How to make Health Insurance Claim?

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    Health Insurance is necessary as it covers your medical expenses. You should buy health insurance according to our needs. Insurance will cover us from any sudden, unexpected cost of hospitalisation or else we would end up paying huge amount from our pocket. Click to know smart ways to get health insurance premium rates lowered over the policy term.

    How to make Health Insurance Claim?

    Health Insurance included most of the charges before and after hospitalization expenses including room rent, boarding expenses, nursing expenses, fees of surgeon, and any other requirement such as anesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines, drugs, diagnostic materials. However, to avail claim on this policy, minimum stay (Usually this is 24 hours) in the hospital is necessary.

    One can make a claim under a Health insurance policy in two ways:

    1. On a Cashless basis and
    2. A Reimbursement Claim

    On a Cashless basis

    For a claim on cashless basis, your treatment must be only at a network hospital of the Third Party Administrator (TPA) who is servicing your policy. Means you should check for the hospitals which are covered by your TPA.
    aIn Cashless claim one can avail treatment without having to pay the hospital bills as the payment is made to the hospital directly by the Third Party Administrator, on behalf of the insurance company. Click to know how to make best use of Cashless Health Plan.

    You have to seek authorisation for availing the treatment on a cashless basis as per procedures laid down and in the prescribed form. Please read the policy document as soon as you receive it to familiarise yourself with the process rather than wait for a claim to arise.

    Claims on Reimbursement Basis

    In reimbursement clause, one needs pay the amount and claim within stipulated time as mentioned in your policy.


    Read the clause relating to claims in your policy document as soon as you receive it to ensure that you understand the procedure and the documents required for making a claim on reimbursement basis.

    When a claim arises you should inform the insurance company as per procedures required. After hospitalisation, you have to ensure that you obtain and keep ready documents such as claim form, discharge summary, prescriptions and bills that you should submit for a claim.

    After discharge, pre-and post hospitalization expenses have to be filed separately. Retain a extra photocopy of bills in case in need later.

    The documents that you need to submit for a hospitalization reimbursement claim are:

    1. Hospital final bill
    2. Receipts for payments made to the hospital
    3. Complete breakup of the hospital bill
    4. Original discharge summary
    5. All investigation reports
    6. Medicine bills with relevant prescriptions
    7. Original signed claim form
    8. Copy of current policy copy and previous years' policy copies (if any)
    9. Covering letter stating your complete address, contact numbers and email address..

    Source: IRDA

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