How to make a health insurance claim: All you need to know

How to make a health insurance claim: All you need to know

Nov 18, 2021, 11:49 AM IST

The process of making claim against your health insurance cover will depend upon the type of policy you have taken. There are two basic types of health insurance policies indemnity plans and defined benefit plans. An indemnity based plan pays the policyholder for actual expenses incurred within the limit of the sum insured of the policy. Whereas a defined benefit plan pays a predetermined sum insured amount irrespective of the cost involved.

Here is how the claim process works for these health insurance covers.

Claim process for indemnity plans
Most of the basic mediclaim policies fall under the indemnity plan. "Going by the name, indemnity-based health plans basically indemnify the policyholder against hospitalisation expenses up to the total sum insured," says Amit Chhabra, Head-Health Insurance, Policybazaar.com. They are two ways in which you claim against these policies - cashless and reimbursement modes.

Cashless mediclaim process: Cashless claim is the process in which the claim amount is directly paid by the health insurance company to the hospital. This facility is only available when you go to a hospital with which the insurance company has prior understanding to offer cashless claim service. These are called empaneled or network hospitals offering cashless claim service.

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