Irrespective of the type of claim you make, the process of intimation, survey, document verification and settlement remains the same. However, in case of reimbursement claims, we also need these additional documents - payment receipt and invoice.
The differences in cashless and reimbursement claims are
Cashless: You make no upfront payment in a cashless scenario. You contact us and we direct you to the nearest garage. Payments that need to borne by us at our preferred garage will be made directly to the garage on completion of the repairs.
Reimbursement: In a reimbursement claim, you make the payment post repairs at the garage of your choice. Once you complete the claims process, we review and compensate your approved claim amount (as per policy terms). Also in case of a total loss such as theft, you can raise a claim and we will pay the IDV of your vehicle to you.
The car insurance claim settlement process requires the policyholder to submit certain documents in order to validate and accept the claim car insurance. You need to fulfill the insurance claim document along with the submission of the necessary documents.
These are the following documents required in the claim settlement process.
Additional documents in case of reimbursement claim
1. Cashless Claim Settlement Method
When you get medical treatment at a network hospital with your health insurance, then you can attain a cashless claim. As per the Cashless Claim Settlement Procedure, you need not pay anything to the hospital for the treatment and medical services. The insurer directly pays to the hospital subject to the amount of the claim. You will need to pay only in case of co-payments or a sub-limit clause that you have chosen during the plan purchase.
2. Reimbursement Claim Settlement Method
If you get treatment at a hospital outside the network of the insurer, you set foot in a Reimbursement Claim Settlement Procedure. As per this process, you have to pay for the treatment at the hospital and get it reimbursed later on from the insurance provider subject to the amount of the claim. The insurer is liable to pay the entire amount of the claim after considering all the voluntary or compulsory sub-limits, deductibles, etc. opted by you at the time of purchasing the policyholder.
Here are the following documents you need to have for the successful claim settlement of health insurance:
1. Original investigation reports
2. Pharmacy bills along with the prescription
3. FIR or post-mortem report if happened
4. Original bills, receipts, and discharge report
5. Original hospital bills and a valid photo ID proof
6. Treating doctor's report, and original consultation notes
7. Final hospital discharge summary
8. Indoor case papers and duly-filled claim form
9. Test reports along with attending doctor’s or surgeon’s report
10. Nature of operation performed and surgeon's bill and receipt
Listed below is the health insurance claim process for reimbursement followed by most of the insurance companies. However, the procedure may differ from insurer to insurer:
Step 1: Intimate the insurer: First, intimate your insurance provider about your hospitalization within 24 hours in the case of emergency admission and 48 hours prior to the hospitalization in the planned admission case. The timeline in both the case varies from insurer to insurer.
Step 2: Complete the documentation process: Visit the hospital (network or non-network hospital) with your ID. Get the reimbursement form from the insurer or you can download it from the insurer’s website. Fill up the claim form. Annexe all the documents mentioned above. Either submit them physically to the insurer’s office or send them via courier.
Step 3: Payment of bills: After examining the documents the insurer’s claim settlement team sends the letter of approval to the policyholder. In the case of approval of the claim, the amount is reimbursed within 30 days. The reimbursement process may vary from insurer to insurer.
Step 4: Claim Settlement: If the claim is rejected, the insured person is asked to revert to the insurer’s query or is provided with the reason for the rejection.
Listed below is the health insurance claim process for cashless treatment followed by the maximum insurers. However, the procedure may differ from insurer to insurer:
Step 1: Find the network hospital: Firstly, you should look for a network hospital to seek a cashless treatment
Step 2: Intimate the insurer: Intimate the insurer about your hospitalization within 24 hours in the case of an emergency (subject to the policy wording) and 48 hours prior to the hospitalization in the planned admission case (subject to the policy wording).
Step 3: Complete the documentation process: Visit the network hospital with your cashless card or the member ID or the policy number. Show the policy number or the member ID or health insurance card at the hospital’s insurance desk and duly fill-up the pre-authorization form available at the hospital.
Step 4: Claim Settlement: The hospital forwards your filled pre-authorization form to the insurer. At the insurance provider’s end, the claim settlement team examines and reviews the received details of the claim and conveys the hospital and policyholder about the approval or rejection.
Step 5: Payment of bills: If the insurer approves the bills, the medical bill is directly paid to the hospital, whereas, if rejected, the hospital bill has to be borne by the policyholder.
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