Health Insurance Claim: A Complete, Easy Guide by OneAssure

Filing a health insurance claim should feel simple, smooth, and stress-free. But for many people, the claim process feels complicated. There are documents to collect, timelines to follow, forms to submit, and medical language that is confusing. At a time when you or your family is already dealing with a medical emergency, the last thing you want is a complicated claim process.

This is exactly where OneAssure steps in.

This landing page explains everything about health insurance claims in simple language. Whether you want to understand cashless claims, reimbursement claims, documents, timelines, or common claim issues, this guide covers every question a customer normally asks.

Our aim is to make the entire claim journey easy to understand so you feel confident and supported at every stage.

A health insurance claim is a request you make to your insurer to pay for your medical treatment. You can either request the insurer to directly pay the hospital (cashless claim) or reimburse you after treatment (reimbursement claim).

A claim is simply a way to use the health insurance benefits that you have already paid for through your premium.

With OneAssure, the entire process becomes easier because our claim support team guides you step-by-step with documentation, approvals, communication, and follow-ups.

Documents vary slightly for cashless and reimbursement claims. Here are the most common documents required.

1. Health insurance policy card
2. Doctor’s prescription
3. Hospital admission note
4. Diagnostic test reports
5. Doctor’s consultation sheets
6. Pharmacy bills
7. Discharge summary
8. Hospital final bill
9. Payment receipts (for reimbursement)
10. FIR (in case of accidents)
11. Surgery notes, if applicable
12. Treating doctor’s report

OneAssure reviews these documents to avoid delays or rejections.

Claim rejections usually happen because customers are not aware of the rules. With OneAssure, we help you avoid such mistakes.

Common reasons include:

1. Missing documents
2. Wrong or incomplete information
3. Hospital not sharing required paperwork on time
4. Treatment not covered under the policy
5. Claim filed late
6. Waiting period not completed
7. Pre-existing disease not disclosed
8. Limits or sub-limits applied

We help identify these issues early so your claim can be processed smoothly.

Understanding a claim is tough. Managing it alone during a health emergency is even tougher. OneAssure makes the entire claim journey simple and stress-free.

Here is how we help:

Here is a simple comparison to help you understand.

Most customers prefer cashless claims because they reduce stress and upfront payments. But reimbursement is equally helpful when network facilities are not available.

OneAssure tells you exactly which claim type is best depending on your situation.

While timelines differ for each insurer, the general flow is as follows:

1. Cashless pre-authorization approval: 2 to 6 hours
2. Emergency cashless approval: 1 to 3 hours
3. Reimbursement claim review: 7 to 21 days
4. Settlement after approval: Within 3 to 5 working days

With OneAssure’s support, delays are minimized because we proactively handle missing paperwork.

Understanding exclusions is important to avoid surprises later.

Here are common exclusions:

1. Pre-existing diseases during waiting period
2. Cosmetic treatments
3. Dental treatments unless caused by accidents
4. Non-prescribed treatments
5. Experimental or unapproved treatments
6. Self-inflicted injuries
7. Injuries due to intoxication
8. Claim raised after the deadline
9. Treatment not matching policy conditions

We explain all exclusions clearly during policy selection.

Simple steps can help you avoid delays:

1. Inform insurer or OneAssure immediately
2. Choose a network hospital when possible
3. Keep prescriptions and reports safely
4. Do not hide medical history
5. Submit documents on time
6. Follow discharge instructions correctly
7. Ask hospital for complete paperwork
8. Double-check claim forms
9. Keep copies of all bills

These small steps can save a lot of time during claims.