Filing a health insurance claim can be stressful, especially when you or a family member is recovering from illness. This comprehensive guide explains everything you need to know about the health insurance claim process in India, required documents, and how to avoid common mistakes that lead to rejection.

Types of Health Insurance Claims

There are two primary ways to claim your health insurance in India:

1. Cashless Claims

In cashless claims, the insurance company settles the bill directly with the hospital. You don’t need to pay anything (except non-payable items). This is available only at network hospitals.

2. Reimbursement Claims

In reimbursement claims, you pay the hospital bills first and then submit the documents to your insurance company to get reimbursed. This can be done at any hospital.

Step-by-Step Claim Process

For Cashless Claims:

1. Pre-authorization: Inform the TPA/insurer before hospitalization (in case of planned treatment) or within 24 hours of emergency admission
2. Submit documents: Fill the pre-authorization form and submit with required documents
3. Approval: Insurer will verify and approve the cashless request
4. Discharge: At discharge, hospital will send final bills to insurer
5. Settlement: Insurer settles bill directly with hospital

For Reimbursement Claims:

1. Payment: Pay all hospital bills yourself
2. Document collection: Collect all original bills, reports and discharge summary
3. Claim submission: Submit claim form with all original documents to insurer
4. Follow up: Track claim status and provide additional documents if requested
5. Settlement: Insurer will reimburse approved amount to your bank account

Required Documents Checklist

Having all documents ready speeds up your claim process. Here’s the complete checklist:

Common Reasons for Claim Rejection & Solutions

Bank-Specific Claim Information

Many banks offer health insurance through their partnerships. Here are direct links to claim information for popular bank-backed insurers:

Frequently Asked Questions