Claim
A “claim” in health insurance is a request by the policyholder to inform the insurance company about hospitalisation and ask for payment of medical expenses.
Notification of a Claim to the insurance company is the first step to filing a claim. The policyholder can do it by directly informing the insurance company or informing the advisor who would inform the insurer on his behalf.
For a valid and admissible claim, the insurance company can directly settle the hospitalisation expenses to the treating hospital through a cashless facility. The cashless facility for claim settlement is available at the network hospitals which are empaneled with the insurer.
Otherwise, the claimant has to pay upfront for the hospitalisation expenses. The insurance company later reimburses the claim amount to the claimant. Reimbursement of health insurance claims is a lengthy and tedious process requiring meticulous paperwork.
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A
- Accident
- Acute Care
- Acute Condition
- Age Limit
- Agent
- Ambulance Cover
- Annual Health Checkup
- Annual Renewal Date / Renewal Date
- Any One Illness
- AYUSH Treatment
B
C
- Cancer Insurance
- Cashless Facility
- Chronic Condition
- Claim
- Claim Assessment
- Claim Rejection / Claim Repudiation
- Claim Settlement
- Claim Settlement Ratio
- Comorbidity
- Congenital Anomaly
- Consumables
- Continuity Benefit / No-Lapse Benefit
- Contract
- Convalescence Benefit
- Copayment
- Critical Illness
- Cumulative Bonus / No-Claim Bonus (NCB)
D
- Daily Hospital Cash / Daily Cash
- Day Care Treatment
- Deductible
- Discharge Summary
- Domiciliary Hospitalisation
- Durable Medical Equipment
E
F
G
H
I
- Illness
- Indemnity
- Injury
- Inpatient Care / Inpatient Hospitalisation
- Insurance Ombudsman
- Insured Person
- Insurer
- Intensive Care Unit (ICU)
- IRDAI
L
M
N
O
P
- Personal Accident Cover
- Planned Hospitalisation
- Policy Document
- Policy Schedule
- Policyholder
- Portability
- Post-Hospitalisation Expenses
- Pre-Authorisation (of Cashless Claims)
- Pre-Existing Disease (PED) / Pre-Existing Condition
- Pre-Hospitalisation Expenses
- Pre-Policy Medical Check-Up
- Premium
- Proportionate Deduction
R
- Reasonable and Customary Charges
- Reimbursement
- Renewal
- Renewal Premium
- Restoration Benefit / Automatic Restoration
- Rider / Add-on Cover
- Room Rent Limit
S
- Shared Accommodation
- Sub-Limit
- Sum Insured
- Super Top-Up Health Insurance Plan
- Surgery or Surgical Procedure
- Survival Period
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