New Delhi. It is known that if a person has taken Health Insurance (Health Insurance) after 24 hours of hospitalization, then he starts getting his facilities. In which, from cashless treatment to medicines, medicine is included in hospital bill and private room. Health insurance has always been important, but Kovid 19 (Covid-19) has increased both its importance and demand. In such a situation, if someone is in your house who has health insurance and in some circumstances dies in spite of treatment in the hospital, then the biggest problem is how to apply for a claim after death. So let’s know how you can apply for a claim settlement in such an odd situation and how –
Bajaj Allianz General Insurance (Bajaj Allianz General Insurance Chief Technical Officer ()Chief Technical Officer) TA Ramaligam (T A Ramaligam,), While speaking to Financial Express, said that in case of death of the insured, the medical expenses payable are decided by the insurer as per the terms of the policy of the insured. They tell that Two features can be found while filing for the Health Insurance Claim, Cashless Claim and Reimbursement Claim.
If the customer selects the insurer’s network hospital for medical treatment, the option of cashless claim can be opted by the insured. The customer has to show his health ID card at the insurance / TPA desk to avail cashless facility in the implanted hospital. After this the process is started between the hospital and the insurance company, where the customer is informed about the progress at every stage and the decision on the request. At present the highest priority is given in COVID-19 cases.
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Cashless Claim Process
1- If there is planning before admitting the hospital, then the customers should contact the insurance desk of the hospital which guides them in the cashless facility. The insurance desk gives the application form (which is signed by the treating doctor) to the insurer. The basis of which the insurer approves the cashless facility. Generally, this approval should be taken 4 – 7 days before treatment.
2- If you are associated with your insurance company, then they will inform you about the documents which may be required. Sharing these documents and medical details with the insurer through the insurance desk, it evaluates the treatment details according to the terms and conditions of the policy and informs the concerned hospital and insurance.
3 – In addition to the documents required by the insurer to the customer, it is necessary to give the following documents to the network hospital: –
A-Pre Arthurization Letter (Filled by insurance desk)
B – ID card issued by insurance company or health insurance policy
C- Aadhar card, PAN card / Form 60 (for KYC purpose)
4- Once the treatment is done and the customer has availed the cashless facility, the original bill and proof of treatment should be left in the hospital. The hospital shares these bills with your insurance company, according to which the insurer pays the hospital.
5- In case of any unplanned or emergency medical treatment, the policyholder can contact the insurer through the facilities of its Customer Service Center or Chatbot to let them know about the registered hospitals. Once in the hospital, customers can request for cashless hospitalization by producing an insurance card provided by the insurer with a policy copy at the insurance desk.
6- Once the client makes this request, the hospital joins the insurance company by filling out a pre-authorization request form and as a result the insurer issues an arthritic letter to the hospital. The insurer also shares details related to the policy coverage of the customer.
7- Once the treatment is over, the insurer will settle the payment of acceptable claims.
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If the client chooses a hospital that is not registered with the insurer, the claim is decided on a reimbursement basis. In this, the customer first has to spend the money and later the bill has to be paid to the insurer after which, upon receipt of the complete set of documents, the reimbursement claims are usually settled within 5 days. For example, Bajaj Allianz General Insurance has introduced a unique facility, in which customers can now submit digital documents through the company’s self-service mobile application for evaluation and disposal, named ‘Carlier Your’. . Through this new facility, a health insurance customer can now receive their claims within 5 working days.
Reimbursement Claims Process
1- The insured has to download the required claim documents from the website of the insurance company or it can also be taken directly from any office / office of the insurer.
2- At the time of filing the claim to the customer, the insurer is required to submit the necessary documents along with the original medical bill. These documents usually include a claim form, bank statement, ID card, hospital discharge summary, check and digosis report and bill, original hospital and pharmacy bill as well as payment receipts and prescription. Additionally, in case of accident, hospitalization, a copy of the FIR may also need to be shared with the insurer.
3- The insurance company evaluates the basis of the claim of the documents after verifying the term and condition (T&C) under the policy.
4- After the assessment, the insurance company pays the beneficiary as per the policy terms.
5- If certain mandatory documents are not found, the insurer can ask for a decision on the claim for these additional documents.
6- In case of claim reimbursement, the insurer provides the grounds on which the claim is non-payable.
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“Ramaligam says that for the ease of our customers we have added our Carlisle Your App (Caringly Yours App), Has enabled digital mode for presenting claims in websites and portals, so that people can access them from the comfort of their homes. All you have to do is click on the pictures of the claim documents and follow the prescribed guidelines for submission. We provide various communication mediums like WhatsApp, Educational Video. Provides real time assistant to customers through contact center.