You have health insurance, but when the time actually comes to go to hospital you are not sure what to do. This article covers the two main ways to claim and the documents to prepare, so that a day of illness is as little trouble as possible.

Method 1: claiming directly through the hospital (fax claim)

If you are treated at a hospital in your insurer's network, the hospital coordinates with the company directly. Simply say you have insurance and present your ID card and insurance card (or give the policy number). The hospital sends the treatment details to the company for assessment, and if approved, the covered portion is deducted from your limit without you paying up front. You pay only whatever falls outside the cover, if anything.

It is worth checking the insurer's list of network hospitals in advance — particularly those near your home and near work.

Method 2: paying first and claiming back

Where the hospital is not in the network, or an emergency leaves no time to coordinate, you pay for the treatment first and submit a claim to the company afterwards, within the period the policy specifies. The main documents usually required are:

  • The company's claim form
  • The original medical certificate stating the diagnosis
  • Original receipts and the itemised statement of treatment costs
  • A copy of your ID card and bank account details for the transfer

The exact list can vary by company and type of claim. Asking before submitting reduces the chance of it being returned.

Tips for a smooth claim

  • Tell the hospital you have insurance from the outset, so the documents are issued in the form the claim requires.
  • Ask for a medical certificate that clearly states the symptoms, the diagnosis and the treatment.
  • Keep every document together as a set, and photocopy them before submitting the originals.
  • Submit promptly — don't wait until the claim deadline is near.

If the decision isn't what you expected

You have the right to ask for the reasons in writing, to submit additional documents, or to appeal the decision. If it still is not resolved, you can complain to the OIC, as with any other insurance matter.

In short

Claiming is not difficult when you know the steps in advance. Remember it simply: at a network hospital, state your entitlement at the counter; where you pay first, keep every document and submit quickly. Having someone who looks after your policy help coordinate makes it easier still.