New India Health Insurance Claims Procedure
New India Assurance has over 160 insurance and financial products that deals especially with general assurance products. The company provides cover commercial requirements such as large industries, SMEs, Retail, Rural, and Social as well as Micro Insurance.
New India Assurance boasts of a distribution network including bancassurance partners, non-governmental organisations, auto majors, corporations, government, and brokers. It has a network of 2,097 offices and counting, along with 1,041 micro offices in India.
The company was the most profitable general insurer during the year 2012 - 2013 in India. Its 'AAA/Stable' rating by CRISIL, giving it an extra edge over other insurance providers. Currently New India Assurance has 8 mediclaim or health insurance policy, each be spoked to the requirements of Indian citizens, which is why it is so popular. It also has a large network of hospitals where cashless facilities are available, across the country.
The process of obtaining benefits under your health insurance policy from the insurance provider is known as health insurance claim settlement. Protection in the form of a sum insured is included when you get health insurance. In the event of an emergency, an accident requiring hospitalisation, or the cost of medical care, the insured sum is used to provide financial assistance.
Types of Health Insurance Claims Settlement:
The various types of health insurance claims settlement are mentioned below -
Cashless Claim Settlement Process - According to the policy document, you can only use the cashless claim option if you are hospitalised to a network hospital. The network hospitals in your city of residence are listed in your policy paperwork. You won't need to take any money out of your wallet to make a purchase in the cashless mode. The full cost of hospitalisation and medical care will be covered by the insurance. All you have to do is give the third-party administrator your cashless health card.
Reimbursement Claim Settlement - You will be expected to pay the hospital bill and the cost of the medical care under this option, either right away after the treatment or prior to discharge. After that, you must submit a claim for reimbursement directly to your insurer. According to the terms of the policy, the insurer will cover the cost of the medical care.
New India Health Insurance Cashless Claims Procedure:
There are two situations that may occur when claiming health insurance. The cashless treatment is one that allows the policyholder to use the insurance as money to seek their treatment without having to pay any money upfront for treatment. The other scenario that is possible is in the case that the treatment has been already done and paid for but claim settlement requires to be made to allow the individual to be returned the money spent for treatment.
Cashless treatment generally allows people to get treated for an illness covering all medical expenses for the treatment through the New India Assurance health insurance on an individual basis. The person concerned can do so at any of the network hospitals enlisted by New India Assurance on their website, or policy brochure, across the country.
Simply follow the steps mentioned below to file a cashless claim:
New India Health Insurance Cashless Claims Procedure:
- Reach out to the network hospital and make sure you are carrying the health card issued by New India Assurance and seek admission.
- Intimating the cashless facility can be done by calling the number mentioned on the card or the health insurance helpline number mentioned on the company website. For planned hospitalization make sure you reach out to the company 2 days prior to admission.
- Submit the health card along with a proof of ID to the network hospital who in turn will conduct the verification of your credentials.
- Once this process is taken care of a pre-authorization form will be required to be filled in, from the hospital, where the attending doctor will have to sign it. In the general case of planned hospitalisation, a letter of authorisation has to be submitted.The pre-authorization form, once completed has to be sent by the hospital to the insurance provider with relevant information.
- In this case New India Assurance will communicate with the relevant bank to update the status of the claim made , which could be either be acceptance or rejection or possibly the request for additional information or documentation.
- Once accepted, the medical bills and costs covered under the policy are settled by New India Assurance, while things that are not covered will have to be taken care of, by the patient/card holder.
- The policy owner has to also verify and sign the original bills and at the same time keep a photocopy of the entire hospitalisation record.
- Here is how the cashless claim process for New India Assurance works: New India Assurance will then approve or reject it based on the policy in place.
- Register the claim within 7 days of the patient's or the covered individual's discharge, and immediately let New India Assurance know about it.
- The policyholder should fill and submit the Claims Form, providing a photocopy of a valid ID proof along with it.
- You need to send the required medical certificates along with diagnosis reports which has been signed by a doctor.
- Reports and discharge summary i.e. original has to be submitted for verification.
New India Health Insurance Reimbursement Claims Procedure:
There are chances when New India Assurance may reject the claim for cashless hospitalisation and treatment. However, the insured individual can claim a reimbursement for the expenses incurred for the treatment with a few simple steps.
New India Health Insurance Reimbursement Claims Procedure:
- Claims Process: The claim will be approved or rejected based on the policy as well as documentation provided.
- The policyholder must let the insurer know about hospitalisation within 7 days of his/her discharge.
- Pre-authorization might be required from the company for certain situations.
- All documents must be submitted within 10 days of the patient's discharge.
- You need to inform the company immediately after being hospitalised.
- After the treatment is completed, all hospital bills have to be settled by the policyholder, you need to keep all the bills and reports.
- You need to then submit the duly filled claims form to New India Assurance for processing and reimbursement. The insurer will reimburse all bills if as long as all the information provided is given correctly.
Documents Required:
The following documents are required for health insurance claims -
- Filled and signed claim application form
- Prescription of doctor
- Papers of treatment
- Original scripts and medical bills
- Card of hospital discharge
- Health card copy
- Invoices of medicine purchased
How to Make Health Insurance Claims?
Follow the steps mentioned below to make health insurance claims -
Step 1: Visit the preferred network hospital
Step 2: At the TPA, submit your cashless card.
Step 3: Complete and send the Cashless Request Claim Form to the TPA.
Step 4: Make sure you have a valid photo ID and your policy number.
Step 5: Provide the pertinent paperwork needed for the therapy
Step 6: Your insurer and the TPA will work together to create a pre-authorization form.
Step 7: The insurer will approve the precision for paying the cost of the therapy after verification.
Step 8: Make sure you bring all of your medical history documentation and hospital bills.
GST rate of 18% applicable for all financial services effective July 1, 2017.
Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.
FAQs on New India Health Insurance Claims Procedure
- Am I entitled to health insurance claims, if I have just bought the health insurance?
Every health insurance policy enables you to cashless care as long as you seek it at a hospital that is part of the insurance provider's network. As was previously stated, you must be hospitalised for at least 24 hours in order to file a claim with your health insurance.
- What are various expenses that the health insurance doesn’t cover?
There are several costs that are not covered by any health insurance plan, such administrative fees, services fees, laundry costs, additional bed costs, toiletry costs, nappy costs, syringe costs, telephone costs, etc. Please refer to the policy wordings for more information on what exactly is not covered by your insurance company.
- What does claim loading in health insurance mean?
When you file claims under your coverage, the health insurance provider adds a fee called "claim loading" to your renewal cost. Loading is a feature of most health insurance companies' policies. The firms calculate loading in a number of different methods.
- What happens if the insurance company denies my health insurance claim?
No insurer may reject your legitimate claim, in accordance with IRDAI regulations. Therefore, if your request for a cashless procedure is turned down for legitimate reasons, you can still pay for the procedure and all associated costs out of your own pocket and subsequently submit a request for reimbursement. Your claim request cannot be denied if it falls under the policy's terms and conditions and is therefore covered.
- Is there a waiting period involved when it comes to health insurance claim?
Yes, customers may be asked to wait for a period of time when it comes to health insurance claims.
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