A health insurance policy is only as useful as the claim it pays. Most claims are settled in one of two ways — cashless or reimbursement — and the process differs for each.

Cashless claims

In a cashless claim, the insurer (or its Third Party Administrator, the TPA) pays the network hospital directly. You pay only for items the policy doesn't cover.

For planned hospitalisation:

  1. Confirm the hospital is in your insurer's network.
  2. Submit the pre-authorisation form at the hospital's insurance desk, ideally a few days before admission.
  3. The hospital sends it to the insurer or TPA, who approves an amount.
  4. At discharge, the hospital sends the final bill for settlement. You pay any non-covered charges.

For emergency hospitalisation:

  1. Get admitted and inform the insurer or TPA as soon as possible — many policies ask for intimation within 24 hours.
  2. The hospital's insurance desk raises the pre-authorisation request.

Keep your policy number, health card and the insurer's helpline number saved on your phone and shared with a family member.

Reimbursement claims

If you are treated at a non-network hospital, or a cashless request is not approved, you pay the hospital yourself and claim the amount back from the insurer.

  1. Inform the insurer within the time limit stated in your policy.
  2. Collect original documents at discharge.
  3. Submit the claim form with documents within the deadline (often 15–30 days from discharge — check your policy).
  4. The insurer reviews the claim and transfers the approved amount to your bank account.

Documents to keep ready

  • Claim form, signed
  • Policy copy or health card, and ID proof
  • Discharge summary
  • Final hospital bill with itemised break-up, and payment receipts
  • Doctor's prescriptions and investigation reports
  • Pharmacy bills
  • Cancelled cheque or bank details for reimbursement
  • For accidents: the FIR or medico-legal certificate, if applicable

Why claims get reduced or rejected

  • Waiting periods — many policies don't cover pre-existing conditions or certain treatments for an initial period.
  • Non-disclosure of medical history in the proposal form.
  • Room rent limits — choosing a room above your eligible category can reduce the payout for related charges too.
  • Non-payable items — consumables like gloves or registration fees may not be covered unless you have a specific add-on.
  • Missed deadlines for intimation or document submission.

A few habits that help

  • Read your policy wording once, while you are healthy.
  • Update your insurer when you change your phone number or address.
  • Keep scanned copies of every document you submit.
  • Ask for a written reason if any part of a claim is deducted.

Our claims desk can help you prepare documents and follow up with the insurer if you need support with a claim.