Everything You Need To Know About Health Insurance Claims – Forbes

Published: Mar 8, 2022, 5:45pm
Health insurance is useful when it comes to covering the medical expenditure arising out of an illness or hospitalisation. Comprehensive health insurance plans cover expenses such as cost of medicines, cost of hospitalisation and surgeries, cost of doctor consultation, among other aspects. 
Some of the major reasons for subscribing to a health insurance policy include:
Safeguard against lifestyle illnesses: Nowadays, more and more people are falling prey to lifestyle diseases such as diabetes, obesity, heart disease, pulmonary issues, etc. While these diseases were previously common among people in their later years, due to sedentary lifestyle and increased stress, these diseases are taking a toll on the younger populace. 
If you are not prepared to face the fallout from a potential illness or condition, you may stand to lose a heavy amount on tests and medication as many of these diseases are chronic. A comprehensive health insurance protects you from the bills that crop up during regular tests and also offer you help in taking care of medication expenses. 
Protection for the whole family: Health insurers offer comprehensive plans which cover the medical requirements of the entire family. With hyper-personalisation now an option, it is possible to choose health covers which protect all the different requirements of your entire family without burning a hole in your pocket. 
Having a comprehensive family health cover will hold you in safe stead in case of any untoward incidents while also protecting your family and enabling you to provide them with optimal healthcare facilities.
Buffer against medical inflation: Inflation is rising every day and this is visible across all categories of goods and services. With constant innovation and new age medicines entering the market, the cost of treatment is rising steadily. 
Everything from consultation charges to cost of medicines, hospitalization, and ambulances, are rising consistently and subscribing to a comprehensive health insurance plan can help you stay ahead of the inflation curve. You can receive quality treatment, years from now, without worrying about the rise in inflation. 
Safeguarding your savings: If you and your family do not have a comprehensive medical cover and fall prey to illness or meet with an accident, you may be forced to dip into your hard-earned wealth and savings to access effective treatment and medical facilities. Insurance ensures that your savings do not go down the drain in case of a health
emergency. 
For any insurance policy, and especially for a health insurance policy, the moment of truth comes at the time of the insurance claim. The very goal of taking a health insurance policy is to ensure that during medical emergencies and also when you are seeking medical treatment, you don’t need to worry about the financial cost of treatment. Just as it is important to purchase an adequate health insurance policy it is equally imperative to understand the claims process so that at your time of need, you can fall back on your health insurance policy.
Once you decide to invest in health insurance, there are several things which you should keep in mind. First of all, remember that the plan comes into play when you are hospitalized or when you have to shell out money for some medical reason. The health insurer will only process your claims if your medical condition is part of the coverage being offered so be sure to read the fine print. It is better to choose a slightly expensive plan with better coverage instead of opting for the cheapest option and then not receiving adequate coverage.  
Health insurance policies admit two types of claims. These are:
Now, the most important thing about cashless claims is that it is hassle-free and seamless. Generally, most insurance companies have tie-ups with a network of hospitals and when you choose a partner hospital for treatment, you can avail of the cashless claim option. 
Under a cashless claim, you would not have to pay any money – the insurance company will settle the claim directly with the hospital. This means that you can seek treatment at any of the network hospitals and the bills are directly settled by the insurance company, without you having to shell any money from your pocket. 
Under the reimbursement option, you will have to first pay for the bills and, once the claim is processed, the insurance provider will reimburse you for the money you have spent, as per the original hospital bills. Inevitably, this will not be as seamless as a cashless claim. However, you do not need to seek medical assistance only at a network hospital. You are free to choose any hospital. 
Steps for Availing Reimbursement Claims
Medical emergencies are a major cause of concern and you may forget the claims process given the stress of the moment. These are some of the things which you should remember in such situations –
While there are several things to be kept in mind while choosing a health insurance policy, it is always better to be safe than sorry. And this has proved especially true in the post-pandemic world, where we are battling unprecedented incidents on a regular basis. 
Investing in a health insurance policy is important to your long-term financial and overall wellbeing as the policy helps you save your wealth and also ensures that you have enough funds to avail the best facilities possible. Make sure that you choose the best health policy in line with the requirements of yourself and your family members.  
Dhirendra Mahyavanshi is the co-founder of insurtech company Turtlemint. He has over 16 years of experience in the insurance, e-commerce and fintech sector. Mahyavanshi is an alumnus of IIM- Calcutta and has a bachelor’s degree in engineering from DJ Sanghvi College of Engineering.
Aashika is the India Editor for Forbes Advisor. Her 15-year business and finance journalism stint has led her to report, write, edit and lead teams covering public investing, private investing and personal investing both in India and overseas. She has previously worked at CNBC-TV18, Thomson Reuters, The Economic Times and Entrepreneur.

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