Optima Insurance Brokers Pvt. Ltd.

Insights

Our views on important risk issues and emerging risks.

Claiming Health Insurance Can Be Harrowing. You Can Make it Hassle Free

Do not make false declarations while taking the policy. The proposal form is the basis of the contract with the insurer. Obviously, insurance companies can’t be expected to honor a claim if the claim is not made in accordance with agreed terms.
5 POINTS TO REMEMBER

Proposal Form is Sacrosanct

Do not make false declarations while taking the policy. The proposal form is the basis of the contract with the insurer.
Obviously, insurance companies can’t be expected to honor a claim if the claim is not made in accordance with agreed
terms.

Fill the complete form yourself and sign it yourself. Do not leave it upon your agent

Read the Policy Document

It is important to read and understand the terms and conditions of a policy well. Ask your insurance broker to explain any term that you do not understand. Be clear about the policy you plan to take to avoid any hassle or heartburn in the future. Insurance companies will honor a claim if the claim is.

Check for Co-Payment Clause

Many policies impose co-payment if treatment is taken in a hospital outside the insurer’s network. It is, therefore, important to know the existence of this clause and to check whether the hospital of your choice is in the network or not. This payment should not come as surprise and a disappointment to you.

Submit All Documents

The documentation checklist required for health insurance claims usually includes first prescription of the doctor, any treatment related documents, investigation reports (X-rays, ECG, lab reports etc.), original medical bills and receipts of the hospital, labs, doctors etc., besides an admission and discharge summary form from the hospital. In case of an accident-related hospitalization a copy of the FIR will also be typically required. Original documents have to be submitted. Insurers will not reimburse bills that are photocopies.

If it Still Happens

If an insurer repudiates a claim, insist on a repudiation letter that explains the basis on which the claim is repudiated. If you do not agree you can represent the claim again as per the escalation matrix in the grievance redressal machinery. If you are still not satisfied, you may approach the insurance Ombudsman, whose decision is binding.


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Optima’s core group has more than 100 man-years of experience in insurance. Our experience has trained us in reading the fine print of insurance policies, understanding it and applying it for the benefit of our clients.

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