1 / 7

Health insurance claim settlement process - PolicyBoss

Health Insurance Claim Settlement Process: Know Details information and document required for both cashless and reimbursement claims procedure.

policyboss
Download Presentation

Health insurance claim settlement process - PolicyBoss

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Health Insurance Claim Settlement Process @ ? 24/7 Hours Days

  2. WHAT IS A HEALTH INSURANCE CLAIM? A Health Insurance claim is a request made by policyholder to the health insurer to avail the services covered under the insurance policy. TYPES OF CLAIM SETTLEMENT PROCESS CASHLESS REIMBURSEMENT

  3. CASHLESS CLAIM SETTLEMENT PROCESS There are two types of cashless claim settlement process. PRE-PLANNED HOSPITALIZATION 01. Recommended that you inform the health insurer 2-3 days prior to hospitalization Inform the Third Party Administrator (TPA) and submit the required documents Insurer investigates your documents and case and inform you about eligibility Insurer pays the bills as per approved claim amount

  4. EMERGENCY HOSPITALIZATION 02. Call up the insurer’s customer care and get details on nearest empanelled hospital Get hospitalized and submit your health insurance details to hospital authorities Hospital sends your claim request along with required documents to Third Party Administrator (TPA) of insurer TPA studies your case and upon approval, settles the bill amount with hospital

  5. REIMBURSEMENT CLAIM SETTLEMENT PROCESS Get admitted in Hospital Pay the bills and collect the documents at the time of discharge Submit all the required documents and filled application form to the Third Party Administrator (TPA) of insurer TPA investigates your claim As per amount of claim approved, reimbursement is made directly to your bank account

  6. REQUIRED DOCUMENTS Duly filled in Claim Form Medical Certificate/Form signed by doctor Prescriptions/Cash Memos of pharmacies/Hospitals Investigation reports Original bills and reports Original Discharge summary/card FIR/Medico-Legal Certificate (in accidental cases)

  7. Thank you KNOW MORE : https://www.policyboss.com/blog/health-insurance/ health-insurance-claim-process/ facebook.com/policyboss instagram.com/policyboss twitter.com/Policyboss youtube.com/user/policyboss linkedin.com/company/policyboss

More Related