Step-by-Step Guide to Filing a Claim Under Senior Citizen Health Insurance Plans

With rising medical treatment costs and health concerns, having medical insurance for senior citizens is crucial. This type of health insurance policy is designed specifically for senior citizens, keeping their healthcare needs in mind.

If you already have a senior citizen health insurance plan and need to file a claim, this guide is for you.  In this blog, we will learn in detail about the health insurance claim procedure for senior citizens.

Understanding Medical Insurance for Senior Citizens

Medical insurance for senior citizens is a plan designed for individuals aged 60 and above. This type of insurance provides coverage for various medical expenses, specifically catering to the unique healthcare needs of older adults.

With so many senior citizens’ health insurance plans available in the market, it can be daunting to choose the right plan. Hence, it is best to compare medical insurance plans for senior citizens before making a purchase decision.

Furthermore, when choosing a health insurance policy, it is crucial to go with the best claim settlement health insurance company. This helps to predict how the claim procedure will be.

Steps to File Health Insurance Claim for Senior Citizens

The general procedure for filing a health insurance claim for the best mediclaim policies involves two methods:

• Cashless Claims
• Reimbursement Claims

Steps to File Health Insurance Claim for Senior Citizens: Cashless Claims

• Step 1: Policyholders need to notify the insurance company 48 hours before admission to avail of the cashless claim service in any authorised hospital.
• Step 2: If it is an emergency, then the policyholder can notify the insurance company within 48 hours of admission.
• Step 3: Fill out the necessary pre-authorisation form at the hospital’s TPA desk and submit all the necessary documents.
• Step 4: The hospital will file a cashless claim request for the policyholder.
• Step 5: Upon approval, the hospital can initiate the treatment procedure for senior citizens.
• Step 6: The insurance provider will settle all the bills directly with the hospital. Policyholders do not need to pay anything out of their pocket.

Steps to File Health Insurance Claim for Senior Citizens: Reimbursement Claims

• Step 1: Notify the insurance provider about the admission of senior citizens into the hospital.
• Step 2: Upon admission into the hospital, seek the necessary treatment and care from the staff.
• Step 3: Pay for all the medical expenses out of your pocket.
• Step 4: Upon discharge, collect all the necessary documents from the hospital, such as diagnosis, prescription, discharge summary, hospital bills, and more.
• Step 5: Visit the insurance provider’s website to file a claim. Submit the claim form and all required documents.
• Step 6: The insurance provider will verify the claim form and all submitted documents.
• Step 7: Upon approval, the claim amount will be sent directly to the policyholder’s registered bank account.

Documents Required for Health Insurance Claim Procedure

Here is the list of documents senior citizens need to submit to raise a claim request.

• Duly filled and signed claimed form.
• Senior citizen health insurance policy document
• Identity proof
• Address proof
• Doctor’s prescription
• Medical illness diagnosis
• Prescription of medicines and original pharmacy bills
• Doctor’s consultation slips and prescriptions for diagnostic tests
• Discharge summary
• Breakup of the hospital bill
• Ambulance charges
• Certificate from the attending doctor
• Any additional documents asked by the insurance provider

Tips for Health Insurance Claim Procedure for Senior Citizens

Navigating the health insurance claim procedure can be a bit more challenging for senior citizens, but understanding the process can make it much smoother. Here are some essential tips to follow when filing a health insurance claim for senior citizens:

• Understand the coverage, exclusions, process and health insurance claim settlement ratio in detail before you need to make a claim. This will help you know what is covered and what is not covered.
• Notify the insurance company as soon as possible about hospitalisation or medical treatment. This will allow you to familiarise yourself with the documentation needed and avoid delays.
• Keep medical bills, prescriptions, doctor’s notes, test reports and any other documents ready. The insurance provider may ask for these to process the claim.
• After submitting the claim, follow up with the insurance company regularly to ensure the claim is being processed on time. Any delay could impact the approval process.
• If there is a discrepancy in the claim amount or a claim rejection, communicate with the insurance company and provide any missing information or clarification.

Conclusion

Choosing the best mediclaim policy for senior citizens is important. However, it is also crucial to know the health insurance claim procedure for senior citizens. A complicated claim process can lead to disappointment and frustration among older people.

Hence, it is important to go with an insurance provider that has a high claim settlement ratio. TATA AIG offers health insurance for senior citizens that is customised based on their unique healthcare needs. They also have a team of 650+ claim experts on board to guide you through the claim process.

Kennett Arin

University of Houston graduate with 5 years of blogging experience, excelling in content strategy, SEO, and audience engagement. Connect with me on LinkedIn.