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Documents Required for Health Insurance

When you think of securing your financial future, one of the aspects that concern you the most is your health. As you age, health issues increase consistently, leading to emptying your pockets. In such cases, purchasing a health insurance policy seems most feasible to handle health emergencies. Buying a health plan is easy and you need to fulfill a few eligibility criteria and document requirements. ...Read More

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Documents Required for Health Insurance

List of Documents Required for Health Insurance

Documents Required for Health Insurance
October 17, 2024

Table of Content

 

Documents Needed When Buying a Health Insurance Plan

While planning to purchase a health insurance plan, first and foremost it is necessary to know about the coverage. Once finalised, you will need to provide some basic documents according to your chosen plan to verify the policyholder's identity, proof of income, and age. Filing a claim is simple and convenient but arranging the necessary documents beforehand is essential. 

In case there is any document missing, you will be refrained from enjoying the benefits of the policy. Let us look into the documents you need to submit while filing a health insurance claim to ensure a smooth and hassle-free process:

1. Age Proof

This is one of the most important documents you should submit while choosing a health insurance plan. The age proof of all insured members is a must to submit. Here are the age-proof documents required for any health insurance:

  • Birth Certificate

  • Aadhaar Card

  • Driving License

  • Passport

  • PAN Card

  • 10th or 12th Mark sheets

2. Address Proof

Submitting an address proof during the purchase of health insurance is mandatory. The insurer uses the provided postal address for easier communication with you. Following are some of the address proof documents that you can submit:

  • Voter ID

  • Aadhaar Card

  • Passport 

  • Driving License

3. Identity Proof

The identity proof of the policyholder is essential for insurers to maintain records. To avail the benefits of the plan, the following documents are considered for verifying the identity and coverage amount of the policyholder. Here is a list of the updated identity proof papers required for the life insurance plan:

  • Passport

  • Voter ID

  • Aadhaar Card

  • Driving License

4. Passport Size Photograph

All insured individuals under the chosen health insurance policy must submit a passport-size photograph for easy approval.

Things to Keep in Mind When Buying Health Insurance

With the rising cost of healthcare services in India, purchasing a health insurance policy is of utmost importance. With options of several insurance policies, it might be challenging to find the right policy for you.

Thus, here are the things you should keep in mind to purchase the best health insurance plan and keep your family safe and secure:

1. Proper Coverage Amount

It is important to avail a proper coverage amount for your health requirements. Choose a higher assured sum if there are any pre-existing diseases. With the rise in medical costs every year, the coverage amount you select today might be irrelevant after 4 years. So, considering future medical expenses, choose an insurance policy that provides sufficient coverage amount.

2. Coverage Amount

Different insurance providers offer lucrative coverage amounts. This amount however varies from one provider to another. Go for health insurance with the lowest premium. A policy with less premium can be beneficial if providing comprehensive coverage at the premium you can pay. Another alternative option is a low premium at the cost of the insurance coverage.

Thus, it would be ideal to choose a policy offering adequate coverage without sacrificing its associated benefits and premium amount.

3. Network Hospitals

Network hospitals offer you cashless treatment throughout the country. Providing your policy number, you can avail of cashless treatment from any of the network hospitals of your health insurance company. Opt for the policy offering you an extensive list of network hospitals. This way you can receive medical treatment hassle-free.

4. Claim Settlement Process

To receive quality healthcare, make sure to go through the health insurance claim process of your chosen insurance company. Conduct some research, review the customer feedback and choose the health insurance provider offering seamless claim settlement services. Also, check out the documents you need to present for health insurance appropriately.

How to Buy Health Insurance in India?

Purchasing health insurance in India is simple and easy. Still, policyholders find the purchasing process a little complicated at times. Here is a detailed guide to follow to buy health insurance in India smoothly and hassle-free:

  • Research: Make a thorough comparison of the policies available to different insurers considering the policy's premiums, coverage and benefits 

  • Assess Needs: Choose an appropriate health insurance plan considering your healthcare needs and budgetary requirements

  • Application: Enter your personal and medical-related information to fill out the health insurance application form accurately

  • Documentation: Submit all essential documents such as address proof, medical history, identity proof and others

  • Premium Payment: Following the insurer’s guidelines, pay the premium amount either online or offline

  • Issuance of Policy: Once smooth approval of documents, the insurer issues the required policy documents 

Types of Health Insurance Claims

Every policyholder needs to understand the different types of health insurance claims to reach an informed decision making. The two main types of health insurance claims are cashless claims and reimbursement claims. 

Read the following pointers to get a detailed overview of the types of claims: 

  • Cashless Claim

For a cashless health insurance claim, you need not worry about treatment because it is the insurer who takes the entire responsibility on behalf of you. The policyholders under this claim prefer to opt for medical treatment in the network hospital the insurance provider offers. A network hospital ties up with the insurance company to offer cashless claim benefits. You will get the required list of network hospitals on the website of the insurer, TPA website or TPA portal. 

Considering the medical and hospitalisation expenses, the policyholder needs approval from the insurance provider to start with the  cashless facility. Thus, raising a cashless request to the insurance provider is a must. After this, the insurer will proceed with verification of the details provided and once approved, the eligible expenses are paid directly to the hospital. 

It is important to note that health insurance providers consist of a wide network of hospitals providing quality treatment to ensure policyholders receive on-time and reliable treatment with fast recovery. The respective network of hospitals is located in different places throughout the country to avail services with ease. 

  • Reimbursement Claim

A reimbursement claim is applicable when the policyholder opts for any costly treatment from a network / non-network hospital . In this scenario, the policyholder remains solely responsible for covering hospitalisation and medical expenses on their own. Further, they should file a claim request for necessary reimbursement from the insurance provider by submitting all relevant medical bills and invoices. 

On request, the insurer verifies all detailed information with supporting documents and reimburses the expense that occurred aligning with the policy coverage.  

Documents Needed for Filing a Health Insurance Claim

Here are the documents needed for filing health insurance under your chosen health insurance policy.  Mentioned list is an indicative list of required documents and we reserve the right to call for additional documents or raise further requirements. 

  • Filled up health insurance claim form accurately

  • Original copies or Photocopies of investigation reports such as X-rays, CT scans, blood test reports, etc.

  • Copy of the insurance policy/health card. Although it isn’t mandatory.

  • Original discharge summary report of hospital/day care summary

  • Copy of prescription or consultation papers of doctors

  • Original medicine bills

  • Original copy of hospital-related bills

  • Original bill payment receipts

  • Copy of KYC documents

  • Original invoice or sticker 

  • NEFT details

  • FIR or medico-legal certificate (MLC) (applicable for cases of accident)

Documents Needed for Cashless Treatments

One significant advantage of cashless treatment is there is no hassle of submitting relevant documents to the health insurance company. The documents needed for cashless treatment vary from one lender to another. 

Listed below are the documents mandatory to submit to avail the benefits of health insurance:

  • Valid ID proof and a passport-size photograph

  • Claim pre-authorisation form

  • Documents that include driving license, Aadhar card, Voter ID and PAN Card

How to File a Health Insurance Claim?

Filing a health insurance claim is a complicated and challenging process. A proper understanding of the steps involved in filing a claim will help to ensure that the process is simple and easy. 

Here is a detailed step-by-step guide on how to scrutinise health insurance documents conveniently: 

Step 1: Arranging health insurance claim documents in chronological order is essential. The documents include medical bills, receipts and reports. Make sure these documents entail detailed information such as the costs associated with the disease, name of the patient, document number, signature, etc. 

Step 2: Fill out the health insurance claim form with accurate and updated information. Before filling out the form, make sure to go through the instructions carefully. You can download this form from the official website of the respective insurer. 

This form should be attached with all necessary medical reports and bills to present it with the required set of documents for a health insurance claim. 

Step 3: Submit both the original and copies of the documents needed for health insurance. Additionally, keep sets of policy documents separately for yourself. 

Step 4: Review the necessary policy documents before you submit them finally. In case, any single document is missing or contains insufficient details, the claim will not be processed at all.  The decision will be kept on hold till all required documents are submitted. 

Summary

Valid and accurate documentation is the pillar of a successful health insurance claim. By arranging all necessary documents in chronological order, every policyholder can lower the chances of claim rejection. Irrespective of whether it is a cashless claim or a reimbursement one, presenting accurate and minimal paperwork helps streamline the claim process with smooth and swift approval. Thus, with rising healthcare costs each day, it is important to continue investing in a suitable plan to keep yourself and your family safe and secure. 

FAQs on Documents Required for Health Insurance

1. What documents are needed for a health insurance claim?

For claiming health insurance, you need your identity proof which includes a passport, Aadhar Card, etc & PAN of Policy owner if not available on our records along with income proof and address proof with necessary medical history documents.  

2. Is Aadhaar mandatory for health insurance?

As per the guidelines, Aadhaar is not mandatory for health insurance. Insurers must adhere to KYC norms through proper submission of listed documents.

3. Who is not eligible for health insurance?

Individuals who are categorised in the low-income category with pre-existing diseases are not eligible for health insurance.

4. Can I apply for health insurance without certain documents?

Under certain scenarios, you are allowed to apply for health insurance without documents depending on the requirements of insurers. However, missing out on submitting any documents can reject the application process.

5. Which disease is not covered by health insurance?

Any cosmetic surgery, genetic disorder, voluntary abortion, self-injury or pre-existing illnesses are not covered under any health insurance plan. This basically might vary from policy to policy. 

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Francis Rodrigues Francis Rodrigues

Francis Rodrigues has a decade long experience in the insurance sector, and as SVP, E-Commerce and Digital Marketing, HDFC Life, manages the online sales channel, as well as digital and performance marketing. He has had hands-on experience in setting up sales channels and functional teams from scratch over a career spanning 2 decades.

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Vishal Subharwal Vishal Subharwal

Vishal Subharwal heads the Strategy, Marketing, E-Commerce, Digital Business & Sustainability initiatives at HDFC Life. He is responsible for crafting and ensuring successful implementation of the overall organisation strategy.

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