Health Claim Settlement: 6 Responsibilities of the Policyholder

Health Insurance Claim Settlement

Health insurance is a big financial reliever. From cashless treatment facility to no claim bonus, it has many benefits. But do you know that policyholders also have some responsibilities that ultimately help insurance companies to serve them better?

Here are some important responsibilities that each insured/family members should complete while filing a health insurance claim settlement.

How to get medical insurance claim? 

Under the health insurance policy, you claim in two ways:

  1. Cashless Facility
  2. Reimbursement

Responsibilities of a policyholder in case of claim settlement

(1) See the list of network hospitals – During any medical emergency, you should first see the list of network hospitals. Make sure the hospital is offering adequate treatment required.

(2) Always visit network hospitals to facilitate recruitment – Cashless treatment in network hospitals. This is because cashless hospitalization facility is available only in network hospitals. You cannot get it in any non-network hospitals.

(3) Read the exclusion list carefully – It is the most important duty of a policyholder to read the exclusion list before filing the claim carefully. You cannot claim for status which is not part of the policy coverage. This typically happens when making a claim for critical illnesses.

Check out: Critical Illness vs Normal Health Insurance

(4) Submit all the required documents – As a responsible policyholder, you should safely keep all the necessary bills for hospitalization, surgery, medicines, doctor’s prescription and pre-authorization form. You should keep all the originals in one folder and submit them to the hospital TPA desk and claim management team of health insurance.

(5) Timely Notice – If you want to get claim settlement on time, you should intimate the claims management team and hospital TPA desk on time. In case of emergency, it should be within 24 hours and before 48 hours in case of planned entry.

(6) Never hide past medical history – To ensure claim settlement, you should never hide your past medical history. Share information about your pre-existing illness when buying a policy.


Health insurance saves you and your loved ones financially. It always helps you during medical emergency and protects your hard earned money. Therefore, as a policyholder, you should perform your duties to ensure timely claim settlement and avoid last minute chaos.

Author Bio:

I am Nikesh Mehta, owner and writer of this site.

Nikesh Mehta - Image

I’m an analytics and digital marketing professional and also love writing on finance and technology industry during my spare time. I’ve done online course in Financial Markets and Investment Strategy from Indian School of Business. I can be reached at [email protected] or LinkedIn profile.

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