How to File a Claim Under Senior Citizen Health Insurance Plans

As a senior citizen, you might be eligible for a variety of health insurance plans that can help you cover medical expenses. These plans are designed to ensure that you have access to quality healthcare and are able to cover some of the expenses associated with medical treatments. If you are enrolled in a senior citizen's healthcare insurance plan, you may be able to file a claim to cover the costs of your medical treatments and services.

This article will show you how to file a claim under senior citizen health insurance plans, including the steps you must take and the documents you must provide. It will also inform you of the various types of coverage that are available to you.

Understanding Senior Citizen Health Insurance Plans

Before filing a claim, it is important to understand the types of coverage available through senior citizen healthcare insurance plans. In most cases, these plans are designed to provide coverage for hospitalisation, doctor visits, prescription drugs, and other medical expenses.

The type of coverage available will vary depending on the plan you choose. For example, some plans may provide coverage for routine care, such as annual checkups and preventive care, while others may provide coverage for more serious medical treatments. Additionally, some plans may provide coverage for out-of-pocket costs, such as copayments and coinsurance.

When choosing a plan, it is important to consider your healthcare needs and select which plan best meets those needs. Additionally, it is important to consider the cost of the plan and make sure you can afford the premiums.

Filing a Claim

The policyholder can file a claim under a senior citizen healthcare insurance policy in the event of an unexpected hospitalisation or emergency medical treatment. The policyholder can file a cashless claim for treatment at a network hospital or for a refund of treatment expenses incurred at a non-network hospital. The steps for filing a reimbursement or cashless claim under a senior citizen healthcare insurance policy are as follows:

Making a Cashless Claim

The following are the steps you can take to file a cashless claim under a senior citizen health insurance policy for medical treatment received at a network hospital:

• Step 1: Hospitalisation at a hospital in the insurance company's network.
• Step 2: Complete and submit the pre-authorisation form, which can be availed at the network hospital.
• Step 3: The hospital authorities will submit a pre-authorisation request to the TPA (Third Party Administrator), which will be authorised by the insurance company or claims team to begin the insured senior citizen's cashless hospitalisation.
• Step 4: The insured senior citizen will receive treatment, with the insurance company directly covering the treatment costs.

Reimbursement Claim for Senior Citizens' Health Insurance

To file a reimbursement claim for a senior citizen healthcare insurance plan, follow the steps outlined below:

• Step 1: Immediately notify the insurance company if the insured senior citizen is hospitalised for immediate medical treatment.
• Step 2: Gather all medical records and bills from the insured senior citizen at the time of discharge.
• Step 3: Complete and sign the claim form. Submit the claim form to the third-party administrator (TPA) along with all supporting documents such as medical reports, chemist bills, prescriptions, hospital admission and discharge certificates, and so on.
• Step 4: The insurance company will evaluate the claim, and the policyholder will be reimbursed.

Bottom Line

When selecting a plan, it is important to consider your healthcare needs and make sure you can afford the premiums. Once you have selected a plan, you can contact the best health insurance company in India to begin the process of filing a claim. Following the steps outlined above, you can have peace of mind knowing that your medical expenses are covered. Niva Bupa offers a number of plans for senior citizens which can help them to prevent financial emergencies during medical crises.