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4 Easy Steps for filing a Reimbursement Process

Buying a health policy is very vital as it ensures you are financially secured in case of medical emergencies. While going for treatment, you can opt for cashless facility or reimburse the medical bill at a later date.

In case of Cashless facility, the insured person has to carry his health card to a network hospital at the time of admission, the hospital fills in the pre authorization form and the TPA approves it. After obtaining the treatment, the insured person can walk out of the hospital without paying anything from his pocket.

However, in case of reimbursement, the insured person gets his treatment from non-network hospital, pays the medical bills from his pocket and gets it reimbursed from the insurance company. The documents (medical bills/ x-ray/ reports) should be sent to the insurance company within 30 days from the date of discharge. The number of days for filing claim can differ depending upon the policy of insurance company.

You should read the fine print of terms and conditions of the medical policy. It makes you aware of exclusions if any in the insurance policy.

While claiming your bill, you can follow the below mentioned steps:

  1. Arrange all receipt of medicine/hospital bill in a chronological order

The first thing is to get all the receipt of medical bills, reports, x-rays, consultation fees, discharge summary in place and arrange it date wise. Also, arrange the pre hospitalization and post hospitalization bills (medicine/consultation/reports) for the purpose of reimbursement. Generally, pre hospitalization period is of 30 days before hospitalization and post hospitalization period is of 60 days after discharge of the insured person.

The medical bills, reports, consultation fee or any other document submitted should contain the date of bill, invoice number of bill, name of the patient, name of consulting doctor, the bill amount with tax (VAT/ Service tax) and signature of authorized personnel.

  1. Download the claim form online

You can obtain the claim form by downloading it from the website of insurance company.  After downloading the form, take a print out of it.

The claim form is divided into 2 parts i.e. part A and part B. Part A is to be filled in by the insured person and Part B is to be filled in by the hospital.

In Part A you have to fill details like:

  • Policy number of the insured person

  • Company/TPA ID

  • Name and address of the insured person

  • Insurance history

  • Details of hospitalization of insured person

  • Details of pre and post hospitalization claim

  • Claim documents checklist

  • Details of bills submitted and

  • Bank account details  

Whereas in Part B, hospital will have to fill details like:

  • Name and address of the hospital

  • Details of the patient admitted (name of patient, date of admission, date of discharge)

  • Details of ailment diagnosed

  • Claims documents submitted checklist

  • Declaration by the hospital

  1. Take a copy of all the documents to be submitted

Once you have filled up the form i.e. both part A and part B, attach all the receipts of bills you have arranged and take a copy of all the documents which has to be sent to the insurance company via post. You should file the copy of documents which can serve as proof in case the documents are lost or misplaced during transit.

You might also be required to attach a valid government photo Id, a cancelled check and FIR/Post mortem report if applicable.

  1. Thoroughly recheck the documents and dispatch them

Once you have all the documents in place, thoroughly recheck it and send them to the insurance company.

After the insurance company receives documents, they evaluate the case and documents. If the case is approved, the amount will be reimbursed within a week or a fortnight depending upon the terms of the medical policy. In case of incomplete documents/ rejection of claim, the claimant is informed by the insurance company stating reasons.

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