Hospitalization costs have increased to the point where, in some circumstances, the first two or three claims may be all that are needed to use up the whole amount covered. Health insurance providers offer a restoration bonus or refill of the covered amount in such a situation once each year.
In India, the majority of private health insurance providers offer restoration benefits, but you should still inquire about this benefit with your health insurance provider. Your sum insured amount doubles with the refill benefit, which aids in covering all of your medical costs.
When the limit of coverage or the limit of sum insured is used up throughout the policy period, the insurer reimburses the cost of medical treatments by replenishing the basic coverage amount once a year or as per the restrictions mentioned in the policy wordings. The goal is to make sure the insured person receives payment for the medical care they get and may live in peace.
Consider a situation where you follow all the proper steps for health insurance but make a mistake at the final end. After experiencing a health condition, you take the time to shop around online, choose a proper insurance, pay the premium, and submit a claim. However, you learn that your insurance claim was denied because it was made too late by the firm. That is certainly a possibility. As a result, while filing a claim, one must follow the deadlines. Continue reading to find out how long you have to file a claim in India for a health insurance.
Term Time Limit
When it comes to ensuring a seamless claim settlement of a health policy in India, there is a fixed time restriction that policyholders need to abide by. The timeframes of various insurers may vary. Additionally, various claim types have varying time constraints. The deadline for a cashless claim, for instance, differs from the deadline for a reimbursement claim.
Why Time Limit?
For the purpose of reducing fraud, an Indian health insurance policy has a rigorous time restriction for filing a claim. Less time is given for fraudsters to fabricate information when there is a deadline for applications. A deadline is also beneficial for controlling the administration side of claim settlement.
Is there any Time Limit for Filing Insurance Claims?
There are many instances when insurance holders may not be able to immediately file for claims. But is there any time limit for filing such claims? The answer to this is ‘No’. However, insurers will check whether the policy was active at the time of the event. Moreover, they also investigate the reasons for filing such delayed claims.
There is no time limit set for nominees to intimate the claim after the death of the policyholder.A nominee’s ability to submit a death claim is unrestricted by time. When a death claim is submitted, a life insurance company is subject to a deadline. In accordance with the Insurance Regulatory and Development Authority of India’s 2017 regulations, a death claim under a life insurance policy must be resolved within 30 days of the date that all necessary papers and clarifications were received, either by being paid, rejected, or repudiated, with full disclosure of the reasons.
However, even if they have the policy documentation, the insurer may have trouble paying any more family members if the dead nominee also passes away after a specified amount of time.The family members can still make a claim even in such a case.
There is still an option to file the death claim even in cases when the policyholder and nominee have both passed away. Legal heirs of the insured are required to offer pertinent supporting documentation in such a situation. In addition, the claim will be paid if the decedent policyholder left a will or testament and named an executor to carry it out.
There is a deadline for the policyholder to notify the insurance company of the claim following hospitalisation. There are several time constraints for various types of health insurance claims, such as cashless or reimbursement. In order to get health benefits, policyholders must follow the deadlines.
In the case of availing of the cashless facility, one has to inform the insurer about the planned hospitalization 48 or 72 hours in advance (depending on the insurer). And, in case of an emergency, the insurer should be informed 24 hours after hospitalization. However, to avail reimbursement, you can file a claim within 30 days to a maximum of 90 days (depending on the insurer and the policy terms and conditions) of receiving a discharge summary from the hospital.
Filing a reimbursement claim beyond 90 days can lead to claim rejection. Typically, the insurer investigates the reasons for the delay and the claim can be rejected if it is not authentic.
One must notify the insurer of a scheduled hospitalisation 48 or 72 hours in advance if using the cashless facility (depending on the insurer). Additionally, the insurer should be contacted 24 hours following hospitalisation if there is an emergency. However, you must submit a claim within 30 days to a maximum of 90 days (depending on the insurer and the terms and conditions of the policy) after getting a discharge statement from the hospital in order to be eligible for payment.
Reimbursement claims that are submitted after a 90-day window may be rejected. Usually, the insurer looks into the causes of the delay, and if the claim is not real, it may be denied.