Clear and Simple Answer! What Is an Insurance Claim? And How to Claim
Today, increasing health risks make insurance crucial for protection and peace of mind and insurance is another option that can effectively alleviate financial problems. When the unexpected happens, insureds can file claims to receive policy benefits.
When it comes to claim proceeds, they not only help mitigate emergency expenses, but also ensure that insureds receive appropriate care and compensation. Furthermore, they provide financial security and peace of mind for insureds and their families.This article will guide you through benefits of claims, and essential things you should know before filing a claim. Let’s explore together.
Skip ahead to the section you’re most interested in:
1. What is an insurance claim?
3. Can you make multiple claims?
4. How many days to receive claim proceeds?
1. What Is an Insurance Claim?
An insurance claim is the payment or benefit provided by an insurance company to the insured, based on the coverage amount and conditions stated in the policy. The process of requesting this payout is called “filing an insurance claim.”
There will be different details of claim payments. The insurance claim will provide 3 types of benefits:
- Compensation for medical expenses when receiving treatment at a hospital
- Income compensation when hospitalized
- Compensation when the insured becomes disabled or passes away
2. Types of Insurance Claims
For insureds who wish to file a claim, the process will depend on the provisions of each policy. There are basically two types of claims that can be filed:
Fax Claim
This type of claim offers convenience for insureds receiving treatment at a network hospital. Insureds can file claim to pay for medical treatment without having to pay in advance. Normally, insureds can notify the hospital and process the claim immediately. It takes no more than 1 day after receiving complete documents from the insureds, or slightly longer if the company requests additional health information review.
Direct Claim
This is a claim in which the insureds must file a claim themselves. This can be submitted directly to the insurance company in some cases, such as the insureds having to pay in advance, submitting a fax claim that is not approved and therefore having to pay in advance and submitting later, or not receiving treatment at a network hospital.
3. Can You Make Multiple Claims?
Yes, you can. If you receive treatment for the same illness or related conditions from the same illness in which the claim was just filed within 90 days from the last hospital discharge, it will be considered as the same treatment. In this case, your medical expense coverage will continue from the initial claim that the insured received treatment.
4. How Many Days to Receive Claim Proceeds?
If you are wondering how long it takes to receive your claim payout, the process can be divided into two main cases:
Cashless Claim Process (No Advance Payment Required)
If your policy includes a cashless benefit (no need to pay upfront), simply prepare the required documents and follow these steps:
- Present your insurance card along with your national ID card or driver’s license.
- The hospital will verify your insurance coverage directly with the company.
- Receive medical treatment according to the doctor’s plan.
- Upon discharge, the hospital will submit your claim information to the insurance company.
- The insurance company will review your claim within 1 hour (for standard cases; more complex claims may take longer than 1 hour).
- You will receive an SMS notification once the hospital has submitted your documents and again after the company has completed its review of the claim.
Read more >> Interesting facts about advance payment: What is it? Is it really worth it? All the answers are here.
Filing a Health Insurance Claim In Case of Advance Payment
For insureds who have already paid medical expenses upfront and wish to request reimbursement, the claim review period is divided into two main scenarios:
General Health Claim
If you submit a claim for treatment of general illnesses covered under the policy, the insurance company will review the claim within approximately 7 business days after receiving all required documents. In cases where additional documents are requested, the review period may extend up to 90 days.
Cases Requiring Additional Health Claim Review
If the insured receives treatment for a condition that requires further medical assessment, the insurance company may request additional health records and supporting documents. In such cases, the review period will take 30–90 days from the date that the company receives all documents.
However, receiving the full benefits of health insurance depends on understanding the policy conditions. It is important to carefully review coverage details, exclusions, waiting periods, and claim conditions before making a purchase. This not only ensures clarity but also helps prevent misunderstandings that could lead to future complications.
Stay worry-free about unexpected financial burdens and live with peace of mind supported by a reliable health insurance plan from Muang Thai Life Assurance.
For more information
☑️ Call 1766 (available 24/7)
☑️ Contact a life insurance agent
- Please study the details of coverage, conditions and exclusions before making a decision to purchase insurance.
Source: Retrieved on 05/02/2025