Understanding the steps to be followed after getting discharged and being aware of the documents required can help you go through the claim process smoothly and efficiently.

Here is a blog that delves into explaining how to process medical insurance claims, the requirements and a few tips for claiming health insurance.

Types of Health Insurance Claims

Before we understand how to make a medical claim, let’s know the different types of health insurance claims applicable to individual health insurance and family floater health insurance plans.

Cashless Claims

In a cashless claim, the insurance provider settles the hospitalisation and the treatment bills directly with the hospital.

At the time of discharge, you pay for the expenses not covered by your policy, and we will settle the remaining applicable expenses. The cashless hospitalisation benefit applies to emergency and planned healthcare needs and can be used at the network and non-network hospitals.

Also Read: What is a Cashless Everywhere Facility?

Reimbursement Claims

In a reimbursement claim, after being discharged from the hospital, the policyholder must pay the necessary bills out-of-pocket.

Further, to seek reimbursement, they must submit the receipts and medical documents to us within 15 days from the date of discharge

Tips to Claim Health Insurance

Incomplete or incorrect documentation, misunderstanding policy coverage and missed deadlines for submitting claims are some of the common issues that can create significant challenges during claim settlements.

Here are a few tips for claiming health insurance.

Getting the Discharge Summary

One of the most vital documents that needs to be procured first is the discharge summary. This document should have all the necessary details, starting with the person’s name and age, as well as the diagnosis and treatment provided. In addition, it should contain any further course of treatment, if applicable.

It is good to have a photocopy of this document as soon as you get it, as it could also be useful after the reimbursement. The document must be kept safely until the claim is approved.

Saving all the Bills and Receipts

During hospitalisation, a major part of the money goes into room rent, medicines, and other treatment procedures. At every point, it is necessary to have a dated cash memo for whatever amount you pay in exchange for whatever service you receive.

So, before discharge, ensure that all bills and cash memos, including full dates and details, are collected and organised in one place for future submission.

Do remember, bills are subject to acceptance depending on their authenticity. Handwritten bills may not work here so it is necessary to have all computer-generated bills.

Filling out the Claim Form

For speedy reimbursement, the claim form can be prepared and preferably filled out before discharge. To avoid discrepancies, ensure that you provide accurate details concerning the healthcare needs and medical services availed.

Getting the Medical Certificate

Get a medical certificate from the attending doctor. The medical certificate will have basic details, such as the reason for hospitalisation and the period for which the policyholder was hospitalised. As it validates crucial details, it can aid in a smoother claim process.

Getting the FIR (First Information Report)

In case the policyholder is hospitalised after an accident, an FIR must be filed and submitted to us for the medical insurance claim. It will serve as an official record and aid in validating the claim.

How to Claim Health Insurance After Getting Discharged?

RCare Health is our dedicated in-house health claims unit. The contact details are mentioned on the policyholder’s Health Card.

Steps for Cashless Claims - Emergency and Planned Hospitalisation

• Verify Hospitalisation Bills

  After the doctor advises discharge from the hospital, the policyholder must review the hospitalisation bills and verify the expenses. If there are no discrepancies, they can sign the bills.

• Submit the Hospitalisation Bills and the Medical Documents at the hospital

  After the verification, the policyholders must submit the hospitalisation documents, such as the discharge summary and medical investigation reports, at the hospital. They can retain a copy of all the documents submitted for future reference.

• Claim Settlement

  Upon verification of the medical records and the hospitalisation bills, we will directly settle the bills at the respective hospital.

Steps for Reimbursement Claims - Emergency and Planned Hospitalisation

• Verify and Settle Hospitalisation Bills

  After the doctor advises discharge, the policyholder must verify the hospitalisation bills and settle them out-of-pocket.

• Gather Documents

  Upon settling the bills, the policyholder must ensure that all the necessary documents are gathered from the hospital. Some of the most important documents required in the original are:

• Discharge Summary

• Doctor’s Prescription

• Hospital Bills

• Payment Receipts

• Pharmacy Bills

• Medico-Legal Certificate for accident-related hospitalisation

• Implant sticker or invoice, if applicable

• Register Claim and Submit Documents

  After collecting the necessary documents, register the reimbursement claim with RCare Health and submit the documents.
  In addition to the documents mentioned in the above step, policyholders should also produce the following documents:

• ​Claim form

• Proof of Identity

• Copy of Health Card

• Cancelled Cheque

• First Information Report in case of accidents

Scanned copies of the original documents need to be shared with us within 7 days of discharge.

Further, the documents should be submitted to the following address:

Reliance General Insurance,
No. 1-89/3/B/40 to 42/ks/301, 3rd Floor,
Krishe Block, Krishe Sapphire, Madhapur,
Hyderabad 500081.​

• Register Claim and Submit Documents

  Upon verifying the claim and supporting documents and successfully approving them, the payments will be reimbursed. In case of any discrepancies, policyholders will be promptly notified.

For Post-Hospitalisation

At Reliance General Insurance, we cover post-hospitalisation medical expenses for up to 180 days from the date of discharge. Policyholders can contact RCare Health and register their claim for the post-hospitalisation expenses with all the relevant supporting documents.

Important Steps to Consider For Hassle-free Claim Settlements

• For Cashless Claims - Emergency and Planned Hospitalisation

• For the cashless hospitalisation benefit to be applicable, the policyholder must inform RCare Health and register the hospitalisation within 48 hours for emergencies and before 48 hours for planned treatments.

• Policyholders must also ensure that they get the pre-authorisation form from the hospital at the time of admission, fill out the details and submit it for authorisation.

• The representatives at the hospital will connect with us to complete the process. Upon approval, the pre-authorisation form has to be shared with us with the medical documents.

• For Reimbursement Claims - Emergency and Planned Hospitalisation

• For both emergency and planned hospitalisation, the policyholders must intimate RCare Health about the admission. Emergency hospitalisations should be informed as soon as possible, while planned treatments must be communicated prior to admission. 

Important Links:

• Download Claim Forms

• Online Claim Intimation

Wrapping Up

Understanding health insurance claims and the related processes is simple and straightforward. By following the essential steps specific to the type of claim, whether cashless or reimbursement, policyholders can pave the way for a smooth claim settlement process.

In addition, timely submission of the claim and accurate documentation of all the necessary details help accelerate the claim approval process.

Reliance General Insurance offers affordable health insurance policy options with customisable features to meet the healthcare needs of individuals and families. Explore our range of products for a healthier and more secure future.

Frequently Asked Questions

Can I claim health insurance after discharge from the hospital?

Yes, you can claim health insurance after being discharged from the hospital. For reimbursement claims, you need to submit the relevant documents, including bills and medical records. For cashless claims, ensure you have provided the pre-authorisation form, verified the bills, and submitted them to the hospital during discharge.

In addition, for post-hospitalisation expenses incurred within 180 days of discharge, you can raise a claim with RCare Health, provided you include all necessary supporting documents. 

How to claim health insurance online?

You can follow these two simple steps to claim health insurance online:

1. Register the claim - Online Claim Intimation

2. Share the scanned copies of the documents within seven days of discharge. (Email - rgicl.rcarehealth@relianceada.com)

Is claim intimation mandatory?

Yes, claim intimation is mandatory for both cashless and reimbursement claims. In the case of cashless hospitalisation, the claim intimation should be made within 48 hours for emergencies and before 48 hours for planned treatments. In case of reimbursement claims, the claim intimation should be made as soon as possible for emergencies and prior to the admission for planned treatments.