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Yes, a request for authorization of cashless access may be denied on various reasons such as the ailment/ disease for which the hospitalization is required is not covered under the policy or the insured might not have the sum insured balance to cover the claim. This means that the customer’s request for cashless is denied and he/she cannot claim for reimbursement as well.
Reimbursement of your claim can be obtained by applying for reimbursement facility after the treatment is done. Below are the steps to avail reimbursement claim from your health insurance provider.
Step 1: Intimate the insurance company regarding the claim and take a note of the “Claim reference number”. Fill the claim intimation form with the maximum details which form the first hand information provided by the customer regarding hospitalization.
Step 2: Submit all the necessary documents for claim processing which include:-
A health card is a card that comes along with the health policy which is similar to the identity card. This health card can be used to avail cashless hospitalization facility at any of the network hospitals. A health card mentions the name, age, contact details of the insured and the contact details of the TPA. In Case of emergency the insured customer can reach out to the numbers mentioned in the health card. E-health card can also be downloaded from the website and used for cashless hospitalization at any of the network hospitals.
A cashless Health Insurance policy is a policy in which the hospital costs are covered directly between the insurance company and the network hospital. No cash has to be paid by the insurance policyholder.
Cashless hospitalization is the process in which in the insured would get admitted in the hospital for treatment and the costs would be borne by the insurance company. The hospitalization cost would be paid to the hospital by the insurance company directly without the intervention of the customer. For this the insurance companies discuss packages with the hospitals and fix a price for a particular type of treatment. Cashless hospitalization is the best mode of claim settlement in a health insurance policy as the rising hospitalization costs are posing a serious threat to the people and causing a huge dent in their savings during hospitalization.
You can claim any number of times in your health insurance policy as long as the sum insured is not exhausted. The sum insured in your policy is the maximum limit which can be utilised by you for claiming any number of times. There is no limit on the number of claims that can be made in your health insurance policy.
Health insurance premium are dependent on the age of the prospect and the coverage selected. But in some cases the health insurance premium could be increased at the time of renewal due to the heavy claim ratio that the insurance company has incurred over the past year. It means that the claims paid exceed the premium collected by the insurance company.
A top up policy is an additional coverage for people already having an individual health insurance plan or employer health insurance policy. It is useful in case of a single illness which consumes the entire sum insured in the base policy. The top up policy triggers only after the sum insured in the base policy is exhausted and the deductible under the top up is crossed due to hospitalization. Having a top up policy without a base health insurance policy is like having a bike without an engine. A top up policy has a deductible amount which would be almost 20% of the top up policy sum insured. For example let us take a base policy with Rs.2 Lacs and Top up policy with Rs.5 Lacs, in case of hospitalization first the base policy sum insured will be utilised and then the top up policy kicks in.
In any health insurance policy, the amount settled by the insurance company would be the claim amount incurred or the sum insured mentioned in the policy whichever is less. The maximum liability of the insurance company in case of claim would be the sum insured mentioned in the health insurance policy copy. There are certain expenses which are incurred during hospitalization such as Laundry expenses, food expenses which are not paid by the insurance companies. Consumables expense is paid by certain health insurance policies, consumables include gloves, hand wash, sanitizers etc. The claim amount paid by the insurance company varies from case to case and it can neither be agreed nor denied that the entire claim amount being paid in case of hospitalization.
To claim medical insurance, follow these general steps:
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