A smooth Claim settlement is the basic expectation of all policyholders. Your claim settlement can be a nightmare if not handled professionally and can also cost you a bomb. The following pointers will help you understand the claim process and ensure a smooth claim settlement.

At the time of Buying a policy:
Ask for the Policy Wordings and read through that in addition to looking at the Product Brochures. No Insurer would ever break the promises of the policy wording.

Be clear about what will be covered and what will not be covered.

Avoid Policies with Room Rent Limits, Sub Limits, and Co-Pay.

Ensure that the policy fully covers Modern Treatment and AYUSH Treatments.

Disclose all your medical history upfront when you purchase a policy. Share the Discharge Summary of all the Surgeries and Hospitalisations undergone to date. Share the names and dosages of Medications /Injections, if any, being used as of date.

Ensure that you read the Proposal Form personally for its accuracy before submission.

Read and understand the standard exclusions, pre-existing diseases waiting period, excluded treatments, and sub-limits.

Have a qualified and knowledgeable Health Insurance Advisor to guide you in choosing the right Insurer, The right policy, and The right cover, age, and support during claims.

In case of Hospitalisation:
Have a copy of your Policy document easily accessible to your family for emergencies.

Always go for cashless hospitalization if possible. In case of emergencies, inform the Insurer as soon as possible.

Take pre-approval and go for planned treatments/surgery wherever possible.

Know the good cashless hospitals near your residence and workplace so you know where to go in an emergency.

Intimate the claim to the Insurer within 24 hours and get the Claim Intimation Number.

Inform your Insurance Advisor about the hospitalization with all the details.

In case of a reimbursement Claim:
Ensure that all Bills are signed and Sealed.

All documents submitted have to be original.

Submit Prescriptions, Test Reports, and Bills with Listing and Summary.

Part B of the Claim Form has to be Completed, Signed, and Sealed by the Hospital.

Part A has to be Completed and Signed by the Insured.

The claim form should have your Policy Number, Claim Intimation Number, Email ID, Mobile Number, and address.

Do not forget to add Hospital Cash if your policy provides a fixed daily hospital cash benefit.

Attach Your Self-attested PAN and Aadhar Copy along with your Policy copy, passport-sized photograph, and Cancelled Cheque.

Submit your Claim and collect an Acknowledgement. Also keep a copy of all Original documents submitted, to you.

Respond promptly with details if there are any queries from the Claims team.

Always get a final claim settlement sheet from the company showing details of the claim and the rejected amounts, if any, with reasons against each claimed item.

Have Clarity about the Policy wording, and ensure that you get what the Insurer promises in writing.

Ensure you know how much is covered, what is covered, and what is not covered in your policy.

If you are not satisfied with the claim settlement, you can write to the grievance cell of the Insurer. If you still do not get fair treatment, write to the Ombudsman for a quick settlement. All the contact details are available in your policy document.

Transparency and Good Faith are the foundation of any Insurance Policy. If you are transparent in your disclosures at the time of taking the policy, clear about the policy features and coverage, and follow the claim process, then the claims will be settled as per the policy wording for sure.

Professional support always matters, so stay connected with your Health Insurance Advisor.

By, Dr. Ashok Chandran, Health Insurance Specialist

Continuous Adequate Cover should be the basis of any Health Insurance.

Let us ask ourselves, Why do you need Health Insurance?

• Medical costs are continuously increasing at over 14% per annum. It is impossible to bear the huge costs without Insurance.
• Lifestyle Diseases are increasing and impact all.
• Accidents are very common and can happen to anybody, anytime.
• Adequate health coverage helps us to choose the best doctor, the best hospital, and the best line of treatment. Thus Insurance can be Life Saving.
• Adequate Health coverage protects your savings and your family's life goals. Hospital bills today are so huge that, Absence of adequate health coverage disrupts your financial stability and disrupts all your family goals.

For the above and more reasons, one can say that it is critically important that we should be covered under Health Insurance adequately every minute of our life without any breaks.

Can you depend on Corporate Insurance for Continuous coverage for a Lifetime?

• Normally when the employment ends, the medical cover also cease to exist. Group Insurance cannot be ported to Individual Cover.
• Group Insurance is generally taken by companies to fulfill legal compliances and industry norms, or saving in taxes. The real Insurance need of employees and their families is not the criteria.Everyone in your family has different Insurance needs as per their age, health and family history.Individual policy for each family member as per their Insurance needs is a need of the hour.
• Many policies have a Waiting period for certain diseases or cover. Thus when you join a new company your policy may not cover everything from day one.
• Generally when people switch jobs there is a gap in Insurance while switching, which can be a Day or even months. This period without cover is a very high risk.
• When premiums increase, many companies simply stop the medical cover.
• Thousands of companies do not have any Health Insurance scheme for their staff; you may still join them as we seldom look at health Insurance as a criteria for selecting employer.
• Corporate Mediclaim is normally low in value and the sum Insured can be 1-2 Lac or a maximum of around Rs. 15 Lac. Inadequate Insurance is equal to having No Insurance.
• Corporate Insurances are a Floater and not individual policies that take care of every individual as per their needs. You can expect only general basic features in a group policy.
• Critical illness or Accidental long term or permanent disability will lead to termination of employment by the employer. In this scenario There will be no Income, The Medical costs will be the highest and there will be no Insurance Cover for protection.

Your Wealth, Health, Job, Position, Income, Family, Knowledge, Connections, Hard Work Etc. does not guarantee you any control over life.

Life consistently throws opportunities and challenges at you.

Man has no control over Death, Disability, Disease, Disaster, Accident, Incident Etc; The financial impact of the same on your family can only be minimised, with adequate Insurance covers.

There are sure events like children's education, marriage, Buying House, Retirement Etc. for which you can have a goal based financial plan, and invest accordingly. 

Your Family's Financial Future is defined by your Financial Awareness, Financial Actions and Discipline and not by your current Income or Wealth.

Insure, Invest and Allocate Assets as per your Risk Profile & goals, and Review it with your Advisor at regular intervals.

Financial Discipline and Planning over a period of time, is the only way to Financial Independence and Freedom.

Finally, God has his own ways, But never fail to do what is in your hands, to protect yourself & your family, and to be Financially Free.

All Investments are subject to Risks, Terms & Conditions. Talk to your Advisor, Read, Understand and Be Financially Aware Before Investing.

Dr. Ashok Chandran
We are on a Mission to Transform a Million Lives by 2030, through Free Financial Awareness For All.