December 17, 2019
claim settlement, claims guide, Insurance Claim
In previous blog, we explained how a student can file insurance claim in the US in case of a US based health insurance provider. In part 2 of this 2 part blog series, Student Cover tells you how you can file a claim in case you purchased a health insurance plan from an India based health insurance provider operating in the US. Click here to go to part 1 of this blog series.
Before, we move further, one must however understand the major difference between the types of plan benefits that India based companies offer to their clients as compared to US based companies.
1. No Co-pay or Co-insurance – India based health insurance company plans do not require the clients to share cost in terms of co-pay and co-insurance. The healthcare cost is borne 100% by the company. In comparison, clients of US based health insurance providers have to pay both co-pay as well as co-insurance cost.
2. Only $ 100 Deductible – Unlike US based companies, health plans from India based health insurance providers requires them to pay only $ 100 as deductible. US company plans may require them to pay $ 100 – $ 500. They major difference however is that $ 100 deductible in case of India based company applies each time they get the treatment, whereas their US counterparts charge them $ 100 – $ 500 deductible in year.
3. No Network Hospitals – In US, those having health insurance from US based provider have the option of getting treated either by an in-network healthcare provider or an out-of-network provider. The insured get better benefits in terms of co-pay and co-insurance if there get treated in an ‘in-network’ provider. However, India based insurance company plans do not have any of these. An insured can get treated in any medical institution and get same benefits.
4. Limited Coverage – All US based company plans that are ACA compliant are required to provide unlimited coverage including coverage for pre-existing conditions, preventive healthcare etc. India based company plans however are not mandatorily required to provide these benefits.
In order to claim benefits from India based company’s health plan, clients should do the following:
If the health insurance plan was purchased through Student Cover, then the insured can email Student Cover at firstname.lastname@example.org. Our executive will enter the claim request and provide the insured with claim registration number. It will then immediately get in touch with the insured person’s health insurance company and provide it with his or her relevant details.
If however, the health insurance was purchased either online or through any other agent, the insured must either call or email that agent or the health insurance company on the contact detail provided by the company.
Note: For certain treatment and procedures, the insured are required to inform the health insurance provider in advance before undergoing treatment. Insured are advised to read the policy document and contact the insurance provider for such treatment and procedures.
Once the claim request has been registered, the health insurance company will send an email to the client which will contain a claim form. The clients are required to fill the claim form which includes details such as name and contact details, age, gender, plan ID, nature of injury or illness, medical institution with he or she is availing/availed treatment etc. One should be very careful while filling the form and should put only correct and complete information to prevent the claim being rejected or denied by the insurance company. Student Cover provides free assistance to its clients in filling claim forms.
To support the claim, the insured is required to show documentary evidence of treatment or medical procedure. In order to do that, they are required to upload the following documents and email it to the health insurance provider’s given email address.
Similar to US based insurance company plans, health insurance claims in case of India based company get settled either through direct payment to the healthcare provider or reimbursement of medical expenses incurred to the insured.
Documents required for direct settlement:
a. Covering letter to specify the claim and address for sending the claim (same as in proposal form)
b. Claim Form duly signed by the Treating Doctor and Insured.
c. Copy of passport, visa with entry and exit stamp.
d. Medical reports and discharge summary issued by the Hospital furnishing the name of the Insured, period of treatment, details of treatment rendered.
In addition to the required documents mentioned above, those seeking reimbursement have to furnish the following documents.
e. Bill & receipts in originals for:
i. Charges paid towards Hospital accommodation, nursing facilities and other medical services rendered.
ii. Fees paid to the Medical Practitioner, special nursing charges, etc.
iii. Charges incurred towards any and all test and/ or examinations rendered in connection with the treatment.
iv. Charges incurred towards medicines or drugs purchased from outside duly supported by the prescriptions of the medical practitioner attending on the Insured.
f. Copy of Cancelled Cheque (Insured’s name should be printed on Cheque) or Active Bank Account Statement which contains Insured’s Name, Account Number and IFSC Code of the Bank. Details furnished in Part C of the claim form must match with details mentioned on cancelled cheque / bank statement.
g. PAN Card copy.
Once all documents are uploaded, the insured can then email them to the insurance provider. Those who purchased health insurance from an India based provider through Student Cover do not need to send any hard copy back to India. However, those who have purchased it online or through some other vendor must check with the health insurance provider. In many cases, they are required to mail the hard copy of the documents to the insurance provider’s office in India.
After sending the documents, the insured need to regularly follow-up with insurance provider. In case of Student Cover, the follow-up is done by the organization on behalf of the insured and provide assistance, free of cost, to the insured in case of any dispute arises due to denial or rejection of the claim.
Claim process in case of India based insurance company is similar to that provided by US based company. The insured are required to inform the insurance provider, register their claim and send the required documents. The advantage that Student Cover clients get in case of India based company is that we provide free assistance both during claims process and in case of any dispute with the company.
Disclaimer: This blog was written based on the personal research of the writer. Readers are advised to exercise discretion and read the insurance document, its terms and conditions before taking purchasing any health insurance plan. Neither Student Cover nor the writer will be held liable for any wrongful interpretation of the content of this blog.
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