4 Ways to Easily Process Health Insurance Claim?

Health insurance claim

A recent Economic Times online survey shows that almost 60% of the people who filed claims were dissatisfied with their experience.

Health insurance claim
Health insurance claim

So in this article, I decided to look at health insurance claims in greater depth, focusing on the areas where maximum claim related conflicts occur and what you can do to extract the maximum value from your policy during claims and come out of the experience truly satisfied.

One of the biggest reasons for dissatisfaction with claims is a lack of awareness of the policy terms and conditions.

It can’t be stressed enough that every policyholder should read one’s policy document as soon as you receive it. If any terms and conditions are not clear, you should call us up your insurer to understand it better.

Also Check How To Buy Best Health Insurance

Top 4 Things To Be Careful with Health Insurance Claim

Let’s understand the top conditions that you have to be careful of :–


Most health insurance policies require the patient to be admitted for a minimum of 24 hours or more to avail of the benefits. This is a firm rule but excludes a few daycare procedures, which will be mentioned in your policy document. So if you were to go to your hospital fora tetanus shot, for example – you won’t be able to file a claim on that basis.


Your policy will have limits of certain procedures like the maximum price of the room that you can avail of. Now you might want to go for a higher-priced room, and you’ll assume that you can pay the difference between the actual rent of the room and the allowable limit. Pls, don’t do that.

Contact your insurance company before you do something like this because insurers often treat room up-gradation as a partially payable claim. In other words, never decide to alter the terms of your insurance contract unilaterally.


The third area, you need to pay attention to your waiting period on specific diseases. The waiting period is a sort of a hibernation period during which any claims made will not be admissible. A good number of consumers are unaware that claims for certain conditions are inadmissible for up to two years.

While these are a handful of conditions but it includes popular ones like tonsils, hernia, cataract, etc. A list of these medical conditions will be available in your policy wordings.

And finally, there is a waiting period on pre-existing conditions where there is a wait of 3 to 4 years.

This is another clause that several policyholders are not aware of because they did not read the policy document and leads to dissatisfaction when they apply for claims within the waiting period for pre-existing ailments.

A common problem related to this is that consumers don’t state their pre-existing condition while taking the policy.

This generally happens when consumers allow agents to fill the proposal form on their behalf or when they take the application process very light, and omit these details accidentally or on purpose.

This is a tough situation for the policyholder and the insurer, but because every insurance contract is agreed on the basis of good faith – there is every probability that the claim will not be admissible in case the declaration made by the policyholder is false or partial.


The fourth area and the last of the key clauses that have a significant impact of the claims are limiting conditions like co-payments, sub-limits, and exclusions. Co-payments are where you will pay part of the claim, and the insurer will pay part of the claim.

If you have ever made a car insurance claim without having zero depreciation on your car insurance policy, you would have noticed that you had to pay like 30-35% of the total bill to the workshop, and the insurance company paid the rest.

Similarly, co-payment may be triggered in your health insurance contract in some situations, which is why you should read the policy document carefully once you receive it.

The same is true for sub-limits, which by definition, mean that the insurance contract has a capping on how much is payable for a particular illness.

I have commonly seen sub-limits used for procedures like cataract, total knee cap replacement, and kidney dialysis.

These, too, will be in your policy document and will go something like Rs. 20,000 per eye for cataract removal. And finally, the exclusions.

This is one part that I can’t stress enough on and becomes the cause of a lot of hardship.

Most health insurance policies don’t cover maternity and childbirth, yet a huge number of claims are lodged toward these due to a lack of awareness of policy exclusions.

Other exclusions in the policy include participation in adventurous activities, abuse of intoxicants like alcohol, mental disorder-related ailments, etc.

There are some smaller payments which are generally not included payable. Again, most policyholders assume that these expenses are claimable, but that is not the case.

Some expenses which get omitted in the payable claim include registration & discharge charges, cost of hearing aid, any toiletries, donor screening charges, etc.

Understanding co-payments, sub-limits, and exclusions is a must to ensure you are claiming the right procedures as contracted under your health insurance contract.

The secret to a happy claims experience is to have a clear understanding of what is claimable and what is not under the terms of your policy, most of which are available in the policy wordings.

This includes inclusions, exclusions, waiting periods, sub-limits, etc. If you are thorough in your research, you wouldn’t have to worry about claim rejection.

And when you know what is in your policy, it also gives you the necessary knowledge to fight for any unjust calls made by the insurer’s claims team.

And if you have any doubts about anything in your policy, feel free to comment in the comments section below or call your insurance company for better clarification.

If you liked this article, share it with your friends, and don’t forget to check out the health insurance section on the ETMONEY app for more information on everything we have discussed in this article. Thank you for reading this article.

How to Buy Best Health Insurance?

best health insurance

Every year, 55 million Indians are pushed into poverty because they have to pay for their healthcare. This made me realize how vital health insurance is because accidents can happen at any time. 

I am not an ‘agent.’ So I am not going to try and sell you a policy, but by the end of this article, you will know exactly what you need to do to buy the best Health Insurance policy for yourself or your spouse, your children or your parents because in this article we are going to see ‘What is health insurance’ and ‘what are the parameters you need to check before you buy one’?

best health insurance
best health insurance

A step-by-step procedure to pick the best health insurance policy. And towards the end, I’ll give you a Bonus Tip to ensure that you ‘touch-wood’ never have to claim health insurance. 

Suppose you get hospitalised because of some illness or accident; then, the expenditure will be in lakhs for the surgery, hospital room, medicines, tests, etc. 

But if you have a health insurance policy, they will take care of all of these expenses for you, and in return, they’ll charge you a small premium every year. 

So obviously, health insurance is a smart thing to have because it saves your health, and it saves your bank balance.

Check Out Samagra ID website for all Your

Parameters to Check before Buying Best Health Insurance

But not every health insurance provider is excellent. So, let’s quickly see the six parameters that you need to check before you buy health insurance. Don’t worry; I’ll also tell you where you need to check these parameters. Let’s start. 

Claim Settlement Ratio

It is the ratio of the number of claims settled by the insurance company divided by the number of claims it has received. 

So obviously, higher this ratio, more are the chances that this company will also settle your claim without any issues. Above 90% is a good number. 

Network Hospital Covered

Now, there is something called a ‘cashless facility’ wherein, if that insurance provider has a tie-up with the hospital that you are admitted in then, the hospital will directly send the bills to the insurance provider, and you don’t have to pay anything. 

But if there is no tie-up, you have to pay the hospital bills first and then get reimbursed from the insurance company. 

It is too much of a hassle if you are recovering or have a patient to take care of. 

Make sure that your insurance provider has a tie-up with a large network of hospitals and that your favorite hospitals are covered in that network, especially the ones that are closer to your home. 

Hospital Room Eligibility

There are lots of things that make the patient uncomfortable, who is already in distress. So make sure that your insurance covers at least the cheapest private room available. 

Waiting Period

Health insurance policies cover pre-existing illnesses after a certain wait period. For example: Suppose you have diabetes, then after 2-4 years of wait-period, can you claim any hospitalisation due to diabetes. 

So if you have any pre-existing illness, check that the waiting period of that insurance is as less as possible. 

Family Floater Health Insurance Policy

Now, instead of buying separate policies, parents along with two minor children can be combined in one plan. 

In that plan, depending on the insurance provider, each insured member will be given a separate coverage amount, or all the members will share a combined sum. 

For example, suppose its a policy of 10 lakhs for five members, so each of these five members can either have 2, 2 lakhs coverage each, or share ten lakhs no matter who claims. 

The premium of such insurances is slightly higher, but they are a money saver because you don’t have to spend on multiple policies. 

On a side note, if your employer is giving you a health insurance policy then check if you can also include your parents in the same because in my opinion, your company will be able to negotiate with the insurance provider better than you more so, if you do it as a group.

Miscellaneous charges

Along with the significant surgical expenses, a good policy also covers ambulance charges, pre, and post-hospitalisation charges, and some even throw in a few health-checkups here and there.

Apart from these six generic parameters, the other parameters that vary from person to person that you need to check are these. 

If you are planning a baby and want maternity expenses covered. If your family has a history of cancer, and you want to be covered for chemotherapy, radiation, or any other specific critical illnesses. 

If you want day-care procedures like cataract surgery or even dental included. Our requirements are different. 

So, the best health insurance policy for me will be different than the best health insurance policy for you. 

But don’t worry, I’ll give you a step-by-step procedure of how to find the best health insurance policy for you in the next segment. 

This was about health insurance. Now, there is something called a ‘Life Insurance’ wherein the company pays a lump-sum to the beneficiaries in case of the insured person’s death. 

Check out 3 Things You Need to Know About Insurance

4 Steps to Buy Best Health Insurance

So here is a 4 step procedure to find your best health insurance policy. 

Step 1

Write down what your requirements are. What hospitals you’d like, whether you want your parents included in your policy, maternity expenses covered, what illnesses you want to be covered, etc.

Step 2

Now go to these health insurance comparison websites like PolicyBazaar, Coverfox, etc..

They will show you the list of insurances that will be best for you, according to your age and other details. 

Here you will find policies as low as Rs. 9000/- per year, which is less than Rs. 25/- per day. But more than premium, check their features and features not covered. 

While you are at it, google, ‘5 Best Health Insurance Policies of India’, to get an idea of what policies people are talking about and reading their reviews. 

Step 3

Directly go the website of that insurance policy provider, call their executives and tell them your requirements.

Talk to 3-4 executives (of different insurance providers) before you make a decision. They’ll only come to your office/home to give you the papers. 

Now, an important point. Sometimes these executives are in a hurry just to sell you the policy. 

So it’s your job to read it carefully and fill in if you have any pre-existing illnesses. If you miss writing illness and because of this, your claim gets rejected tomorrow, then these executives cannot be held accountable because their job was only to sell you that insurance. 

So don’t be in a hurry, read carefully, and mention everything truthfully. 

Step 4

Do not forget to reap the tax benefits of paying your medical insurance premium under Section 80D. 

And that’s about it. Now, where are you going to invest the money that you are saving from the taxes? See, health insurance is an investment for life. 

You can get a decent health insurance policy for a premium of Rs. 25/- per day BUT you can get the best health insurance policy… for FREE!

Just eat at home, exercise for 20-30 minutes, and sleep well every day, and you can avoid most of the lifestyle diseases that our generation suffers from today. 

All health insurance providers want the same thing, for you to be healthy because even they don’t want to pay your hospital bills! And I am sure you don’t want to get admitted either. 

After living in the hospital for four days and looking at all types of patients, I’ve realised that health is not wealth. It is MORE than wealth! 

Today’s bonus tip is this. Take care of your health because nobody else is going to do it for you. 

3 Tips You NEED to Know About Insurance


Everybody needs insurance at some point in their lives, but you’ve got to understand that the entire industry is a total money-making machine.

It is way easy to get ripped off if you don’t follow a few simple rules so in this article I’m covering the three things that you need to know about insurance so that you don’t get ripped off.


You can be a little bit smarter about it so that you can save some money and all of these strategies apply to all the different types of insurance like life health and auto insurance so definitely pay attention. Hopefully, you’ll learn something new.

Now I’ll warn you right now that I’m not a professional when it comes to insurance so definitely seek one out if you’re looking for that type of information. Still, I do know that basic math can usually cure a lot of these problems and that’s what I’m into, so this is the information that I’m going to share with you guys.


The first thing that you need to know about insurance is that you should always shop around with a whole bunch of different companies before you go with any insurance and then also don’t stay with the same company forever because a lot of the time you’re going to find better deals elsewhere I say this because statistically, you will remain with the same company for years because once you get your automatic payments set up, you’re probably not going to switch companies.

After all, that’s just how it is insurance companies make everything super complicated to understand so naturally we don’t even want to change companies just because it’s a lot easier in that sense.

I would recommend that every couple years you look into a bunch of different insurance companies and check their premiums and their coverage to see if maybe you can get some better value out of another company plus a lot of the time you’ll find that when you threaten to cancel your policy, they’ll come back with a better rate because they’re trying to negotiate you to stay on board with them and this all happened just because you’re looking at different companies so if you do love your insurance company.

You never want to leave them then I would at least do this tactic to make sure that your rates don’t inflate over time. The goal here is to get the most coverage that you possibly can from your insurance while at the same time paying the lowest premium possible, and that’s pretty much all that I would ever worry and then keep in mind that a lot of the insurance companies that you see on TV are some of the most expensive ones out there because they have to pay for all that marketing.

They have a bunch of gimmicky features that you also have to pay for as well you need to do a little bit of research, and I guarantee you you can find a lot of insurance companies out there that have reasonable prices and excellent coverage.


Now the second thing you need to know about your insurance is how your deductibles can affect your monthly premiums. I want you to pay attention here because I think I can save you some money so.

The way your deductible works is that whenever you have to claim with your insurance, you’re going to have to pay your deductible first before they end up paying out any money and this is all pretty simple.

But the problem is when you have a low deductible you’re going to have higher monthly premiums, and this is a problem because you usually don’t need to use your insurance. After all, the way it works is that if you have a $500 deductible on your car and then you make a claim you’re just going to have to pay at least $500 before they’re going to pay anything out and then your monthly premium.

I would bet it is probably around 75 bucks a month but if you change your deductible to $1,000. You are going to have to pay$1,000 if you need to make a claim but the thing is is that your monthly premium is going to go down to probably 55 bucks a month and statistically that’s going to save you a lot more money over time.

So with this math, you can tell that in two years you’re going to make up four hundred and eighty dollars which is almost the difference in that deductible so as long as you’re not getting in a wreck in two years or so

It’s a better value for you, but if for some reason you’re the type of person that arrives in a wreck every six months or so later I would go with the lowest deductible possible because you’re probably going to end up needing it and that’s going to save you more money.

But overall if you look at the stats you’re going to find that; statistically, you’re probably not going to get in a car wreck, and that’s why I’m always going to recommend going with the higher deductible and keeping the lower premiums because it’s still going to save you more money in the long run.

Another thing here is that if you have an emergency fund saved up then this is what you should be using for your deductible, and you should always keep your premiums low just because you have an emergency fund to cover the problem if something happens and then also keep in mind that no matter what your deductible is you’re probably not going to claim with your insurance unless you have to because the problem here is that when you make a generally your premiums are going to go up a little bit, and that’s something that we all try to avoid

So a lot of the times unless you’re getting into a big accident this isn’t something that you need to worry about now if you do end up calling your insurance provider and raising your deductible.

Still, your premiums only go down about a dollar a month then I would say that this probably isn’t a good thing to do because it’s going to take way too long for that money to make sense as far as value goes so if that does end up happening then I would stick with the same deductible that you already have or I would look into going with a different insurance company to find something better.


Then the third thing you need to know is that a lot of different types of insurance out there are a total ripoff so what I want you to do in most cases are just some basic research and some basic math, and you can easily find out if it’s going to be a good value for you or not.

It’s kind of like when you go to Best Buy, and you get a new laptop for only 300 bucks. Still, then they offer you an extended warranty for$100 as insurance, but that’s just a total ripoff because that’s a third of the cost of the laptop only for something that’s probably not going to happen so that right there is a prime example of insurance that I think is a total ripoff.

Because it’s just not worth spending that much money to cover something that you can replace yourself because at the end of the day I feel like you should only be getting insurance.

If you can’t replace the item or repair it on your own now take for example whole life insurance which is a life long life insurance policy with the built-in savings accounts well in my opinion.

I don’t think it’s worth it and I’m going to give you two examples right here that I think you will agree with the first reason is just the fact that when you’re older, you probably don’t need life insurance anymore because at that point you’re going to have your assets all paid off and if something did happen your family should be safe at that point in your life, and that’s one of the big problems.

I have with whole life insurance because you’re paying more in your premiums just to have a giant life insurance policy when in reality you don’t need it for your entire life you only need it for 10 or 20 years when you’re young when you have to pay off those assets and if something happened to your family you couldn’t pay them off, but when you’re older you’re not going to have that problem, and honestly, in some situations, it does make sense to have a life insurance policy when you’re older

But I feel like, for the most part, you should have your debts paid off by that time in your life and like I said earlier the only reason that you need insurance is to cover something financially that you can’t cover on your own if something were to happen to it now the other stupid thing about whole life insurance, in my opinion, is that a lot of your premiums are going into an investment account which is something that I don’t think that you should be paying for on top of the premiums on your life insurance.

It might sound like a good idea on the outside to have an investment accountinside your life insurance policy but the problem with it is that it’s a totalripoff because there’s a ton of hidden fees in there that you have to pay andyou’re actually going to end up with an investment that’s paying out less than the Nifty 100 index which you can get on the stock market I mean the average return from the nifty 100 index all the way back to 1923 has averaged 10% ifyou’re not including inflation so the thing is is that that’s actually a farbetter return than you could ever get from your whole life insurance policyand that’s why I don’t agree that it’s a good idea to be spending your extramoney on a stupid policy when you could invest it on your own.

So if it were me I take the extra money that you would be spending on your premiums but instead, I would invest that in the stock market on my own terms so that I could get a better return because remember that any extra money that you’re paying on your monthly premiums is money that you could be using as an investment or just something else in your life rather than insurance do some basic math and some basic research.

Whenever you’re looking for any insurance because a lot of the time you’re going to find out if it’s worth it or not just by doing those two things there are a ton of big commissions in the insurance industry and that’s why they always want you to buy all the stupid fancy policies and the add-ons.

Still, in reality, you need to do your homework and your research so that you can get the best value for the insurance policies that are best for you.