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How To Fill A Health Insurance Claim Form

Posted by Royal Sundaram on 16 Jan 2018

How To Fill A Health Insurance Claim Form

A claim rejection may not be a pleasant feeling, especially at a time when there is a medical issue. To ensure it doesn’t happen, you need to fill the claim form with all the correct details. Here is how you do it.

For a simple understanding, we divide the claim form into various sections.

Section A: This section requires you to fill in details about the policyholder.

  • Ø Policy number
  • Ø Third Party Administrator (TPA) ID.
  • Ø Your name, address, phone number
  • Ø Email Id and an alternate Email Id

 

Section B: This section requires you to provide details about your health insurance history.

  • Ø Do you own any other mediclaim or health insurance?
  • Ø Company name and policy number
  • Ø Sum insured under that policy
  • Ø Date of commencement of first insurance

 

Section C: This section requires you to provide details of the hospitalized individual

  • Ø Name, age, D.O.B., gender
  • Ø Relationship to the policyholder
  • Ø Complete communication address
  • Ø Occupation and employer details

 

Section D: This section requires you to provide details about the hospitalization details

  • Ø Name and complete address of hospital where admitted
  • Ø Reason for Hospitalization and details on room category
  • Ø Admission and discharge date
  • Ø System of medicine administered

 

Section E: This section requires you to provide claim/claims information details

  • Ø Total hospitalization charges
  • Ø Pre and post hospitalization charges
  • Ø Ambulance charges
  • Ø Health check-up costs

 

Section F: This section requires you to provide details on the cash/benefits

  • Ø Hospital daily cash
  • Ø Any critical illness benefit
  • Ø Cash for surgery
  • Ø Benefits for pre/post hospitalization.

 

Section G: This section requires you to tick the documents you submit.

  • Ø Hospital bill. (main bill, break-up), other medical reports.
  • Ø Pharmacy bill and medical prescriptions
  • Ø FIR/MLC in case of accident injury.
  • Ø KYC documents with cancelled cheque of bank where policyholder owns an account.

 

Section H: This section requires you to provide details on the bills you need to enclose

  • Ø Main hospitalization bill
  • Ø Pre-hospitalization bills
  • Ø Post-hospitalization bills
  • Ø Pharmacy bills

 

Section I: This section requires you to provide the bank details as mentioned.

  • Ø Your PAN details
  • Ø Your account number.
  • Ø The bank branch and account number
  • Ø The IFSC code

 

Section J: This section requires you to provide declaration

  • Ø It means that you confirm that all the documents and data you’ve provided is genuine
  • Ø Write the day’s date
  • Ø The place (your city)
  • Ø Policyholder’s signature

Bear in mind, the insurer will verify all details before approving any claims. Therefore, you must provide genuine details.

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