You’ve paid your premiums. You’ve chosen a good policy.
But when the time comes to use your health insurance, are you ready?

Most people aren’t.

Health insurance claims often get delayed — or worse, rejected — due to confusion, missing documents, or simple mistakes. But don’t worry — with the right steps, you can ensure a quick, smooth, stress-free claim process.

Whether you’re filing a cashless claim or going for reimbursement, this guide covers everything you need to know.

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🏥 Types of Health Insurance Claims

✅ 1. Cashless Claim

• You don’t pay upfront (except non-covered expenses)

• Hospital settles directly with the insurance company

• Available only at network hospitals

✅ 2. Reimbursement Claim

• You pay the bill yourself

• Submit documents after discharge

• Claim is settled in 7–30 working days

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🔹 How to File a Cashless Claim (Planned or Emergency)

💡 Step 1: Choose a Network Hospital

Check if the hospital is listed in your insurer’s cashless hospital network.

🔍 You can find this list on the insurer’s website or policy app.

🏥 Step 2: Visit TPA/Insurance Help Desk

Once admitted, go to the hospital’s insurance desk and present:

• Your health card / policy number

• Aadhaar and PAN (for ID verification)

📝 Step 3: Fill Pre-Authorization Form

Hospital will send a cashless approval request to your insurer.

This includes:

• Doctor’s diagnosis

• Estimated treatment cost

• Admission details

⏳ Approval usually takes 1–6 hours (faster for emergency cases).

📑 Step 4: Hospitalization & Treatment

Once approved, treatment begins. Keep original bills safely, just in case.

❗ Some exclusions (like gloves, food, diapers, etc.) may not be covered.

✅ Step 5: Discharge & Final Bill Settlement

The insurer pays the hospital directly. You’ll only pay:

• Non-covered items

• Expenses beyond sum insured (if any)

Get your discharge summary and final bill copy before leaving.

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🔸 How to File a Reimbursement Claim

If you go to a non-network hospital or your cashless claim was denied, follow these steps:

📦 Step 1: Collect All Documents

You’ll need:

• Original hospital bills

• Payment receipts

• Doctor’s prescription

• Diagnostic reports

• Discharge summary

• Pharmacy bills

• Cancelled cheque

• Duly filled claim form

📁 Make both physical and scanned copies of everything.

📮 Step 2: Submit the Claim

Send it to the insurer’s TPA (Third Party Administrator) or upload via their online portal.

✅ Use speed post or upload via app for faster processing.

⏳ Step 3: Wait for Approval

The insurance company will:

• Verify documents

• May request clarification from you or hospital

• Process the claim in 7 to 30 working days

✅ You’ll get SMS/email updates during the process.

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🧠 Tips to Ensure a Smooth Claim Process

✔️ Inform insurer within 24 hours of emergency admission
✔️ Keep policy card and ID handy at all times
✔️ Always declare pre-existing conditions honestly
✔️ Maintain a file of medical history and old reports
✔️ Don’t throw away any bills or reports until claim is settled
✔️ Follow up politely if approval takes time

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❌ Common Mistakes to Avoid

• ❌ Late notification to the insurer

• ❌ Missing or unclear documents

• ❌ Claiming for excluded treatments

• ❌ Submitting fake bills (will lead to blacklisting)

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🔍 What If Your Claim Is Rejected?

Stay calm. You can:

1. Ask for written reason for rejection

2. Submit missing documents, if that’s the reason

3. Appeal to the insurer’s grievance cell

4. Escalate to the IRDAI ombudsman if unfairly denied

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🧾 Final Thought: Be Prepared Before the Emergency

“Insurance is a parachute. But it only works if you know how to pull it.”

Claims aren’t difficult — but they require attention to detail. Save this guide. Share it with family. And make sure you and your parents know these steps in advance.