Claims Guide

Health Insurance Claims, Explained Simply

Whether the hospital settles your bill directly (cashless) or you pay first and claim later (reimbursement) — here's exactly what happens, step by step.

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Cashless Hospitalisation, Step by Step

For planned admissions, start this 2-3 days in advance. For emergencies, the hospital's insurance desk can begin this on arrival.

1

Get Admitted

Choose a network (empanelled) hospital for your insurer.

2

Show Insurance Card

Present your health card & photo ID at the hospital's Insurance Desk.

3

Hospital Sends Pre-Auth

Hospital submits a pre-authorisation request to your insurer / TPA.

4

Insurer Approves

Approval usually within 2-6 hours for planned care, immediate for emergencies.

5

Get Treated

You receive treatment — the insurer pays the hospital directly.

6

Final Bill Review

Hospital sends the final bill to the insurer before discharge.

7

Discharge

You pay only non-covered amounts (like excluded consumables).

8

Keep Your Documents

Retain the discharge summary, bills and prescriptions.

Documents You'll Need

Hover over a card for why it's needed. Keep digital copies of everything.

Health Insurance Policy / e-card

Proof of coverage

Photo ID (Aadhaar / PAN / Passport)

Identity verification

Doctor's Prescription & Admission Advice

Medical justification

Investigation Reports

Blood tests, X-rays, scans

Original Hospital Bills & Receipts

For final settlement

Discharge Summary

Treatment summary

Pre-Authorisation Approval Letter

Proof of approval

Claim Form

Provided by hospital/TPA

Previous Medical Records

If you have a chronic illness

Referral Letter

If referred by another doctor

Cashless Claims — FAQs

Quick, straight answers to what people ask us most.

What is a cashless claim?
The insurer pays the hospital directly — you don't pay upfront.
How do I find a network hospital?
Visit your insurer's website or call the TPA helpline to locate empanelled hospitals.
How long does pre-authorisation take?
Planned hospitalisations: 2-6 hours; Emergencies: immediate intimation, approval within hours.
What if my pre-auth gets rejected?
Pay and file a reimbursement claim — rejection of cashless doesn't mean claim denial.
Can I go to any hospital for cashless?
Only insurer-empanelled (network) hospitals. Others require reimbursement.
Who fills the claim form at the hospital?
The hospital's insurance desk fills and submits it on your behalf.
What costs are not covered in cashless?
Consumables, non-medical items, and exclusions listed in your policy.
Do I need to inform my insurer before admission?
Yes — for planned hospitalisation, intimate 48-72 hours before; emergencies within 24 hours.
Can a family member initiate cashless on my behalf?
Yes, with your insurance card, ID proof, and their own ID.
What if the hospital doesn't have a TPA desk?
Call your insurer's 24x7 helpline immediately — they'll guide the hospital.

Reimbursement Claims, Step by Step

Use this process if you were treated at a non-network hospital, or if a cashless request wasn't approved in time.

1

Get Admitted

At any hospital — network or non-network.

2

Intimate Your Insurer

Call within 24 hours of an emergency, or 48-72 hrs before a planned admission.

3

Get Treated

Pay the bills yourself during hospitalisation.

4

Collect All Documents

Gather every bill, report and discharge summary.

5

Fill Claim Form

Complete the reimbursement claim form from your insurer/TPA.

6

Submit Documents

Submit within 15-30 days of discharge — check your policy.

7

Insurer Reviews

Claims team scrutinises documents — typically 7-15 working days.

8

Claim Settled

Approved amount is credited to your registered bank account.

Documents You'll Need

Hover over a card for why it's needed. Keep digital copies of everything.

Duly Filled Claim Form

Insurer's reimbursement form

Original Bills, Receipts & Pharmacy Invoices

Proof of payment

Doctor's Prescription & Admission Note

Medical justification

Discharge Summary

Treatment summary

Investigation Reports

Lab, radiology, etc.

Health Policy Document

Proof of coverage

Photo ID & Address Proof

Identity verification

Cancelled Cheque / Bank Details

For NEFT transfer

Pre-Hospitalisation Bills

Up to 30-60 days prior

Post-Hospitalisation Bills

Up to 60-90 days after

Reimbursement Claims — FAQs

Quick, straight answers to what people ask us most.

Can I claim from any hospital under reimbursement?
Yes — any registered hospital qualifies, unlike cashless which is network-only.
What is the deadline to submit a reimbursement claim?
Typically 15-30 days from discharge — check your specific policy terms.
Will I get 100% of my bills reimbursed?
Only covered expenses as per your policy — deductibles, co-pays & exclusions apply.
What if I lose original bills?
Duplicate certified copies from the hospital may be accepted — contact your insurer early.
How long does settlement take?
Usually 7-15 working days after complete document submission.
Do I need to intimate even if it's an emergency?
Yes — intimate within 24 hours; delayed intimation may lead to claim queries.
Can pre- and post-hospitalisation expenses be claimed?
Yes — typically 30 days before and 60 days after discharge, as per policy.
What if my claim gets partially settled?
Request a deficiency letter or claim summary — you can appeal with additional documents.
Is ambulance cost covered?
Most policies cover it — check your policy schedule for the limit.
Can I submit the claim digitally?
Most insurers now accept digital/email submissions — check your insurer's portal.

Need Help With a Health Insurance Claim?

Whether you're about to be admitted or already navigating a claim, our advisors can guide you through the process and follow up with the insurer on your behalf.