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Cashless claim (network hospital)
- Show your health card + ID at the hospital's insurance desk.
- Hospital sends pre-authorization to the insurer/TPA.
- Approval usually in 2–6 hours for planned admission; emergency admissions get provisional approval fast.
- You pay only non-medical expenses and deductibles; the insurer settles the rest directly.
Reimbursement claim (non-network hospital)
- Inform the insurer within 24 hours of emergency hospitalization (or before planned admission).
- Pay the bills, collect every document (see checklist).
- File the claim form + documents within 15–30 days of discharge (varies by insurer).
- Settlement typically in 15–30 days if documents are complete.
Document checklist — keep everything
- Claim form (duly filled & signed)
- Discharge summary
- All hospital bills + receipts (pharmacy, diagnostics)
- Doctor's prescriptions & consultation papers
- Investigation reports (X-ray, MRI, blood tests)
- ID proof, policy copy, cancelled cheque (for NEFT)
If your claim is rejected
- Ask for the rejection reason in writing — vague denials aren't acceptable.
- Common fixable causes: missing documents, pre-existing disease waiting period confusion, filing delays — many get overturned on reconsideration with complete papers.
- Escalate: insurer grievance cell → Insurance Ombudsman (free, binding up to ₹50 lakh).
Our clients never fight alone — claim support is free for them, for life.
Frequently asked questions
How long does a cashless claim take?
Pre-authorization approval typically takes 2–6 hours for planned treatments. Emergency admissions get faster provisional approvals. Keep your health card handy.
What documents are needed for a health insurance claim?
Claim form, discharge summary, all hospital bills and receipts, prescriptions, test reports, ID proof, policy copy, and a cancelled cheque for bank transfer.
Can a rejected health insurance claim be reopened?
Often, yes. Many rejections are for incomplete documents or waiting-period misunderstandings. File a reconsideration with complete papers; if that fails, approach the Insurance Ombudsman — it's free.
Cashless or reimbursement — which is better?
Cashless at a network hospital is smoother — no big out-of-pocket payout. Reimbursement works anywhere but needs you to pay first and file carefully.
Related guides
Insurance is the subject matter of solicitation. Figures on this page are illustrative estimates for education, not quotes — actual premiums depend on insurer underwriting, age, health and plan terms. Read all policy documents carefully before buying.