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How to Fill a Health Insurance Claim Form?

  • Author :
  • TATA AIG Team
  • Published on :
  • 15/07/2022

The one thing that the COVID-19 pandemic has taught all of us is that life is full of uncertainties. You never know when a medical emergency will strike you and take away all your savings with it. Even a single instance of hospitalisation can set you back by a few lakhs of rupees. And if, God forbid, you get diagnosed with a critical illness, there is no limit on how much money you will require for your treatment.

That is why we advise you to secure yourself as well as your family members with a health insurance policy. A health insurance policy provides financial protection against the exorbitant healthcare expenses you may incur should you require hospitalisation due to a medical contingency. And keeping in mind the rising cases of lifestyle diseases and the spiralling healthcare costs, having a medical insurance plan has become even imperative in today’s times.

Types of Health Insurance

Depending upon the number of people covered by the policy, there are two types of health insurance plans available in India. These are individual health insurance plans and group health insurance plans.

  • Individual health insurance

Policies that provide health coverage for individual policyholders are known as individual health insurance plans. These health plans cover only a single person, and their premiums are determined based on the current age, health condition, gender, profession, location, and lifestyle habits of the applicant. In addition, individual health plans cover the policyholders up to a certain sum insured.

  • Group health insurance

As the name suggests, a group health insurance policy covers more than one person. It acts as an umbrella policy wherein two or more people are covered under a single health insurance policy. A group health policy is generally purchased by employers to provide health insurance benefits to their employees. You can also purchase a group health insurance policy to ensure medical coverage for all your family members.

There are other types of insurance plans including family floater health insurance plans, critical illness insurance plans, etc.

Health Insurance Claim Filing

Although a health insurance policy covers all hospitalisation expenses, merely having it doesn’t mean that you are protected from all the hassles. In the event of a medical emergency or hospitalisation of an insured person, you will need to file a health insurance claim on your policy to reap its benefits.

And to file a health insurance claim, the first thing that you need to do is fill up a health insurance claim form. You can find this health insurance form on the website of your insurer, or you can also collect it by visiting the branch office of your health insurance provider.

Steps to fill your health insurance claim form

It is very crucial to fill out your health insurance claim form carefully, as any discrepancy or negligence can lead to the rejection of your claim. And the rejection of your health insurance claim can prove to be detrimental as you may have to pay for the hospitalisation expenses out of your pocket in that case.

Let’s look at the steps you need to follow to fill up a health insurance claim form:

  • Collate the required documents

Before you start filling out your health insurance claim form, you should obtain and collate all the documents required for the same. You will need to submit these documents to the insurer to begin your claim settlement process.

Some common documents required for a filing a health insurance claim include your health insurance policy copy, your proof of address (Voter ID card, Aadhar card, Ration card, Driving licence, Passport, etc.), your proof of age (PAN card, birth certificate, class X or XII mark sheet, etc.), your photo ID proof (Voter ID card, PAN card, Aadhar card, etc.) and your medical bills or invoices (in the case of reimbursement claims).

  • Collect and fill the claim form

After you’ve collated all the documents in one place, you can proceed to fill out your health insurance claim form. You can get your health insurance form online by visiting the website of your health insurance company. Else, you can walk in at the nearest branch office of your insurer to get an offline copy of a health insurance claim form.

  • Start filling out your health insurance claim form

After you have obtained a health insurance claim form from your insurer, you can start filling the various sections in it one by one. You can get a few photocopies of your claim form before filling it out so that you have a backup in case you mess up.

A health insurance claim form consists of two parts – Part A and Part B. Part A needs to be filled out by the policyholder, whereas part B of the claim form has to be filled out by the hospital. So, let’s discuss how to fill the claim form Part A.

You can proceed to fill out part A of the form by entering a few primary details of yours, including your full name, policy number, residential address, phone number, and e-mail id. Then, you may need to provide the details of your medical history and hospitalisation. Ensure that you enter all details correctly to avoid the rejection of your claim.

  • Review and submit your claim form

After you’ve filled out your health insurance claim form, you can review it for any errors before submitting it to the insurer. We recommend reviewing your claim form at least twice before submitting it, as you may not be able to change the details at a later stage. And any incorrect information may lead to the rejection of your health insurance claim.

  • Attach the required documents

After submitting your health insurance claim form, you will need to attach the required documents to validate your claim. The documents required for filing a health insurance claim are mentioned above in Step 1. You can either upload the soft copies of your documents if you have filed an online health insurance claim, or you can submit the hard copies to the insurer in the case of an offline claim

The Two Types of Health Insurance Claims

You can consider the following two types of health insurance claims while filling your claim form:

  • Reimbursement claim

Under a reimbursement claim process, you will need to first pay at the hospital out of your pocket, and then you can claim a reimbursement of your expenses from the insurer. To file a reimbursement claim, you will need to fill out a health insurance reimbursement form. You can avail of this facility at any hospital of your choice.

  • Cashless claim

In the case of a cashless claim, you are not required to pay anything at the hospital as the bills are settled directly with the insurance companies. However, a cashless claim facility is available only at network hospitals.

Conclusion

You can file a health insurance claim online or offline. However, you must take extra precautions while filling out a health insurance claim form. Any mistake or error can lead to the rejection of your claim, and you may have to bear the entire expense.

At Tata AIG, we ensure a smooth claim settlement process for health insurance policies. As a result, you can compare health insurance from different insurers and buy the best plan as per your requirements.

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