Digit Health Insurance Claim Settlement
With all the uncertainty that Covid-19 has thrown at the world, and after hearing about the hefty bills that friends and relatives have had to pay during hospitalization, you have decided to get health insurance. What criteria should you keep in mind while selecting a policy or what factors should you select an insurer on the basis of?
The first thing that comes to mind might be sum insured. You might then want to find out what the premium is, to ensure you can afford it. You will definitely check the inclusions and you might – if you can afford it – consider paying extra for some rider or add on.
However, over and above ensuring competitive levels for premium and sum assured, there are two extremely important factors that you should use to evaluate various insurers:
- Claim settlement ratio
- Network of hospitals
The size of the insurer’s network of hospitals might be more important for some policyholders than others. For example, a policyholder who typically has some amount of liquid capital to use in an emergency, might be less concerned with the network of hospitals as cashless hospitalization is not absolutely essential for him. It might be more important for a policyholder who typically does not have liquid capital of savings to utilise in a health emergency.
However, the most important factor (that everyone should actually put at the top of their lists – even above premium amount and sum insured), is claim settlement ratio. This is like the report card of the insurance company. It gives us an idea of their behaviour, their personality or their outlook when it comes to claim settlement. A sum insured of Rs 10 lakh actually means nothing if the insurer habitually rejects claims, even the genuine ones.
Digit Health Insurance claim settlement ratio stands at 63.56% which is considered moderate to average. Most health insurance seekers looking for long term health insurance policies prefer to go with insurance companies that display moderate or average settlement ratio because of the view that a high settlement ratio might affect the company’s profitability (and ability to stay in business) in the long term.
Additionally policy seekers that place high focus on cashless hospitalization will find it encouraging to note that besides Go Digit’s claim settlement ratio, it also boasts a fairly large network of nearly 6000 empanelled hospitals across 16 indian cities.
Now let’s explore the Digit Health Insurance claim settlement process:
There are actually two distinct processes for making your health insurance claim, known as cashless hospitalization claim and reimbursement claim. Let’s find out how they are different.
- A cashless hospitalization claim can be made only if the policyholder is admitted for treatment or surgery at any of the empanelled hospitals.
Plus points:
- Easier process with fewer documents to be collected by the policyholder
- Assurance of payment by the insurer
Pain points:
- The patient or the patient’s caregiver had to run around coordinating with the insurance claim officials at the hospital
- The insurance claims department at the hospital does not typically function 24×7
- A reimbursement claim is the option used when the policyholder undergoes treatment or surgery at a non network hospital or if insufficient information prior to hospitalization results in rejection of a cashless hospitalization
Plus points
- No need to run around during hospitalization which is already a high stress period for anyone
Pain points
- Lack of assurance about claim approval. However, with Digit Insurance’s claim settlement ratio, that is above average some of the policyholder’s concerns should be allayed
- A ton of paperwork and maintaining little slips of paper during one’s hospitalization. However this too can be managed by keeping a box or envelope by ones bedside.
Step by step guide to making health insurance claims at Digit Health Insurance
Cashless hospitalization claim
- As soon as the health emergency strikes, look for an empanelled hospital in your city.
- Inform Digit Health Insurance of the hospitalization within 24 hours of admission
- Planned hospitalization requires a 72 hour prior intimation to the insurer
- Find the relevant officials and get hold of a pre-authorization form
- Fill up the form and return it to the relevant official
- Double check with your Digit Health Insurance about the process being underway
- Wait for approval from Digit Health Insurance
- There is no need to worry if the claim is rejected at this stage. Information might be lacking at this time and you can always go for a reimbursement claim later. Secure your health first.
Reimbursement claim
- Inform Digit Health Insurance about your hospitalization within 48 hours of getting admitted. Be sure that you have your policy details handy.
- Collect all bills, receipts, tests and certificates obtained during your hospitalization.
- Keep copies with you and submit originals to the insurer along with the claim application form. This must be completed within 30 days after the policyholder is discharged.
- Your claim will be settled by digit health insurance within 30 days after you submit the last of the documents required by the insurer for scrutiny.
FAQs
Is it true that the insurance company settles cashless claims with less investigation?
Not at all. The insurer will investigate documents and tests and paperwork with the same level of fine combing in either claim process. It is the policyholder that might find the cashless hospitalization process to be easier or seemingly less stringent on the face of things. However, rest assured that behind the scenes, both processes attract the same level of due scrutiny.
I have life insurance. Why do I need health insurance?
Life insurance is only able to offer a payout in the unfortunate event of the policyholder's demise oe in some cases if the policyholder outlives the policy term. There is no action or payout if the policyholder is hospitalised. It is definitely a good thing that you have life insurance but you need health insurance to support you in a health emergency.
