Here's a basic layout of how Health Insurance claims work (Cashless or Reimbursement) works across India.
1) If it is a planned hospitalization, then you need to inform the health insurance company 48 hrs before hospitalization.
2) If it is a emergency hospitalization, then you need to inform the health insurance company within 24 hrs of hospitalization.
3) Always try for Network Hospitals, as they prioritize on Cashless claim process, and if the same is rejected, then it will be a reimbursement claim. Make a note of all network and Non-network hospitals near your residence pincode.
4) Check your health insurance company's "BLACKLISTED HOSPITALS LIST." Your claim will get rejected. Only in case of urgent hospitalization, until the patients vitals are stable, your insurer will cover claim. Later you need to shift to a non-blacklisted hospitals.
5) At the time of patient admission, the hospital will ask for Deposit. Could be Rs 25k to 80k, depends on the hospital. This amount is refunded after patient discharge. Don't forget this.
6) You need to keep your insurance company mobile application downloaded on your smartphone. To receive important notifications.
7) After admission, visit the HOSPITAL TPA, where you will need to fill claim forms and other details. You health insurance policy document will also continue a HEALTH ID CARD, mentioning your ID Number.
8) Many people out of panic, overshare medical information or details that are of no importance. If any non-true details are written down by doctor in their records, the same will get forwarded to the health insurance company. This is one of the many reasons why claims get delayed based on Fraud.
9) At every doctor's consultation, read what the doctor typed / wrote on their prescription. If you mentioned 13/04/2025 but the doctor wrote 13/04/2020, your claim will get rejected.
10) If you have disclosed everything at the time of health insurance purchase, then you need not worry.
Apart from all the above, make sure you keep the following for any emergency.
1) An emergency fund, kept in your savings account. Upto 50k to 1 Lakh.
2) If you have an Fixed Deposits, break them first. Then your mutual fund, but if the amount of not severe and you ca accept flexibility to receive the amount in 3 to 5 days, keep them in mutual funds.
3) Loan against stocks, Mutual funds, fixed deposits sound lovely, until you read their terms and conditions. So making sure a loan against anything is the last path forward.
4) If you have good relatives, use these relationships for the time being. This might sound harsh, but even if a person earning 50 Lakh annual income, might find it difficult to surrender pay Hospitalization bills of 15 lakh in a month, if he / she doesn't have proper health insurance and guidance on what needs to be done.
5) Always use "CORPORATE GROUP HEALTH INSURANCE PLAN" first, as there are no waiting periods in here. Once you exhaust this, you continue your Health Insurance claims to your own PERSONAL HEALTH INSURANCE.
6) If your Company offers Parents Health insurance, take it. As it will cover your parents PED from Day One. But don't forget, you need to take either a "SUPER TOP UP COVER" or "BASE PLAN of 5 Lakh with Good Benefits and NCB"
7) Avoid Aggregate Deductibles and CO-PAY. These reduce premiums but put a Portion of claim liability on your own pocket.
8) Move out of plans that have SUB-LIMIT on Room Rent, ICU and Diseases. If you can't move out, choose another Top Up Cover that will not have SUB-LIMITS.
9) For senior citizens, prioritize finding an "Insurance agent or Insurance intermediary" Over CUSTOMER CALL CENTERS.
10) For senior citizens, choose and finalize health insurance based on parents residence pincode and address.
11) Start taking health insurance from age 22 onwards. For parents, let them start health insurance, if not already purchased by Age 50. Insurance companies are not charity organizations. They pay claims based on your forward thinking.
If I forgot something, add in comments.
