Page 235 - IC38 GENERAL INSURANCE

CHAPTER 10

HEALTH INSURANCE CLAIMS

Chapter Introduction
In this chapter we will discuss about claim management process in health
insurance, documentation required and the process of claim reserving. Apart
from this we will also look into claims management under personal accident
insurance and understand the role of TPAs.
Learning Outcomes
A. Claims management in insurance
B. Management of health insurance claims
C. Documentation in health insurance claims
D. Claims reserving
E. Role of third party administrators (TPA)
F. Claims management – personal accident
G. Claims management- Overseas travel insurance
After studying this chapter, you should be able to:
a) Explain the various stakeholders in insurance claims
b) Describe how health insurance claims are managed
c) Discuss the various documents required for settlement of health insurance

claims
d) Explain how reserves for claims are provided for by insurers
e) Discuss personal accident claims
f) Understand the concept and role of TPAs

229