So you’ve opted for health insurance to safeguard your finances against the soaring healthcare costs. Now that you have this assurance, it is important to understand how the claim process works to ensure smooth proceedings during an emergency.

 Opposed to common belief, the health insurance claim process is relatively easy. By understanding this, you can simplify claim filing and ensure timely settlements. Whether you are going for a cashless facility or reimbursement, this blog is your guide to all the steps to a successful health insurance claim.

How to Make a Health Insurance Claim?

To make a successful insurance claim, you should be familiar with the policy's terms, inclusions, exclusions, and limits. Follow these steps to initiate a claim-

1. Inform your insurance provider about the medical treatment or hospitalisation immediately.
2. Check the health insurance plan paper and collect all required documents for filing a claim.
3. Submit the claim following the guidelines provided by your insurer.
4. Keep track of the claim process through the online portal or customer service of the insurance provider.

Types of Health Insurance Claims 

Health insurance claims can be divided into two types- cashless and reimbursement claims. Both have unique processes and specific documentation requirements.

Cashless Claims

Cashless claims can be made at a network hospital only. Once your claim is approved, the amount will be paid directly to the hospital without your further involvement.

Reimbursement Claims

Reimbursement claims can be filed for treatment in a non-network or a network hospital. Post-hospitalisation, you have to pay for all the expenses immediately and file for reimbursement later.

Step-by-Step Procedure for Filing a Cashless Health Insurance Claim

Follow these steps if you are opting for a cashless insurance claim:

1. Choose a network hospital of the insurance provider for getting treatment.
2. Inform the insurer about the planned or emergency hospitalisation.
3. Submit the pre-authorisation form at the hospital.
4. Get the pre-authorisation approved by the insurer.
5. The insurance provider will take care of the bills.

Step-by-Step Procedure for Filing a Reimbursement Claim

For reimbursement claims, no pre-authorisation form is generally needed. However, after discharge, you need to submit all the documents on the out-of-pocket expenses. You can mail these documents along with the duly filled claim form to your service provider or TPA.

1. Notify the insurer about the hospitalisation
2. Pay the medical bills upfront
3. Collect the hospital bills, medicine prescriptions, and test reports
4. Fill out the claim form, attach the required documents, and submit.
5. Await the review and processing of the claim by the insurer.

Types of Hospitalisations Covered by Health Insurance Claims

The most common types of hospitalisations covered by medical insurance providers are-

1. Planned Hospitalisation: For elective surgeries or treatments scheduled in advance
2. Emergency Hospitalisation: Unplanned medical situations that require immediate attention
3. Day-care Treatment: Medical procedure that does not need 24-hour hospitalisation
4. Domiciliary Hospitalisation: Treatments done at home due to the inability to transfer the patient to a medical unit

In the case of planned hospitalisation at a network hospital, the specified time required to intimate your insurance company is at least 1-2 days in advance. For emergency hospitalisation, you have to inform the insurer within 24 hours.

Documents Needed to File a Health Insurance Claim

Before filling out a health insurance claim, make sure to have the following documents ready-

1. Completed claim form 
2. Original hospital bills with a breakdown of the cost
3. A summary of hospitalisation and treatments or discharge summary
4. Prescription, test reports, and diagnostic results
5. Identity proof of the policyholder or patient
6. Bank details in case of reimbursement claims

Things to Consider While Applying for a Health Insurance Claim

There are certain points that you need to know before applying for a health insurance claim-

1. Waiting Period: Ensure the policy covers the health condition without any waiting period restrictions.
2. Deadlines: All claims must be submitted on time to ensure smooth processing.
3. Network Hospitals: Check the hospitals on the insurance provider’s network to benefit from a cashless claim facility. 
4. Pre-existing Conditions: See if the insurance claim covers pre-existing health conditions.

Tips to Avoid Health Insurance Claim Rejections

Notifying the insurer on time, providing correct information, and submitting completed documents are some of the important steps to avoid claim rejections.

Make sure to-

• Disclose accurate personal and medical details while buying the policy
• Adhere to the terms of the policy
• Submit all required documents with claim form
• Inform the policy provider on time about hospitalisation
• Review all forms and fills before submitting

Steps to Check the Status of a Health Insurance Claim

You can check the status of your health insurance claim in the following ways-

Website

1. Go to the online portal of the insurance provider.
2. Give your login credentials and the claim reference number to get the status.

Customer care service

1. Call the customer care department of the insurance provider
2. As requested, provide your claim reference number and other details to know the claim status.

Mobile app

1. Download the mobile application of the insurer
2. Login with your details
3. Enter your policy number and get the status of your claim.

Email updates

 Check your inbox for any status updates sent from the insurance provider.

FAQS

1. What is the difference between cashless and reimbursement claims?

Cashless claims are direct settlements between the insurance provider and the hospital, while reimbursement claims include the policyholder, who the insurer repays after the hospital bills have been paid upfront.

2. Can I file a claim for pre-existing conditions?

You can file a claim for pre-existing conditions after the waiting period as specified by the policy.

3. When does a claim get rejected?

A claim can be rejected due to non-disclosure of important information, delay in claim filing, or in case the medical condition is beyond the coverage provided by the policy. Always provide correct details and adhere to important deadlines to avoid a claim rejection.

4. What happens if a claim is rejected?

In case of a claim rejection, you can contact the insurance provider with additional documents or clarification and follow their guidelines to clear the issue.

5. Can I file multiple claims in a year?

Yes, if the total claim amount is under the sum insured by the policy, you can file for more than one claim in a year.

6. Can I make a yearly claim for insurance?

Yes, you can make a yearly claim on your health insurance within the limit allowed by the policy.

7. What is a claim investigation?

Claim investigation helps insurance companies analyse and differentiate fraudulent claims from genuine ones. Your claim form and documents will be thoroughly scrutinised and a suitable decision will be made. Therefore, ensure you fill in the details correctly in the form and submit the documents as per the requirement.

Conclusion

Having a health insurance plan is not enough, timely filing of claims during an emergency is essential to gain complete benefit of the policy. The claim process is simple to ensure the policyholder gets the required financial support during a health crisis. However, it is essential to be familiar with the steps of filing a claim and the necessary documents required to ensure the procedure is hassle-free.

Disclaimer: The information provided in this blog is for educational and informational purposes only. It is not intended as a substitute for professional advice, diagnosis or treatment. Please consult a certified medical and/or nutrition professional for any questions. Relying on any information provided in this blog is solely at your own risk, and ICICI Lombard is not responsible for any effects or consequences resulting from the use of the information shared.  

In today's times, when critical illnesses and medical inflation are on the rise, a wellness program comes as a relief for policyholders. Read on to understand wellness programs and their benefits.

What is a wellness program?

ICICI Lombard General Insurance offers wellness program along with your health insurance policy or super top-up plan. Through it, you, as a policyholder, are rewarded with wellness points for keeping yourself hale and hearty by pursuing any of the activities covered. These points can be redeemed later as per the redemption terms and conditions, subject to a maximum.

Why should I opt for a wellness program with my health insurance policy?

According to a recent report published by the World Health Organisation (WHO), the probability of death in India from the four major non-communicable diseases – cancer, cardiovascular, chronic respiratory,and diabetes,is 26% for individuals aged 30-70 years. Let us have a look at the probable underlying causes:

As evident, these four diseases can be prevented or controlled with a small yet significant change in lifestyle. While diseases caused by heredity, radiation and infections are not avoidable after a certain extent, tobacco use and sedentary lifestyle should be controlled to ensure a long and healthy life.

Home insurance premiums may be exempted in the future

Fiscal Support Needed for Home Insurance

Insurance is a way of protecting oneself from a financial loss. It provides the insured a hedge against unforeseen loss events. General insurance provides protection against loss to property, unanticipated expenses, or future income.

The government strives to improve insurance penetration, both life and non-life. It provides tax exemption for the amounts paid as premium for life insurance as well as health insurance.

The government is also involved in creating capacity for insuring risks from terrorism and motor third party damage. Property insurance is of equal importance. Almost every business entity insures its property – factory and/or office premises. Home insurance is as good as non-existent.

Individuals Consider Home Insurance Avoidable

There is an absolute lack of awareness about home insurance. Even the sections of the population that are aware of and avail life and health insurance are ignorant of the importance of insuring their homes and belongings. It does not cost much but the premium for home insurance is considered a cost that can be avoided. General insurance companies have negligible portfolios of home insurance.

Know how an in-patient AYUSH cover can benefit you and your family

In 2013, the Insurance Regulatory Development Authority of India (IRDAI) asked health insurance companies to provide cover for Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) treatments. Similarly, there are several ongoing government initiatives also, to promote alternative medicine, including the promise for an All India Institute of Medical Sciences (AIIMS)-like Ayurveda hospital.

In November 2014, the Department of AYUSH was elevated by forming a government body – Ministry of AYUSH – in order to develop education and research in the natural medicine departments and therefore make maximum medical assistance available to patients.

The departments include Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) as well as other alternative medicine systems. The Department of Indian Systems of Medicine and Homeopathy was started in March 1995, whereas the name AYUSH was coined in March 2003.

Despite such government initiatives and interventions to popularize AYUSH, both the rural and urban Indian population are still largely inclined towards allopathic treatments. According to the National Sample Survey Organization (NSSO), 90% of the Indian population – both rural and urban – prefer allopathic treatments over alternative healthcare options.

However, AYUSH offers several benefits over allopathy, especially for recuperation from critical illnesses like cancer. It is believed to cause minimum side effects and considered to focus on treating the cause of the disease rather than just the symptoms. The treatment methods use organic components and are more cost effective.

AYUSH Benefits Under Your Health Insurance Policy

With the IRDAI move asking insurers to provide cover for AYUSH treatments, the demand for health insurance for alternative treatments has increased to some extent. An AYUSH cover in your health insurance policy covers in-patient hospitalization expenses.

The medical expenses incurred for in-patient treatment taken under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy will be covered in the policy. We also reimburse enrolment fees paid by the policyholder to Yoga institutes as part of our preventive and wellness healthcare add-on. The sum insured for this benefit ranges from ₹2,500- ₹20,000 depending on the plan.

Life is full of uncertainties and health insurance is the best way of protecting yourself from them. Often people insure their health, home and assets but ignore their source of income. An accident can leave you partially or permanently disabled for the rest of your life and result in loss of income.

A majority of casualties arise due to road accidents and the numbers of accidents have increased in the past few years. Most accident-related policies have a permanent or partial disability cover where a fixed percentage of sum insured is paid to the policyholder depending on the nature of disability.

While choosing a policy you must opt for income protection benefits depending on your monthly expenditure. The benefits of monthly income are triggered only in the event of death or permanent disability. For temporary disability, income protection benefit would be available only for a brief period.

India has seen significant changes due to advancements in the medical and healthcare industries. The development of effective immunizations and treatment plans, coupled with the importance of health insurance, has led to the eradication of many deadly diseases. However, the country is still challenged by some killer diseases that just don't seem to declare exodus.

Here is a list of top ten killer death diseases in India:

1. Cardiovascular Diseases
   

This amounts to about 24.8% deaths in the country. Although preventable, the disease is killing more people each year. Understanding the causes and following precautions can help preventing the disease and possibility of death among individuals. It is surprising that heart diseases in India occur 10-15 years earlier than in the west.

Causes of Cardiovascular Diseases

1. Use of tobacco
2. Diet, physical inactivity, and obesity
3. High cholesterol and high blood pressure
4. Heredity

Prevention Methods

1. Quit smoking and use of tobacco
2. Eat a heart healthy diet
3. Maintain healthy weight

2. Respiratory Diseases

These diseases account for 10.2% deaths in India. According to a survey, India accounts for 47 per cent of global measles death!

Causes of Respiratory Diseases

1. Smoking
2. Air pollution
3. Silica dust, Asbesto, grain dust

Prevention Methods
1. Stay active, make sure your workplace is safe
2. Eat a healthy diet
3. Breathe deeply
4. Quit smoking

3. Tuberculosis

The disease accounts for 10.1% deaths in the country.

Causes of Tuberculosis

1. Contagious causes

Prevention Methods

1. Vaccination with BCG vaccine
2. Eat a healthy diet
3. Regular preventative tests

4. Malignant and Other Tumours

About 9.4% people in India die due to malignant and other tumours. Here is a list of causes of tumour development in the body:

Causes of Tumours

1. Chemical or toxic compound exposures
2. Ionizing radiation
3. Pathogens
4. Genetics
5. Some unknown causes

Prevention Methods

1. Avoid tobacco usage
2. Eat a healthy diet
3. Maintain a healthy weight and stay active
4. Get regular medical care and immunization

5. Illdefined Conditions

It is sad but true that around 5.3% population in India die due to III defined conditions due to unknown and undetermined.

Prevention Methods

1. Get regular medical care

6. Digestive Diseases
   

   Disorders related to digestive system accounts to 5.1% of deaths in India. The major cause is negligence of people while consuming food.

Causes of Digestive Diseases

1. Unhealthy food
2. Medications: Aspirin
3. Alcohol and tobacco abuse

Prevention Methods

1. Quit smoking and void use of alcohol
2. Eat a healthy diet
3. Exercise lightly 5 days week
4. Avoid daily use of aspirin, sulpha drugs, and steroids

7. Diarrheal Diseases
   

   About 5.0% people in India die of diarrheal diseases.

Causes of Diarrheal Diseases

1. Food poisoning (bacterial infection)
2. Eating foods that upset the digestive system; allergic food
3. Medications and radiation therapy

Prevention Methods

1. Wash hands frequently
2. Eat a healthy diet
3. Quit alcohol

8. Unintentional Injuries
   

   Accidents cause 4.6% of deaths across the nation. India is rated as the number 1 country when it comes to deaths in road accidents!

Causes of Unintentional Injuries

1. Accidents/disasters

Prevention Methods

1. Drive carefully
2. Carry a first aid kit

9. Intentional Self Harm
   

   Suicide is the second most cause of death among Indians aged 15-29 years. It accounts to 3.0% of total deaths in India.

Causes of Intentional Self Harm

1. Suicide

Prevention Methods

1. Don't stress yourself
2. Talk to loved ones
3. Rehabilitation and counselling

Junk foods can be a treat to the taste buds, but their ill effects are widely known. Consuming them regularly can have adverse effects on your health and may cause irreparable damage to the body. Scientific research has shown that junk food, foods with added sugar, and processed foods, can make you prone to type 2 diabetes and heart diseases. These foods can eventually make your brain weak and non-functional.

Eating junk food affects both your physical and mental health. Let’s deep dive into some details of junk foods and their harmful effects.

Why is Junk Food Unhealthy?

Any food with zero or negligible nutritional value, high in fat and trans fat content, can be termed junk food. Most fast foods, including candy, soft drinks, bakery products, burgers, along with salty and oily foods, can be termed junk food. They are high in calories, salts, and fats, and are usually low in vitamins, minerals, and other nutritional contents. The more we consume these foods, instead of healthier and nutritional options, the less our body will get the essential nutrients and vitamins needed for proper functioning.

Does Eating Junk Foods Cause Health Complications?

Eating junk food regularly can lead to several health complications, while occasional indulgence is unlikely to cause significant harm.

10 Harmful Effects of Junk Food on Health

Consumption of junk food can lead to a lot of health problems. Let’s look at a few of the harmful effects of junk food.

1. Obesity

One of the major harmful effects of junk foods from your favourite fast food restaurantsis obesity and its related health complications. The excessive sugar, calories, and fats present in junk foods contribute to weight gain. Obesity can lead to many medical issues, such as diabetes, joint pain, and heart diseases.

2. Depression

Junk foods are loaded with sugar and fats that can cause certain chemical reactions in the brain, affecting its functioning. The body may lose essential nutrients and amino acids by consuming too much of them. These symptoms can eventually lead to the inability of the brain to deal with stress and can leave you feeling depressed.

3. Loss of memory and learning problems

A study published in the American Journal of Clinical Nutrition stated that people who ate junk food performed poorly on cognitive tests. It concluded that junk foods can deteriorate your memory and leave you with a weaker brain. These foods may lead to sudden inflammation in the hippocampus of the brain that is responsible for memory and recognition.

4. Worsens appetite and digestion

Consumption of excess junk food may leave the brain in a dilemma. Excessive sugar intake can cause blood sugar levels to fluctuate and make the brain demand more food, eventually leading to overeating. This can make it difficult for the body to digest excessive junk food.

5. Inadequate growth & development

The deficiency of nutrients and vitamins is one of the many bad effects of junk food. Nutrients and vitamins are essential for the proper growth and development of the body. Unhealthy eating habits, even if they involve consuming junk food in small amounts,combined with an imbalance of fatty acids and the need for nutrients, can hamper the development of your brain and other body parts. Excess soda and sugar intake can also lead to tooth decay and the weakening of bones.

6. Dental Problems

Regularly consuming sugary or processed food, followed by an irregular dental care routine, leads to tooth decay and infections. One of the most common reasons behind cavities is junk food, which is why dentists advise people, especially children, to avoid over-consuming sugar and packaged items.

7. Skin Issues

High sugar, oil content, and glycaemic index found in junk food can lead to acne breakouts and other skin-related conditions. Since gut health has a direct effect on skin and hair, consuming unhealthy foods’ effects are visible on one’s skin.

8. Type 2 Diabetes

High sugar content can lead to insulin resistance, resulting in diabetes and worsening the cases of pre-existing diabetes. Junk food also causes excessive weight gain, which in turn increases insulin resistance in a person.

9. Liver Damage

People who regularly consume junk food, especially fried and processed items, are more prone to develop non-alcoholic fatty liver. The excess fat in these food items is absorbed by the liver. This stresses the organ and hinders its natural function.

How to Reduce the Amount of Junk Food You Consume?

Reducing junk food intake requires conscious effort and planning:

• Meal Preparation: Preparing meals at home ensures control over ingredients and cooking methods.
• Healthy Snacking: Opt for fruits, nuts, and yogurt instead of chips or candies.
• Stay Hydrated: Sometimes, thirst is mistaken for hunger; drinking water can reduce unnecessary snacking.
• Mindful Eating: Pay attention to what and when you eat to avoid impulsive junk food consumption.

How to Make Healthy Food Choices?

Making healthier food choices involves:

• Reading Labels: Understand nutritional information to make informed decisions.
• Balanced Diet: Include a variety of nutrients by consuming different food items.
• Limit Processed Foods: Choose whole foods over processed ones to avoid additives and preservatives.
• Portion Control: Be mindful of serving sizes to prevent overeating.

FAQs

1. Can I eat junk food occasionally?

Yes, occasional indulgence is acceptable, but it should not be a regular part of your diet.

2. Are all fast foods considered junk food?

Not necessarily. Some fast-food options offer healthier choices; it's essential to choose wisely.

3. How can I teach my children to avoid junk food?

Lead by example, provide healthy alternatives, and educate them about nutrition.

4. Does junk food affect mental health?

Yes, studies have shown a correlation between high junk food consumption and increased risk of depression and anxiety.

5. Can exercise offset the effects of junk food?

While exercise is beneficial, it cannot completely counteract the negative impacts of a poor diet.

6. How to identify junk food?

Any food with high fat, sugar, and salt content and low nutritional value is considered junk food. Fast foods, edibles with preservatives, and food items with long shelf life are common types of junk food.

Conclusion

Give a thought to the harmful effects of junk foods before you get into the habit of consuming them. While there is no substitute for proper eating habits and the intake of nutrient-rich food, it would be prudent to arm yourself with a health insurance policy. Why? Well, a health insurance policy can help provide financial coverage against any medical emergency caused by diseases and maladies. Even if you do maintain a healthy and fit lifestyle, a health insurance policy can be a backup for any unfortunate medical incidents or complications.

Disclaimer: The information provided in this blog is for educational purposes only. Please consult a medical or nutrition professional before making any significant changes in your daily diet. Relying on any information provided in this blog is solely at your own risk, and ICICI Lombard is not responsible for any impact or consequences resulting from the use of the information shared. 

In case of planned or emergency hospitalisation, you may want to go to a hospital that’s in your vicinity. If the doctor who’s been treating you works at a particular hospital, chances are you would prefer that one over others. Now, it may be possible that your health insurance company's hospital network doesn't cover your preferred hospital. Then, the only option you would you have at hand is to make a reimbursement claim on your health insurance.

You might have too many doubts about a reimbursement claim that range from what is a reimbursement claim to what you can do to ensure a smooth and speedy settlement of your reimbursement claim. Hence, here we are to help you get acquainted with its complete process and further understand its intricacies.

What is a reimbursement claim?

In a reimbursement claim, you pay the hospitalisation expenses from your pocket, and the health insurance company later pays that amount to you provided you submit all the necessary documents. You will have to apply for a reimbursement claim only if you choose to get your treatment done at a hospital which is not a part of your health insurance company’s hospital network or if you miss opting for a cashless claim.

While making a reimbursement claim, you need to be careful about the coverage of your treatment and related expenses under your family health insurance policy. Your health insurance company can turn down your claim if your policy doesn't cover them.

How is a reimbursement claim different than a cashless claim?

A reimbursement claim can take longer to process than a cashless claim. For a reimbursement claim, you need to ensure you collect and submit all the documents and bills related to your hospitalisation. On the other hand, in a cashless claim, the empanelled hospital will do the job of sending your documents and bills to the insurance company, and the claim will be settled with them directly.

In a reimbursement claim, you have to wait till you get your money reimbursed from the insurance company, whereas in a cashless claim, the insurance company will pay it straight to the hospital. You will only have to bear the expenses that are excluded from your policy or are over your sum insured.

Since your insurance company does not have a tie-up with the hospital, your reimbursement claim will be thoroughly investigated. This may further delay your claim settlement. Cashless claims instead tend to get settled faster and in a hassle-free manner.

When do I need to inform you about my reimbursement claim?

In case of planned hospitalisation, you can inform us two days before admission, and in case of emergency hospitalisation, you need to inform us within 24 hours of hospitalisation.

What are the steps involved in a reimbursement claim?

Unlike cashless claim, you have to take the initiative when it comes to making a reimbursement claim. Here are the steps involved in a reimbursement claim process under our health insurance.

1. Step 1: You intimate the claim

You can call our 24x7 toll-free number 1800 2666 or SMS ‘HEALTHCLAIM’ to 575758 (charge – ₹3 per SMS) or email us at ihealthcare@icicilombard.com to inform us about your hospitalisation.

2. Step 2: You get your papers ready

Once you have made the payment at the hospital, arrange all the documents chronologically. Start from the original bills for doctor’s consultation, X-ray and other medical expenses to your discharge summary, medical reports and hospital bill. With us, you can also include the bills of your medical expenses 30 days before hospitalisation and 60 days after.