What Happens to the Health Policy Coverage Once a Claim Is Filed

What Happens to the Health Policy Coverage Once a Claim Is Filed

A Health insurance policy come with its own set of claims, coverages and ways to file. Some involve payment compensation after hospitalization, surgical and post-surgical expenses and care. Some policies need to be renewed after the expiry of each premium for the continuation of the policy, every year. For limited premium payment in case of family floaters, although the policy term is for lifetime, the premium payment period is short. One may even opt for multiple policies while there are restrictions on the number of health insurance claims suited in some of the Mediclaim policies.

Eligibility criteria of a claim, primarily rests on the age group a person belongs to, compulsorily satisfying adulthood which is obviously starts from 18 years and generally is considered till 65 years, whether for individual or family floater policies. For children, the health insurance policy is usually considered from 95 days of age till a maximum of 24 years. To further analyze if the client is worthy of the claim or not, the policy holders keep a check on the records of lifestyle diseases, habits like drinking and smoking and pre-existing diseases.

For a cashless claim, the documents required for health insurance claim is the Cashless Health Card that the insurance provider had presented with, and this has to be submitted at the TPA counter. For a reimbursement claim, one has to fill the reimbursement claim form received from the insurer not exceeding more than 30 days after discharge, followed by the submission of the Discharge Card given by the hospital to the insurer.

The fate of the claims once they are filed:

Loading: Loading is the extra charge that is applied to the renewed premium each year, normally at a rate of 5%, resulting in the reduction of the amount of the health insurance claim that has already been paid during the settlement to the policy holder.

Medical Benefits: Perks such as reimbursed hospitalization and surgical benefits that are even available in different installments for family floaters during the time of treatment. ULIP based limited premium policies for lifetime payment often comes with the plan of promised provision of daily hospitalization payment grants, and this has to be done with the help of a TPA(Third Party Administration). Also, an additional surgical benefit is commenced irrespective of the granting of daily hospitalization expenses, and all plans are determined before the purchase of the claim, unaffected by the number of times the claims have been filed, during the policy tenure.

Hassle-free and free hospitalization: During hospitalization, one doesn’t need to bother about the pre and post treatment expenditure, as it is the insurance policy that settles the matter with the hospital authorities.

Coverage of Pre-Existing Diseases: Irrespective of the presence of a period of a pre-existing disease to get covered, it is secured by the policies, which vary from one plan to the other. The insurance provider compensates the payments for the necessary treatments.

Added coverage: Based on the plan and the additional riders, the other coverage that are provided by health insurance policies are daily cashflow for hospitalization, critical illness insurance and personal accidents.

haeAs a note of information, there has been a change in the rules and according to the new ones, the accrued cumulative bonus that is considered after a new claim is filed, it gets reduced at the same rate to which it had accrued for numerous health insurance companies.

Hence, one has to keep in mind that for a claim-free year one has to make a claim to get another bonus. For a no-claim year, the rise in bonus is about 50%, and the reduction is the same for a claim year. Also, the insurer can even reduce the bonus amount instead of the base sum.

Health insurance policies have different coverages, but once some individuals file a claim, the compensation is secured and the policy goes on. However, the overage undergoes some stark changes, like reduced benefit and premiums.

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