Filling up Reimbursement Claim Form: Step by Step Guide

Health is one aspect of our life that we always prioritize, no matter what. Today, health insurance plans are the smart way to go, as the cost of healthcare is increasing day by day. These insurance plans can relieve your stress with their umpteen features and benefits [1]. Apart from cashless facility, an important benefit you can enjoy with a health insurance plan is claiming reimbursement after getting discharged from the hospital. If you have not made any reimbursements earlier, this process may seem a little tricky, but it is not. Read on to get a proper insight into what a reimbursement claim is and how you can file it.

What is a reimbursement claim?

If you buy health insurance in India, the insurance companies offer you cashless and reimbursement claim benefits. You file a reimbursement claim when you undergo medical treatment at a hospital of your choice, where you will clear all your medical expenses from your own pocket [2]. To get reimbursed for these expenses, you will need to file a reimbursement claim. This could apply to both network and non-network hospitals (non-network hospitals are the ones not listed by your insurer.)

How to file a reimbursement claim form?

Filing a reimbursement claim form is not a daunting process. Just follow these simple steps:

Claim form- part A:

Details of the primary insured

This section requires you to give details of your policy number along with your certificate and TPA (third party administrator) numbers. You may have to fill out details of the company and the insured patient’s consumer ID.

Details of the insurance history

This section includes your insurance history to assess if you have any other types of health insurance or mediclaim policies. If you have, fill the details by providing company name and policy number.

Details of the insured person hospitalized

In this section you have to fill in the basic details of insured patients like name, health ID card number, gender and address.

Details of hospitalization

Here, you have to fill hospitals details where the insured is availing treatment. The particulars include name of the hospital, room category occupied, and reason for hospitalization.

Details of claim with proper documentation

This an important part of the form containing details regarding the expenses that you would like to claim from the insurance service provider. It is important that you fill this section with utmost precision after checking and attaching all required documents.

Details of bill enclosed

In this section, you mention details like bill number, date, names of the issuing authorities, and amount of all medical bills. Make sure to attach original bill receipts along with the form.

Details of primary insured’s bank account 

Always double check while filling the details of the insured’s bank account as this is         where you will be receiving a refund for your reimbursement claim.

Declaration

It is important to read the declaration thoroughly before signing the document to understand the terms and conditions as mentioned in the form. It also hereby ensures that the details you have given are true and you will be liable in case of any discrepancies.

Claim form- part B

This form is to be filled by the hospital. It includes the following.

Details of the hospital

The hospital will mention details like name and hospital ID. This section also requires information of the doctor treating the insured patient.

Details of the patient admitted

The hospital will fill the details of the insured patient who is undergoing treatment. These include the IP registration number, admission details and time of discharge.

Details of ailments diagnosed

In this section, the treating doctor will mention diagnosis done as a part of the treatment plan. 

Checklist of the documents required for claim

This is a checklist for the hospital to verify the claim documents. Ensure all your forms and documents are properly signed before sending them off to your health insurance provider.

Additional details in case of non-network hospitals

Non-network hospitals are those that are not included in the health insurance provider’s list. In such a case, the hospital has to fill all details about their contact number and location. The hospital also needs to mention about different facilities available.

Declaration by the hospital

The hospital also has to make a declaration stating that the information furnished by them in the claim form is true and correct to the best of their knowledge.

What to check before submitting a reimbursement claim form?

• Make sure all documents have patient’s name, signature and the overall treatment cost
• The documents and the claim form should have the seal of the hospital from where the insured is being treated
• Make sure to attach photocopies of your healthcare card and medical documents with the claim form
• Ensure the address to which you are sending the documents and your form is correct
• Keep a copy of the documents you are submitting for your record

Prioritizing your health is important but it can become a little overwhelming due to the ongoing inflation in the healthcare industry. So, it is important to cover your healthcare expenses against affordable premiums. For it, you can browse through the Aarogya Care range of policies on Bajaj Finserv Health. These policies are specifically curated keeping in mind comprehensive medical coverage and emergency medical requirements. With so many options to choose from, you can use these plans to secure a great healthcare future. A few beneficial features of these plans include preventive health check-ups, doctor consultation reimbursements, huge network discounts and more.