Having a health insurance policy in India is a smart move—but it’s just as important to know how to file a claim when the need arises. Whether you’re planning for a surgery or facing a medical emergency, the claims process can be stressful if you’re not prepared.
In this guide, we’ll walk you through the step-by-step process of filing a health insurance claim in India, both for cashless and reimbursement claims—so you can focus on recovery, not paperwork.
🧾 Types of Health Insurance Claims in India
Before filing a claim, it’s important to know which type you’re eligible for:
1. Cashless Claim
Your insurance provider settles the bill directly with the network hospital.
2. Reimbursement Claim
You pay the hospital bills upfront and then claim reimbursement from your insurer.
✅ Step-by-Step Guide to File a Cashless Health Insurance Claim
📍 Step 1: Choose a Network Hospital
Visit a hospital listed in your insurer’s network. This is crucial for cashless facility eligibility.
👉 Tip: Use your insurer’s website or mobile app to locate nearby empaneled hospitals.
📍 Step 2: Show Health Card at Admission
Present your health insurance ID card at the hospital’s insurance helpdesk. Fill out the pre-authorization form provided.
📍 Step 3: Get Pre-Authorization from Insurer
The hospital sends the documents to the Third Party Administrator (TPA) or insurer. Approval usually comes within a few hours.
📌 For emergency hospitalization, this can be done after admission.
📍 Step 4: Receive Treatment
Once approved, go ahead with the treatment. The insurer will handle payments directly with the hospital (subject to policy terms).
📍 Step 5: Discharge & Final Settlement
At discharge, the insurer clears the final bill. You may need to pay for any non-covered items (e.g., toiletries, registration charges).
✅ Step-by-Step Guide to File a Reimbursement Claim
If you’re treated in a non-network hospital, follow these steps:
📍 Step 1: Inform the Insurer
Inform your insurance company within 24 to 48 hours of admission (in case of emergency) or beforehand for planned treatments.
📍 Step 2: Collect All Original Documents
Keep these ready:
- Discharge summary
- Hospital bills (with GST)
- Pharmacy bills
- Investigation reports
- Doctor’s prescriptions
- Duly filled claim form
- Copy of health card
- KYC documents
👉 Important: Keep photocopies of all documents for your records.
📍 Step 3: Submit the Claim
Submit the claim form and original documents to your insurer or TPA within the required timeline (usually 7 to 15 days post-discharge).
📍 Step 4: Wait for Verification & Approval
The insurer will verify the documents. If approved, the amount will be reimbursed to your bank account, usually within 2–3 weeks.
📍 Step 5: Track Your Claim
Use the insurer’s portal, mobile app, or helpline to track the status of your claim.
🧠 Pro Tips for a Smooth Claim Process
- ✅ Keep your policy number and health card handy at all times.
- ✅ Always ask for itemized bills and reports.
- ✅ Check policy exclusions and sub-limits before treatment.
- ✅ File claims within the deadline to avoid rejection.
- ✅ Save all email/SMS communications with your insurer.
🚫 Common Reasons for Claim Rejection
- Claim filed after deadline
- Treatment not covered under policy
- Missing or fake documents
- Incomplete claim form
- Waiting period not completed
👉 Tip: Always read your policy wordings and terms & conditions to avoid surprises.
🏥 Top Health Insurance Providers in India Offering Easy Claim Process
- HDFC ERGO
- Niva Bupa (Max Bupa)
- Star Health
- ICICI Lombard
- Care Health Insurance
- Aditya Birla Health
These insurers offer digital claim filing, WhatsApp support, and 24×7 helplines.
📌 Conclusion
Filing a health insurance claim in India is simple if you understand the process and stay organized. Whether it’s a cashless claim at a network hospital or a reimbursement claim, following the right steps can ensure that your expenses are covered without delay.
🛡️ Health insurance gives peace of mind—but only when you know how to use it right.