Documents Required to File Health Insurance Claim

Here are some commonly required health insurance reimbursement documents:

1.
• Reimbursement Request Form: This has to be filled with information such as personal data, insurance policy number, specifics of treatment and amount claimed.

2.
• Claim Handling Form: If the claim is passing through a Third-Party Administrator (TPA), the Claim Handling Form must be filled and returned to the TPA.

3.
• Medical Reports: For this, you can include copies of test results, pathology reports, image studies or other diagnostic reports pertinent to treating the patient.

4.
• Original Bills and Receipts: Obtain itemised original bills showing professional fees, hospital costs, pharmacy bills, and diagnostic test results.

5.
• Identity Proof: Attach valid identity proof such as a PAN Card, Aadhaar Card or Passport.

6.
• Copies of Prescriptions: Mail copies of the prescription issued by the attending physician for the prescribed medication/treatment.

7.
• Cash Receipts: If you made any cash payments for treatment, then retain your receipts or transaction documentation.

8.
• Discharge Summary: In case treatment was carried out through hospitalisation, a Hospital Discharge Summary shall include diagnosis, treatment received and other vital details.

9.
• Policy Document: A copy of your state-issued health insurance policy paperwork that shows coverage, terms and conditions should also be attached.

10.
• Other Supporting Documents: As requested by your insurance company, attach all other necessary papers, including any letters of referral or prior authorisation form.

Consider taking time and going through the Health Insurance document to be certain about all the documents required for successful applications. You can also get in touch with the insurer to know about the same.

A reimbursement claim can be made by the policyholder for compensation of medical expenses paid out of his/her own pocket. The insured pays in arrears for services not billed directly by the insurance company.
Policyholders need to submit relevant documents like medical bills to the insurer in order to claim reimbursement. The eligibility of the claim is determined as per the policy’s terms, such as coverage limits and deductibles. The insurer may offer coverage to the policyholder for a specified sum up to stated limits if the application is accepted.

Here is the procedure for applying for health insurance reimbursement:

Applying for a health insurance claim in India for your family can be challenging, but the following tips can increase your chances of a successful claim: