Just think: you are in the hospital, worried about the bills, and your tension is mounting. But if you have health insurance, all these worries are over! There is only one problem – confusion about the claim process. Have you ever thought how easy it can be to make a health insurance claim if you know the right steps?
Today I am going to tell you step-by-step how to make a health insurance claim in India. This guide is so simple that you will read till the end and feel confident! Come on, let’s get started!
Health insurance claims are of two types: Cashless (where the hospital takes payment directly from the insurer) and Reimbursement (where you pay yourself first and then get the money back).
In India, companies like Aditya Birla, Bajaj Allianz, and Niva Bupa offer both options. This guide is inspired by trusted sources like Policybazaar and Bajaj Allianz, who are industry experts.
How to Claim Health Insurance:
Step 1: Check your policy and hospital
First of all, open your policy document. Check what is covered, which are the network hospitals. In network hospitals, there is a cashless claim, while in non-network there is reimbursement.
- Check policy details online or from the insurer’s app.
- In case of emergency, inform within 24-48 hours; for planned treatment, 3 days in advance.
- Do not skip this step, otherwise the claim may get rejected.
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Step 2: Inform the insurer quickly
Inform the insurer immediately before the treatment starts or in case of emergency. Every company has a helpline number or app.
- Share the policy number, patient’s name, hospital details.
- Example: You can intimate in one click through the apps of insurers like Star Health.
- This step is time-sensitive, so take action quickly.
Step 3: Keep the documents ready
Documents are very important for the claim. If this is not completed, the process may get stuck.
- Claim Form: Download from Insurer’s website and fill it.
- Bills and Reports: Original hospital bills, prescriptions, diagnostic reports.
- ID Proof: Aadhaar, PAN, or voter ID.
In cashless, the hospital handles the documents, but for reimbursement, you have to submit them yourself.
Step 4: Submit Claim
- Cashless: Network hospital will get approval from TPA. You just have to pay co-pay (if any).
- Reimbursement: Send documents within 15-30 days of discharge. Insurers like Future Generali allow online submission, which is super fast.
Step 5: Approval and Payment
The insurer will verify the documents. If everything is correct, direct payment will be made to the hospital in cashless mode, and money will come to your account in reimbursement within 7-15 days. If the claim is rejected, ask the reason and appeal.
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Why are documents necessary?
| Document | Purpose |
|---|---|
| Claim Form | Basic details for the insurer, such as policy and treatment information. |
| Hospital Bills | Original invoices that provide proof of treatment. |
| Prescription | Record of medicines and tests. |
| Discharge Summary | Final report from the hospital, summary of treatment. |
| Policy Copy | Insurance policy details for verification. |
| ID Proof | To confirm the identity of the patient (Aadhaar, PAN, etc.). |
This table gives you a quick idea of important documents. Every insurer’s rules may be slightly different, like ManipalCigna may ask for extra proofs.
Tips for Success
- Use the helpline: Insurers like Niva Bupa’s portals or helplines provide 24/7 help.
- Keep documents safe: Do not lose original bills.
- Read the policy terms: Find out about exclusions like pre-existing diseases beforehand.
Friends, making a health insurance claim is not rocket science. Just follow the right steps, and your financial stress is over! If you have any confusion, talk to the insurer’s customer care or ask in the comments.
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FAQs
In how many days does a health insurance claim get settled?
Cashless claims can be settled within 2-4 hours and reimbursement within 7-15 days if documents are complete.
Why is a claim rejected?
Incomplete documents, not following policy terms, or not disclosing pre-existing illness.
Is a claim possible in a non-network hospital Is this true?
Yes, but the money will be refunded through the reimbursement process.
Which document is most important?
Claim form and original bills are most important.
How to submit a claim online?
You can submit it directly from the insurer’s portal or app, such as Onsurity.
Source: Policybazaar
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