What is Claim Intimation? Know its Claim Procedures

Incomplete knowledge of your health insurance policy or limited understanding can be reasons for policy rejections. Apart from providing correct and authentic personal details, it is also essential to know all about your health plan to avoid last-minute rush and claims troubles. A health plan has various clauses, and so, it is advised that a policyholder go through the policy documents thoroughly to have a complete understanding of the same. One of the essential elements in claim settlement is claim intimation.

If you are covered with a Care Health Insurance plan then care claim intimation is a necessary step to follow while raising a claim. The intimation of a claim is necessary for both the insured and the insurance provider to make necessary arrangements. To learn all about Care Health Insurance claim intimation, continue reading.

Kinds of Claim Procedures

To understand the importance of Care Health Insurance claim intimation, you must first begin with overall claim procedures. Depending on the chosen mode of health insurance claim, the process of Care health intimation may also vary.

Usually, health insurance companies deal with two types of claim procedures. Indemnity and fixed benefit claim. An indemnity claim is subject to the sum insured limit up to which the insured can get benefits. In a fixed benefit plan, the insured gets a lump-sum amount upon diagnosis, irrespective of the actual medical treatment expense. These can be claimed as either cashless or reimbursement. Let's get into details:

1. Cashless Claims

Cashless claims are the ones where the health insurance claims are directly settled between the hospital and the insurance company. Under cashless claims, the insurer pays all the admissible medical expenses directly to the hospital. Claim intimation is a necessary step in cashless claims.

Usually, a majority of the medical expenses are covered by the health insurance company and only a few expenses, like consumables, travel costs, etc., have to be borne by the insured/ policyholder. For a cashless claim, it is essential to seek medical treatment from one of the empanelled/network hospitals of the insurance company. However, with the recent announcement of ‘Cashless Everywhere’, you may be able to seek the advantage of a cashless claim if your chosen hospital meets the criteria. 

2. Reimbursement Claims

Reimbursement claims are usually raised when the insured seeks medical treatment from a non-network hospital, or wants to pay the bill upfront. In this claim settlement process, the insured has to pay all the medical expenses. After discharge, the bills have to be submitted for reimbursement of the admissible expenses. In this process also, health insurance claim intimation is a mandatory step.

Care Health Insurance Claim Intimation

Simply put, claim intimation is the process of notifying your insurance company about a possible future hospitalisation or an emergency hospitalisation emergency. Whether it is a planned hospitalisation (for instance, an elective surgery) or a medical emergency, you need to inform your insurer about the hospitalisation needs. There are many ways and sufficient time limits offered under which you must inform your insurer about the hospitalisation. Here are some important details of the Care claim intimation process:

1. You need to raise a Care health intimation irrespective of the claim process chosen: reimbursement or cashless. ATo raise Care insurance claim intimation, you may send an email to Care Health Insurance, call on the toll-free number (1800-102-4499), reach out on the WhatsApp number (8860402452), or visit a nearby branch office.

2. For a planned hospitalisation, the company must be informed 48 hours before hospitalisation.

3. In case of an emergency admission, the Care health claim intimation must be sent within 24 hours of the hospitalisation.

4. The purpose of a claim intimation is to allow the insurance company with sufficient time slot to arrange for the upcoming medical claim and the time to verify the claim of the insured

5. Failing to raise claim intimation may lead to the rejection of your claim since it may be considered an incomplete claim process. So, it is best to be aware of the Care claim intimation needs and do the needful within the time frame.

6. In reimbursement claims, if the insurer or the family does not raise a claim intimation prior to or during the hospitalisation, they may be given a specific timeframe to raise the claim by submitting the essential documents and reasons justifying their incomplete claim process. However, the claim intimation needs to be done right away!

Claim Forms

Claim forms are the formal forms that have to be duly filled and testified by the insured and sent to the insurance company. For Care Health Insurance, you can find the insurance desk in the empanelled hospitals. So, to raise a cashless claim, all you have to do is reach out to the TPA counter and raise a claim. The hospital usually writes most of the claim form sections while you may be required to verify the details and sign on it.

By offering your valid government ID and health card, you may raise a claim. The claim form will reach the insurance company, where within some time, the claim will be verified, and cashless treatment can be continued/ completed.

For a reimbursement claim also, the Care health intimation has to be sent. You may raise Care Health Insurance online claim intimation or offline, as per your convenience.

>> Also Read: How to Make Health Insurance Premium Payment Online

Tips on How to Make Health Insurance Claims

To raise a claim smoothly and get it approved soon, you must follow all the steps carefully and as required. Here are some tips on how you can raise the correct health insurance claim:

1. Choose the Type of Hospitalisation

Before beginning with the claim process, you must decide the type of claim you are seeking. In case of an emergency, you may not be able to decide, but you may do so in a planned hospitalisation. Cashless hospitalisation claims can be a convenient option since the insurance company directly settles the admissible bills with the hospital.

2. Claim Intimation

As discussed above, sending a Care claim intimation is essential. Without intimation, claim rejection chances are higher

3. Maintain Transparency

Incomplete or wrong information about your hospitalisation may pose a threat to your claim approval and may also lead to policy termination and legal charges. So, try to provide all the necessary details correctly to the insurance company.

4. Collect the Documents

While leaving the hospital, make sure to collect all the hospitalisation bills and documents. Bills are a must to raise a reimbursement claim.

5. Check Your Details

While raising a claim, make sure to re-check all your details, including the bank account details. Inform your insurance provider about any changes in the personal details and fill in the form accordingly.

Summing Up

Care claim intimation plays a vital role in the overall health insurance claim process. Missing out on intimation or delayed intimation may not be a prudent move. Raising a health insurance claim properly is only possible when you have sufficient knowledge of your health insurance plan. So, do not skip reading the fine print and seeking help from a Care Health Insurance executive.

Disclaimer: All plan features, benefits, coverage, and claims underwriting are subject to policy terms and conditions. Kindly refer to the brochure, sales prospectus, and policy documents carefully.