Here’s a step-by-step guide on how to file a reimbursement claim under health insurance.

Health insurance is a crucial safety net that helps cover medical expenses, ensuring you receive the necessary care without incurring a financial burden. While cashless claims at network hospitals are convenient, there are times when you might need to pay for medical expenses upfront and later seek reimbursement from your insurance provider. 

Here’s a step-by-step guide on how to file a reimbursement claim under health insurance.

How to file a Reimbursement Claim Under Health Insurance?

Now, let us go through the step-by-step process to file the reimbursement claim under health insurance. Just follow these simple steps and file your health insurance claims easily:

Step 1: Inform Your Insurance Provider

Whether it’s a planned hospitalization for medical treatment or a medical emergency, you have to apprise your insurance company or TPA about it as it will help you in a smooth Medical Insurance Claim Procedure.

Step 2: Get Medical Treatment

After informing your insurance company, you can relax, get treatment from the hospital, and focus on your health recovery.

Step 3: Pay the Hospital Fees

Get your discharge from the hospital, and make sure to pay the entire hospital bills in full. 

Step 4: Organize All Your Medical Documents

To make your Reimbursement claim easier, organize and collect all your medical documents related to hospital treatment including the hospital bills and discharge summary as well.

Step 5: Fill Up the Reimbursement Mediclaim Form

After discharge from the hospital just fill out the reimbursement mediclaim form of your insurance company, which is easily available on its website.

Step 6: Submit All the Documents to Your Insurance Provider

Ask your insurance company about all the relevant documents required, or you can also check the policy details. Make sure you submit all your documents in the stipulated time frame.

Step 7: Process of Document Verification and Evaluation

Your Insurance company will thoroughly verify and cross-check all the documents submitted by you to initiate the Reimbursement claim under health insurance. After the verification, you will be informed about the acceptance or rejection of your claim or your insurance provider will inform you if any other document is required.

Step 8: Disbursement of Claim Amount

On accepting the Reimbursement claim, the insurance company will pay you the claim amount raised by you.

Documents Required to File Reimbursement Claim

To make your reimbursement claim process in health insurance hassle-free, here is a list of documents to check before you file your claim to the Insurance company: 

  • Properly filled out health insurance claim form
  • Originals of blood test reports, X-rays, CT scans, etc.
  • Copy of health card/ insurance policy
  • Hospital discharge summary
  • Doctor’s consultation papers or prescriptions
  • Medicine bills
  • Hospital bills
  • Bill payment receipts
  • Original implant sticker/invoice
  • Copy of KYC documents
  • An FIR or medico-legal certificate (MLC) (in case of an accident)
  • NEFT details

When to file a Reimbursement Claim under Health Insurance?

A Reimbursement mediclaim can be filed under several circumstances, which may include:

  • Non-Network Hospital:

In case, due to a medical emergency, you are admitted to a non-network hospital of your insurance company, you can opt for reimbursement mediclaim.

  • Rejection of the Cashless Claims Procedure

On rejection of the cashless claim request by the insurance company, you can file for a reimbursement claim under health insurance.

  • Need treatment from a Non-Network Hospital

If the insured person requires medical treatment from a Non-Network Hospital, in that case, a Reimbursement Mediclaim can be filed.

Also Read: Health Insurance vs Mediclaim

Things to Keep In Mind

Every Insured Person should keep certain things in mind while filing a Reimbursement Claim under Health Insurance, which may be as follows:

  • Check all the policy documents, details & conditions carefully.
  • Always remember to renew your health insurance before it expires. 
  • Check for the waiting periods applicable under your health policy.
  • Always keep a copy of the original documents that you submit to the Insurance company.
  • Carefully read the claim process of your insurance company.

Wrapping Up

At times, the Medical Insurance Claim Procedure can be overwhelming, taking a lot of your time and energy but if you gather all your necessary documents, duly fill out the claim form, and timely submit your claim, the whole process will become smooth and easy for you. Initiating a Reimbursement Claim Process in Health Insurance does not have to be complicated, all you need to do is stay organized, and informed and read your policy details carefully so that you can receive your entitled health insurance benefits without unnecessary delays.

Also read: 5 Factors to Consider While Getting Health Insurance

Frequently Asked Questions (FAQs):

How to fill out the reimbursement Mediclaim form?

The form is to be filled out carefully including crosschecking for errors and missing information.

Where to submit the Reimbursement Claim of Health Insurance?

The claim to be filed with the insurance company's claims department, online, either via email, or by mail.

Can an insured person track the status of the reimbursement claim?

Yes, as most of the insurance providers offer assistance for online tracking of the status of Reimbursement Claim under Health Insurance.

Can an insured person receive the full amount of the reimbursement claim?

It all depends upon the policy coverage and whether there are any applicable deductibles or not.

What should a person do, if the insurance company rejects his /her reimbursement claim under health insurance?

When the reimbursement mediclaim request is rejected by the insurance company then he/she must review the reason for rejection, rectify the issues, and resubmit the claim or appeal the decision if necessary.

How much time does it take to receive the Reimbursement Claim amount?

After the approval of the Reimbursement Claim, it may take 2-4 weeks to receive the Reimbursement Claim amount, but this also depends on the insurance company’s rules.