Documents Required for Health Insurance

List of Documents Required to get Health Insurance in India

What are the documents required for health insurance?

To buy health insurance, you require an Identity Proof (such as Aadhaar, Passport, PAN card, Voter ID), an address proof (similar to an identity proof, or a utility bill), and a Birth Certificate or equivalent for age proof. You will require passport-sized Photographs and might need a medical report and income proof, particularly for higher coverage amounts.  Here are the documents needed for health insurance

1. Identity Proof

 Identity Proof helps to verify your identity. Documents for Identity Proof include:
 

• Aadhaar card
• PAN card
• A Voter ID card
• A Passport
   

2. Address Proof
 

The same type of documents can serve as address proof. Other choices include:
 

• Ration card
• Recent utility bill (electricity, telephone)
• Rental agreement
   

3. Age Proof

You must give proof of age for all insured members. This could be:

• Birth certificate
• Aadhaar card
• Driving license
• PAN card
• Passport
• 10th or 12th marksheet
   

4. Passport-Size Photographs

Recent passport-size photos of all people who have to be covered below the policy are needed for easy processing.

5. Medical Report

For higher coverage or if you have pre-existing conditions, the insurance company may request a medical examination and submission of the report.

6. Income Proof

Salary slips or other financial documents might be needed to help the insurance company identify the correct sum assured or cover amount for your plan.

7. Filled Proposal Form

You have to fill out and sign the health insurance proposal form, giving all the requested information as true to your knowledge.

Why are documents required for health insurance?

The documents are required for health insurance for many reasons. Here are the reasons why documents are required for health insurance.

Identity and age verification

The identity and age documents help confirm your identity and age, which helps detect your eligibility and the amount of premiums.

Address Verification

The address proof is needed for the health insurance company to send policy documents and communicate with you promptly.  

Fraud Prevention

If you submit these valid documents, it will help health insurance companies prevent fraud and confirm the uprightness of the application procedure.

What are the Documents Required for a Health Insurance Claim?

Even if you file a cashless or reimbursement claim under your health insurance policy, you must submit some documents to your insurer or TPA to process your claim. Let's discuss the documents needed for cashless  and reimbursement claims below:

1) Documents Needed for Reimbursement Health Insurance Claims

Here is the document list that you might need to file for reimbursement of health insurance claims:

• Original claim form that is duly completed, along with your valid signature
• Valid identity proof
• A doctor's prescription recommending treatment in the hospital
• Doctor's prescription suggesting diagnostic tests, medicines, and consultation
• Final hospital bill and payment receipts
• Hospital discharge summary
• Ambulance receipt
• Original pharmacy bills
• Indoor case papers
• First Information Report(FIR), as needed
• Policy copy or health card issued by the insurer
   

Extra documents that might be needed to evaluate the claim

2) Documents Required for Cashless Health Insurance Claims

The following documents are needed to file a cashless health insurance claim:

• Claim pre-authorisation form
• Valid ID proof and a photograph
• Health card or policy copy
• Personal documents, like PAN card, Aadhar card, voter ID, driving license, etc.
   

The valuable thing about the claim of cashless health insurance is that you do not have to think or worry about submitting any medical bills or documents to the health insurance company. The hospital in which you are getting treatment sends all the needed documents and treatment information to your health insurance provider.

What is a health insurance claim?

A health insurance claim refers to a formal request by a health insurance policyholder to their insurance company for reimbursement or payment of medical expenses incurred for treatment, because of illness, injury, or other medical conditions covered by their health plan. The insurance company reviews the claim and verifies the medical expenses. Then it either reimburses the policyholder for their out-of-pocket costs (reimbursement claim) or pays the hospital directly (cashless claim), based upon the policy and claim type.  

How does a Health Insurance Claim work?

The health insurance claim works in a processed manner. Here is how the health insurance works.

1. Medical Treatment

You get treatment for a covered medical condition from a doctor or healthcare provider. 

2. Claim Initiation

You or the healthcare provider(in a few cases) will initiate the claim by submitting a request to the health insurance company. 

3. Document Submission

You need to provide support documents, such as the medical bills, medical records, and receipts, to the health insurance company. 

4. Verification

The health insurance company reviews the submitted documents to make proper verification of the medical expenses and confirm that they are covered under your health insurance policy. 

5. Settlement

Cashless Claim: For planned treatments at a network hospital, the insurance company directly settles the bills with the hospital up to the policy limit. 
 

Reimbursement Claim: After paying the hospital bills, you need to submit them to the insurance company for reimbursement of the applicable amount. 

Types of Claims

There are two types of claims. Let's discuss them:

1. Cashless Claim

The insurance company pays the hospital directly for treatment from a network hospital, simplifying the procedure for the health insurance policyholder. 

2. Reimbursement Claim

The policyholder pays the medical bills out-of-pocket and then promptly submits them to the insurance company for reimbursement.