Steps on how to file a claim for your health insurance Cover in Kenya. Get your benefits for the monthly or yearly contributions you have been remitting.
Health is one of the most important assets you have in life. Some of the reasons many people go to great lengths to ensure they have health insurance is because it is affordable, allows you to have a tax relief, and because accidents are unpredictable. The common health insurance plans include outpatient, inpatient, maternity, low cost, and high cost covers. Some of the insurances that offer medical cover include Jubilee insurance, AAR, APA, Heritage, CIC e.t.c
When it comes to making a health insurance claim, here is how the process works.
Claim as you go
First of all there is the claim as you go. Each time you go to a hospital and are treated, you have a claim on your health insurance. This means the insurance company caters for your treatment depending on the limits of your insurance policy. You can make this claim whenever you want as long as you do not go beyond your limit.
Health Insurance co-payment policies
Many insurance providers have co-payment policies. This means that every time you go to a health care facility, you need to pay a fixed amount to the clinic. The specific amount you pay will vary from hospital to hospital according to your specific policy. Co-payments discourage people who visit clinics for petty conditions just to use up their insurance policy.
Health insurance covers also come with exclusions. Therefore, when you want to make a claim you should know what medications and procedures do not meet the scope of services you are insured against. Some of the common exclusions include food supplements, cosmetic procedures, and elective procedures.
How to Make Health Insurance Claim
When filing a health insurance claim, one of the most convenient ways is when your health provider submits the claim electronically to the insurance company. The other way is when you fill a health insurance claim form and send the paper work to the insurance company yourself.
The main requirements when making a health insurance claim is that you will need a claims form from your insurance provider and itemized receipts from your health care provider. The fields you will be required to fill in the claims form are: your insurance policy number, the recipient of the services, whether it is co-insurance or dual coverage, and the reason for the hospital visit.