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Know the Time Limit for Filing a Health Insurance Claim

Team AckoJan 17, 2024

Imagine a scenario where you do everything right related to health insurance but falter at the last step. You spend time online to compare, select a suitable policy, make the payment, and raise a claim after facing a health issue. However, you come to know that the insurance company has rejected your claim as it was raised too late! Yes, that is a possibility. Therefore, one must adhere to the timelines while applying for a claim. Read ahead to know the time limit for filing a claim against a health policy in India.

Contents

Meaning of the Term Time Limit
Why is there a Time Limit?
Basic Documentation during Claim Settlement

Meaning of the Term Time Limit

There is a predefined time limit that policyholders need to adhere to when it comes to ensuring smooth claim settlement of a health policy in India. Different insurers might have different timelines. Also, there are different time limits for different kinds of claims. For example, the time limit for a cashless claim is different from that for a reimbursement claim.

Why is there a Time Limit?

A health policy in India comes with a strict time limit regarding applying for a claim mainly for fraud mitigation. A deadline for application means less time for fraudsters to falsify information. Also, a time limit is helpful with respect to managing the operation aspect of claim settlement.

In case of a Cashless Mediclaim

If you have a cashless Mediclaim/health policy, you will have to inform the insurance company around 3 days before hospitalization. This is possible when it comes to planned hospitalization. Such an intimation helps to smoothen the process between the insurance company/Third Party Administrators and the network hospital.

In case of an emergency Cashless Mediclaim Policy

It is not possible to predict an emergency situation. As a result, one cannot notify the insurance company three days before the emergency. Therefore, the time limit for emergency cashless Mediclaim policy is 24 hours after getting admitted in a hospital.

In case of Reimbursement Claims

A reimbursement claim means that you have to pay the hospital bills upfront and then claim the same from the insurance company. In such cases, there is no need for intimation prior to hospitalization. However, one needs to raise a claim between 7 and 15 days of being discharged from the hospital.

In case of Post-Hospitalization Claims

There are certain health insurance policies that also settle post-hospitalization claims. Usually, it takes time to raise such claims due to their nature. Therefore, the time limit for such claims is two weeks after a month or two after hospitalization.

Also, read: Including Parents in Employer’s Insurance

Basic Documentation during Claim Settlement

Irrespective of the kind of claim you are raising, it is necessary to provide basic documentation. One must be honest while filing the documents and try to provide as many documents as one can in support of your claim request.

Here is a list of documents that are essential while filing a claim:

Detailed claim application
Discharge card
Bills
Reports
Prescription details

Being Proactive while choosing an Insurer

With a lot of certified insurance web aggregators in the market, policyholders are now aware regarding the benefits of comparing policies before purchasing them. However, one must focus on coverage, premium, and features in totality while comparing. Another crucial factor that people might overlook while comparing and purchasing an insurance policy is the insurer’s credibility.

One should be proactive while choosing an insurer. This can be done by speaking to friends and family, checking online reviews, and reading more about the company online.

Insurance works on faith, honesty, and transparency. You must be fair in raising a claim, be patient while waiting for claim settlement, and trust your insurance company.

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Disclaimer: *Except for exclusions like maternity benefits, undisclosed diseases, etc. Please check policy wordings for more details.

**The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.