When medical expenses hit unexpectedly, knowing how to file a health insurance claim can make all the difference. Whether you opt for cashless treatment at a network hospital or need to get reimbursed after paying bills out-of-pocket, filing your claim the right way ensures a smoother and faster settlement.
In this blog, we break down the step-by-step process for filing a health insurance claim in India.
Explore: What is Health Insurance? Why is it Important?
Types of Health Insurance Claims
1. Cashless Claim
This allows you to get treated at a network hospital without paying upfront (except for non-covered items). The insurer settles the bill directly with the hospital.
2. Reimbursement Claim
You pay the hospital bills and then apply for a refund by submitting all required documents to your insurance provider.
Explore: Why Insurance Claims Get Rejected?
Step-by-Step Guide to Filing a Cashless Claim
Step 1: Choose a Network Hospital
Visit a hospital that is part of your insurance provider’s network. You can find the list on the insurer’s website or through their customer support.
Step 2: Show Your Health Card
Present your policy health card at the hospital’s insurance help desk, along with valid ID proof.
Step 3: Pre-Authorization Request
The hospital will send a pre-authorization form to the insurance provider. This must be approved before treatment starts (for planned procedures).
Step 4: Get Treated
Once approved, you’ll receive treatment without paying the medical expenses (other than exclusions).
Step 5: Settle Non-Covered Expenses
Pay only for items not covered by the policy, like consumables or registration fees.
Step-by-Step Guide to Filing a Reimbursement Claim
Step 1: Inform the Insurer
Notify your insurance provider about the hospitalization as soon as possible—especially for emergency admissions.
Step 2: Pay and Collect Documents
Pay the bills at discharge and collect all required documents such as:
- Discharge summary
- Medical reports and prescriptions
- Hospital and pharmacy bills
- Diagnostic test reports
Step 3: Fill the Claim Form
Download and fill the reimbursement claim form from the insurer’s website.
Step 4: Submit Documents
Submit the claim form and all documents either online or to the insurer’s claims office within the deadline (usually within 30 days of discharge).
Step 5: Follow Up
Keep track of your claim status through calls or the insurer’s online portal.
Common Mistakes to Avoid
- Not informing the insurer within the required time
- Submitting incomplete or unclear documents
- Going to a non-network hospital for a cashless claim
- Forgetting to keep copies of all paperwork
Explore: Difference Between Life Insurance & Health Insurance
Final Thoughts
Knowing how to file a health insurance claim can save you stress and ensure faster claim settlement when you need it most. Whether you’re choosing a cashless facility or applying for reimbursement, follow the correct steps, keep all your paperwork ready, and stay in touch with your insurer throughout. Being prepared is the best way to make your health insurance work forÂ
