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Insurance Claim | Meaning & Process Explained

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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