How to File a Health Insurance Claim in India
In this guide
Step-by-step Process
Cashless Claim — Before Admission
For planned hospitalization: call your insurer's helpline at least 48–72 hours before admission and request pre-authorization. For emergencies: inform within 24 hours of admission. Always use a network hospital (listed on insurer website). Show your health card / policy number and Aadhaar at the hospital's insurance desk.
During Hospitalization (Cashless)
The hospital's TPA (Third Party Administrator) desk handles paperwork. Sign the pre-authorization form. The insurer approves a certain amount — if the final bill exceeds it, inform the insurer during the stay (not at discharge). Keep copies of all prescriptions, reports, and discharge summary for your records.
Reimbursement Claim — After Non-Network Hospitalization
If you were admitted to a non-network hospital (or for emergency), pay the bills yourself and then file for reimbursement. Collect at discharge: original itemized hospital bills, discharge summary, all investigation reports, doctor prescriptions, pharmacy bills, and payment receipts. File within 15–30 days of discharge (check your policy).
Submit Claim Documents
Login to your insurer's portal or app and submit the claim digitally, or send physical documents via courier to the TPA office. Required documents: claim form (signed), hospital discharge summary, all original bills and receipts, doctor's prescription, investigation reports, your policy copy, ID proof, and a cancelled cheque for reimbursement.
Track and Follow Up
Track your claim status on the insurer's website/app using the claim reference number. Reimbursement typically takes 15–30 days after document submission. If rejected, you will receive a written reason. You can file an appeal with the insurer's grievance team, or approach IRDAI Bima Bharosa portal if unresolved.
Documents Required
- ✓Filled and signed claim form
- ✓Original hospital bills (itemized)
- ✓Hospital discharge summary
- ✓All investigation / lab reports
- ✓Doctor prescriptions
- ✓Pharmacy bills with receipts
- ✓Health insurance card / policy copy
- ✓Aadhaar card / ID proof
- ✓Cancelled cheque (for reimbursement)
Official Government Portals
Common Questions
What happens if my claim is rejected?
First, ask for the written rejection reason. Common reasons: non-disclosure of pre-existing disease, treatment not covered under the policy, admission for excluded condition, or missing documents. File an appeal with the insurer's grievance cell. If unresolved in 30 days, approach the Insurance Ombudsman (free service) or IRDAI Bima Bharosa.
Can I file a claim for OPD expenses?
Standard health insurance covers only inpatient hospitalization (minimum 24 hours). OPD coverage is available as an add-on in some plans (e.g., Star Comprehensive, Niva Bupa ReAssure 2.0). Day-care procedures (dialysis, chemotherapy, cataract) are covered without the 24-hour requirement.
Was this guide helpful?