Published On: Wed, Feb 3rd, 2016

3 Things to Keep in Mind While Claiming Health Insurance

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Health Insurance is meant to protect individuals and their families fromunanticipated health crises. There are zillions of stories written about the importance of health insurance and how it protects from financial burdens at the time of need. Sure it does! But what if it fails to do so? The worst thing an insured person can imagine is to not being able to avail the sum insured at the time of a medical mishap. But mind you, this is possible! Many health insurance claims get rejected every year and it brings a lot of distress to the policy holder and the provider as well. However, rules are rules, and they have to be followed.

So what is the secret to getting your claim approved? There is no secret in place. There are just rules and things to keep in mind before making a claim. Here are three most important factors to consider before you file a health insurance claim.

3 Things to Keep in Mind While Claiming Health Insurance

Types of claims

According to IRDA, There are two types of claims and your claiming process depends on the type of claim you are making.

Cashless: To make a cashless hospitalization claim, one must be treated only in a hospital that falls under the network hospital of the Third Party Administrator. The policy holder must be authorized to seek cashless hospitalization according to the policy. To understand the claim process well, the insured must read the fine print of the policy wordings well in advance. You can try HDFC Ergo’s online health insurance, which hashassle free claim procedures with least documentation and settlement duration.

Reimbursement: Reimbursement based claims require you to be very careful with filling the forms and following the rules and instructions because you have to pay the hospital bills at the time of discharge, but later you get reimbursed for the same. While making a reimbursement based claim, take help of your insurer and understand the process well. Apart from that, you need be well aware of the policy wordings.

Registered Hospitals

Many claims get rejected because the hospital where the insured is admitted does not hold a valid registration certificate. So, before you decide to avail medical services from a particular hospital, make sure it is a recognized and registered entity unless you are in an emergency. Moreover, the list of network hospitals must be strictly adhered to. According to Economic Times, the list gets updated frequently, and one should choose a hospital only after checking the list of hospitals on the third party administrator’s website. The benefit to the policy holder is that if the insured has taken approval for a particular hospital before the hospital gets removed from the list of network hospitals, the claim will be settled.

Non-disclosure of material facts

You cannot really consider this fact while making the claim because this is something you should consider while buying the policy, but, this is definitely one of the most important factors to get a claim approved. Make sure you have not hidden any facts about any medical condition you have been facing of faced in the past at the time of purchasing the policy. Be honest about any existing health conditions and there will be fewer chances of claim denial.

If you follow the claim procedure cautiously, chances are your claim will be approved. However, even after due precaution and adherence to the instructions, your claim gets rejected, do not despair. Ensure that you ask your insurer to provide a written document stating the reason for rejection. If you are not satisfied with the reason, you can question your insurer to state the specific clause under which the reason they have provided stands valid. You never know who wins the debate!

About the Author

- Paul Linus is an eminent online journalist who has been writing news, features and editorials on different websites from across the world for about a decade. He can be contacted at

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