So you recently made the smart money move of buying yourself a comprehensive health insurance plan. And just a few days after your policy got issued, something new shows up in your mailbox: your health insurance card.
Now, these cards are your tickets to tapping into the full potential of your plans and guess what, they are complimentary - both the physical and digital versions!
But what’s really the use of these health insurance cards? How are they important? What kind of information do these carry? And most importantly, how do these cards work?
The answers to all of this lie below! Read on!
If you really want to understand the role of health insurance cards for an insurance policyholder, we need to start at the very beginning - what exactly is a health insurance card?
Long story short - A health insurance card is a document that acts as proof of the fact that you have availed of a health insurance policy. Now, this card can be in physical or digital form. You can take a look at the image above - this is a sample of health insurance cards (the specimen here is from a reputed health insurance provider).
The documentation comes into use specifically in the cases of a cashless mode of claim settlement. While the layout of the card varies from one insurer to the other, the information imbibed into such cards remains more or less the same -
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- Personal Details of the Policyholder - One of the first things that you will notice on your card is your name, date of birth, and contact details.
- Emergency Contact Details - Say, you – the policyholder – meet with an accident and have been brought to the hospital alone. With a health insurance card in your wallet/phone, the hospital desk can reach out to the emergency contact listed on the card so that a family member is soon notified about the ongoing health scare that you might be facing.
- Insurer’s Contact Information - Time is of the essence when it comes to raising claims with the Third-Party administrator (TPA) or the health insurer. With your contact information on the card, their help desk contact details, ID, and the insurer’s website, you can conveniently reach out to the parties, without scrambling around the internet for such details, especially when it’s a time-sensitive situation.
- Health Insurance Policy Number - The health insurance card has the policy number enlisted in it, which is specifically instrumental considering how it offers the customised details of your plan, its services, the network hospitals in the link, and other such policy details.
- Group Health Insurance ID - In case you have a group health insurance policy in play, your health insurance card will comprise your specific group number that would specify the group that you belong to and hence, the kind of perks that your plan is offering you.
- Policy Commencement & Expiry Dates - To ensure that there are fewer to no chances of your health insurance claim rejection, your plan has to be active. The health insurance card issued to you reflects the day of your availing of the plan (considering there has been an uninterrupted health insurance plan renewal) and the day that your coverage expires. A look at these two dates, and the hospital desk knows if your plan is viable for the coverage of the medical procedures that you are about to undergo.
(PLEASE NOTE: Even if your health insurance policy lies in the grace period, you won’t have any coverage for your procedures/treatments).
7. Copay/Coinsurance/Deductible Assigned - In case your health insurance plan has any copayment/ coinsurance/ deductible attached to it, your health insurance card will have the details of the conditions on which these are applicable. This helps both a policyholder and the hospital desk in determining what share of the payment will be received from both parties, considering the medical procedure that one has to undergo.
Moreover, in case you, the policyholder have any confusion regarding the portion of the invoice that you are liable to pay, the copay, coinsurance, and deductible numbers mentioned on the card will provide the much-required clarification.
8. Type of Health Insurance Plan Availed - Whether the policy availed is an Individual, Employee, or Family one, your health insurance card will always comprise the type of health insurance.
PLEASE REMEMBER: If you have availed of a family floater health insurance plan, each policyholder is assigned a different policy card, number, and ID.
Benefits of Health Insurance Card?
I. Cashless mode of claim settlement anytime, anywhere
When an individual thinks about why they want to avail of a health insurance policy, the answer is always financial convenience during times of medical emergencies. One of the best reflections of this is over cashless modes of claim settlement during which you, the policyholder, needn’t pay a penny out of your pockets (unless of course there is a copay/coinsurance/deductible) involved.
A crucial part of tapping into this cashless perk is having a health insurance card. The policy ID, number, and other details for your health insurance plan are listed there.
II. Easy access to your health insurance policy provider
Say, you are about to get hospitalised for medical treatments/procedures. Now, there are a few conditions under which you have to reach out to your reputed health insurance provider -
- To ensure pre-authorisation or prior approval for a medical treatment
- To raise a claim
- To gain clarification about the share of the invoice amount
- For any queries related to coverage, permanent exclusions, etc.
Now, every time such a requirement arises, you cannot go over to the website of the insurer and seek out the contact details, especially if there is a time crunch involved. It’s always much easier to carry a digital or physical health insurance card and refer to the contact details of the health insurance provider included there.
III. Convenient access to health insurance policy details
Take a look at your health insurance card and you’ll find all the crucial details about your policy there, or the perfect way to find out the details (contacting your insurer). Because, well, every time you need to know about your plan, you can’t just start scouring through that lengthy health insurance policy document (if it’s even available immediately, that is).
IV. Proof of policy details and coverage
The health insurance card is your ID proof in terms of the plan, the coverage you have, the validity of your plan, etc. Such details are extremely crucial when you are seeking health insurance policy coverage via reimbursement or cashless claim settlement.
V. Instrumental during medical emergencies
Health insurance policies are a great financial security net when it comes to bearing the expenses of medical procedures and other treatments during pre- and post-hospitalisation, OPD, etc. However, these plans are specifically tailored to meet the financial requirements for medical emergencies.
Imagine this -
Amit gets into a near-fatal accident and gets hospitalised. He had no friends and family to bring him because he was in the accident solo. The hospital desk does not know who to reach out to, how he is going to pay off for the hospital stay and the related medical procedures and treatments.
A hospital worker goes through his belongings and in his wallet finds a health insurance card. He submits the same at the hospital desk and reaches out to the emergency contact and the health insurer whose details are also mentioned in the card.
In a nutshell, his health insurance card saved him during a medical emergency that had left him temporarily unavailable for a conversation.
How does a Health Insurance Card Work?
A. In the case of a Cashless Claim Settlement:
STEP 1: The hospital desk reaches out to your respective health insurer.
STEP 2: The hospital personnel provide your policy ID and name.
STEP 3: The health insurance provider ensures that you have an active policy with them.
STEP 4: The help desk on the hospital’s desk informs the insurer about the medical procedure that you are about to undergo and sends in a query about the coverage, copay/coinsurance/deductible applicable to the same.
STEP 5: The insurer confirms the details regarding the same.
What follows these 5 steps is the cashless claim procedure of the exchange of medical history, detailed documents of the medical procedures, room rent bills, consumables, etc. The insurer/TPA checks the documents thoroughly and then disburses the claim amount.
B. In the case of Reimbursement Claim Settlement:
In the case of reimbursement, you, as the policyholder, have to reach out to the provider via the provided contact details on the card, provide your policy ID and number, inform them about the procedure that you have undergone, and query about the kind of claim that you can raise based on the assigned coverage. You can then raise the claim along with the submission of the required documents, which is followed by the cross-verification of the same by the insurer with the respective hospital in question. Once the queries have been cleared, the claimed amount is disbursed (after the deduction of copay/coinsurance/deductibles, checking any disease-wise sub-limits, etc.).
How to avail of a Health Insurance Card?
STEP 1: Apply for a Health Insurance Plan.
STEP 2: Stay prepared with documents related to your IDs, pre-existing medical conditions, disabilities, genetic diseases, chronic ailments, critical illnesses, smoking habits, etc. Make sure to disclose any of the required fields. This will help your insurer offer you the best health insurance policy based on the aforementioned factors.
STEP 3: Your insurer will soon send you the health insurance policy approval confirmation.
STEP 4: Receive the welcome kit from your insurer that will also include your health insurance card.
STEP 5: Cross-check the details on your card carefully. In case of any errors, immediately alert your insurer about the same over a mail or call and send them the document that would rectify the error.
(P.S. Taking prompt action to rectify any errors on the health insurance card has to be your priority. Any issues regarding the details on your card may lead to delays in the claim settlement and/or treatment.)
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Conclusion
A health insurance card is the face of proof for your active health insurance policy. It ensures convenience by making your health insurance plan details easily accessible, irrespective of where you, the policyholder, are. Even in the temporary absence of a family member/friend who has the answers about an individual’s policy coverage, the health insurance card comes in pretty handy.
It’s not a question of whether you want to avail of this card or not, since it’s a complimentary perk offered by health insurers. However, it is a much-required reminder that even if you have a digital card on your mobile and laptop, it is important to carry a physical card with you that would come to use in case of emergencies.
