider buying a Health Insurance plan that your friends or relatives have? Every individual and every individual family has different needs, medical histories, and coverage requirements. Therefore, the plan that is ideal for someone else might not be suitable for you.

Before buying a Health Insurance plan, you should carefully compare various insurance plans that offer different coverage and features. Internet is a great medium as you can compare thousands of health insurance plans online. You can compare plans on their coverage, features, premiums, sub-limits, etc. Buy a plan only after you realize that the plan is ideal for your situation and meets your requirements.

Making mistakes while choosing Health Insurance is common, and the most common cause of these mistakes is the lack of knowledge. Therefore, study multiple insurance plans and talk to different people with health insurance to understand what suits you the best.

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Health insurance is a must have even though you consider yourself to be healthy and leading a healthy lifestyle. It is because the cost of health care is escalating at a rapid pace that if all you have to be hospitalized at any time, the hospital bills would drain your bank balance at a rapid speed. The new age health insurance plan is the cushioning factor that you should opt for while you are still comfortable. The Bajaj Allianz health insurance plans are designed to provide financial support at the needy hour providing the cushioning effect you require. With them by your side, you could concentrate on getting well rather than thinking about how to arrange for the finances to meet the expenses.

New Age Health Insurance Plans

The new-age health insurance plans that come with modern features offer benefits that would provide you with adequate health cover. The new-age features have been adopted by the insurance providers. With almost all insurance providers making sure that their policy is designed to have features that attempt to gain your attention, it is difficult for you to make your choice. The insurance companies are also gearing up to meet the demand in the market diverse products that could cater to diverse customers.  This could surely help you get medical care and beat the inflation in medical costs. But you have got break your heads on deciding what would be the best cover that would meet your needs.

New Age Health Insurance Features

1. The Age Factor

One of the main new age features that have come into force due to the insurance regulatory and Development Authority is the age at which a person can buy an insurance policy. At present, it is possible for a person to buy an insurance policy up to the age of 65. This is being followed by the state-owned insurance companies.  But private insurance companies like Bajaj Allianz new age health insurance have tailored various plans in which you have tax gain plan for which the maximum entry age is 75 years and you also have a health care supreme plan where there is no limit in the entry age at all.

2. The Renewability Feature

It is again mandatory to offer lifetime renewability.   Earlier if you fail to renew, you would be losing even the existing benefits of the lapsed policy.  The new age policies ensure that you are eligible for lifelong renewability even if you have made a claim in the previous year. The renewability can be denied only on furnishing cogent reasons in writing which is a great boon for the policyholders.

3. Pre-existing Ailments

A new age health insurance feature that has been adopted considering the increase in people suffering from many ailments and the longevity of the persons owning to medical care, the new age policies are made available to persons with previous ailments too. But, only if they truly reveal their condition at the time of taking the policy. However,  health insurance coverage for pre-existing illness would be covered only after the waiting period that could vary between different private insurance companies like Bajaj Allianz insurance company, star Health etc, which is usually around 36-48 months. Since exclusion for pre-existing illness is quite common for most of the insurance companies and you have a clause for the waiting period that runs from 2-4 years, you should be careful when you port your insurance policy. Unless proper porting is done, the period will start from zero.

4. Sub-limit

The medical cost you are likely to incur when you fall sick includes

• • Doctor’s fee
  • Room rent
  • Surgery fee
  • Operation charges
  • Cost of medicines

And other such costs, if your insurance policy fixes a sub-limit, which will limit the reimbursement under some or all heads, it might not give you the comprehensive coverage it should give.  Usually, the room rent allowed per day would be 1% of the of the sum insured if it is more than that you would have to pay out of your pocket. The Bajaj Allianz new age health insurance plans the hospitalization expenses are covered with no limit on room rent or any other expenses you might incur. You also stand to gain an advantage in the form of coverage for costs or expenses incurred 60 days prior to hospitalization as well as for a period of 90 days after hospitalization.

5. Daycare and OPD Expenses

Since certain treatments in modern times are expensive but do not need hospitalization even for a day the insurance companies have come up with plans that adequately cover these expenses. The daycare and OPD differ from each other in that, day care involves a considerably heavy cost such as for dialysis, chemotherapy, lithotripsy etc. while OPD refers to small-time expenses that neither can be categorized as daycare or hospitalization, like dental treatment.

6. No Medical Test

The new age schemes make it possible for you to take insurance policy without medical tests up to the age of 45. The Bajaj Allianz new age health insurance plans also make it possible for you to avail free health-check ups. However, it would come into effect only after 3 claim free years. in case of a renewal of the age limit for coverage without medical tests is about 55.

Also read: Top 20 General Insurance Companies in India and Best 20 Life Insurance Companies in India

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Health insurance plan can be subscribed to get protection from various kinds of ailments and diseases. Health insurance policies are offered for newborn babies and children by various insurance companies. The life insurance plan covers the death while the health insurance covers the hospitalization. The healthcare costs are increasing in India and a caring parent should choose the best policy to offer best protection for the child. Even though you are covered by a medical insurance offered by your employer, you should go for an additional policy as per your needs.

Purpose of health or medical insurance

Health insurance will cover eventualities such as surgery, hospitalization and medical treatment. There is a difference between Mediclaim policy and health insurance. The Mediclaim is limited to the hospitalization cost. You will want to claim the medical expenses towards the treatment and the insurance company will reimburse the amount.

With the health insurance plan, you will get additional benefits. The health insurance plan will cover the medical consultation fee, medical bills, cost of diagnosis, treatment cost, boarding charges, ambulance charges, pre-hospitalization & post-hospitalization expenses. Hence, it is a comprehensive policy to take care of your health in the best possible way.

There are some life insurance products which offer medical treatment coverage due to accident or sickness. The insurance company will pay lump sum amount and it will be helpful for treatment.

Benefits of health insurance

The following benefits are enjoyed by buying a health insurance policy from a reputed health insurance company which shows Why you need to get your children insured?

• Sufficient health cover – The health insurance cover offered by the corporate health cover will be insufficient to meet your children’s needs. The insurance plan offered by the employer will cease to exist as soon as you quit the job. Hence, you should want to buy a comprehensive health insurance plan.
• Ability to deal with life-threatening diseases – The number of children being treated for life-threatening diseases is increasing at a constant pace. The risk to various kinds of diseases such as anthrax, dengue, measles, rubella, viral hepatitis, mumps and acute diarrhea disease has increased in the past few years. The health insurance is a great option to fight deadly diseases. Even though the medical facilities are available, they are very expensive. With the help of a comprehensive medical insurance policy, you will get treatment and it is possible to save your child. The family will survive the financial hardship as the medical treatment cost will be borne by the insurance company.
• Healthcare planning – Your child’s health may be spoiled due to accident or injuries. If there is medical emergency, it will be borne by the health insurance company when you subscribe to the best plan. The health care planning and financial planning is essential so that you can live with great peace of mind.
• Income tax benefits – The premium paid towards the child health insurance plan will be exempted under the Section 80D of the income tax act. If you subscribe to a health insurance plan, you will get tax exemption up to Rs. 25,000 in a financial year.
• Additional benefits – In addition to the cost of treatment, you will also get additional benefits with the subscription of medical insurance plans in India. The additional benefits include daily cash allowance, recovery expense, and domiciliary treatment. You can also get additional benefits by customizing the plan as per your needs. Some insurance companies offer attendant benefit, alternative treatment and domiciliary hospitalization.
• Lifelong renewal – some health insurance plans are offered with lifelong renewal option. If you do not claim the policy in the previous year, you will get no-claim bonus.

Individual health insurance plan

You can buy an individual health insurance plan as per the needs of your child. If there are some hereditary health risks, you can choose a plan to include those risks. The sum assured will be in between Rs. 1.5 lakh to Rs. 50 lakhs. The individual health insurance plan covers the pre-hospitalization and post-hospitalization expenses.

Most of the insurance companies cover 60-days pre-hospitalization and 90-day post-hospitalization expenses.

You will get access to a network of hospitals managed by the insurance company. You can choose the policy term for 1, 2 or 3 years with a lifelong renewal option. When you buy an insurance policy at a young age, the premium will be very low.

Family floater insurance plan

The family floater plan is an affordable health insurance option. It is possible to cover all the family members with the help of the family floater plan. The insurance premium will be very low. The sum assured can be utilized by one or all the family members. Hence, one or more children plus parents are accommodated in the health plan. You can also include your parents in the family floater plan. However, the insurance premium will be high for senior citizens. Hence, instead of including parents who are above 60 years of age under your family floater plan, you can buy a separate policy to get your children insured.

Top up insurance plans

It is possible to subscribe top up plans so that the insurance coverage will be enhanced. Instead of buying another insurance policy, you can choose a top-up plan. Terminal illnesses such as cancer and AIDS are not covered by a basic health insurance policy. By choosing top up plans, you can get additional benefits. You can also subscribe to super top-up plans to make the most of your health insurance plan.

You should buy the health insurance plan by offering correct information to the insurance company so that your claim will not be rejected by the insurance company. You should also choose the most appropriate policy as per your child’s needs.

Conclusion

You can go through the various kinds of health insurance plans offered different insurance companies. The insurance plan that offers best features at a low premium can be selected so that you can cover various kinds of health-related risks very easily. A health insurance plan can be subscribed online and you will get assistance with claim reimbursement and 24/7 assistance so get your children insured.

Please refer other financial news in Newskart at Business & Finance section, also know top 20 General Insurance and Life Insurance companies in India.

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