Health insurance is supposed to make life easier, right ? But the moment you hear the words “reimbursement claim”, many people imagine endless paperwork, long queues, rejected claims, and… stress.

But here’s the truth -

Filing a reimbursement claim under health insurance is actually simple - once you know the process.

And this blog is here to make it effortless for you.

Whether you were treated at a non-network hospital, had an emergency, forgot to opt for cashless treatment, or simply prefer the reimbursement method, this guide explains everything in a clear, friendly and step-by-step way.

Let’s dive in.

What Is a Reimbursement Claim in Health Insurance ?

A reimbursement claim is when you pay your hospital bills from your pocket first and then your health insurance company repays the eligible amount later.

This is different from a cashless claim where the insurer directly settles the bill with the hospital.

You will file a reimbursement claim when -

1. You were admitted to a non-network hospital
2. Cashless approval did not come on time
3. You chose not to use cashless service
4. You were travelling and visited a hospital outside the insurer’s network
5. There was an emergency and paperwork was not possible upfront

Why Do People File Reimbursement Claims ?

Reimbursement claims offer -

Freedom to choose any hospital

Network or non-network - doesn’t matter.

Flexibility during emergencies

No need to wait for approvals.

Ease of treatment anywhere in the country

Perfect for travel or remote locations.

Peace of mind

You get your eligible expenses back once you submit your documents.

Documents Required to File a Reimbursement Claim

This is the most important process to claim.

Keeping these documents ready will save you time and avoid unnecessary claim delays.

Here’s the complete list -

1. Duly filled reimbursement claim form

Every insurer has a specific format.

2. Original hospital bills

Must include an itemised list of services and charges.

3. Doctor’s prescription & admission advice

This verifies why hospitalisation was needed.

4. Discharge summary

Shows diagnosis, treatment given and recovery status.

5. Diagnostic test reports

X-rays, blood tests, MRI, CT scan, etc.

6. Pharmacy bills

With prescriptions.

7. Implant/stent invoices (if applicable)

For surgeries like angioplasty.

8. KYC documents

Your identity and address proof.

9. Bank details

Cancelled cheque or bank passbook copy.

10. FIR or medico-legal certificate (only for accidents)

Mandatory for accidental claims.

11. Policy document or e-card

For reference.

Tip - Always ask the hospital for a proper bill with a seal, signature and GST number. Without proper paperwork, insurers will reject the claim.

Step-by-Step Process - How to File a Reimbursement Claim Under Health Insurance

Let’s make the reimbursement claim process super easy to follow.

Step 1 - Inform Your Insurance Company

Most insurers require notification within -

1. 24 hours of emergency hospitalisation
2. 48–72 hours before planned hospitalisation

You can inform them through -

1. Customer care number
2. Mobile app
3. Website login
4. Email
5. WhatsApp (for some insurers)
6. 
   

Why is this important ?

It creates a claim ID and avoids confusion later.

Step 2 - Collect All Original Documents

Once treatment is completed, collect all original bills, reports, doctor notes, payment receipts, discharge summary and prescriptions.

Check for -

1. Hospital seal
2. Doctor’s signature
3. Patient’s name and date
4. Correct bill format
5. GST details

The claim may get delayed or rejected even if you miss even one crucial document.

Step 3 - Fill the Reimbursement Claim Form With No Mistakes

This is the step where most people make mistakes.

Make sure the form includes -

1. Correct patient details
2. Policy number
3. Claim amount
4. Details of hospitalisation
5. Reason for treatment
6. Signature of patient and hospital authority

Incorrect or incomplete forms cause maximum claim delays.

Step 4 - Attach Supporting Documents For Claim

Group the documents in order -

1. Claim form
2. Hospital bills
3. Discharge summary
4. Diagnostic reports
5. Pharmacy bills
6. Payment receipts
7. KYC
8. Bank details

Some insurers ask you to submit original documents, others allow scanning and uploading through an app.

Step 5 - Submit the Documents to the Insurer

You can submit documents through -

1. Insurer’s mobile app
2. Email
3. Post / courier to TPA office
4. Branch office submission
5. Insurance portal

Advise - Always keep photocopies or scanned copies with you.

Step 6 - Verification by Insurer

Once your claim is submitted, the insurer or TPA will -

1. Check your documents
2. Verify your treatment
3. Make sure the claim is within policy limits
4. Ask for clarification if they needed

If the insurer needs extra documents, you will get an email or SMS.

Step 7 - Claim Approval and Reimbursement

After verification, the insurer will approve your claim and transfer the approved amount to your bank account.

It usually takes -

1. 7–21 days for most insurers
2. Some can take longer if documents are incomplete

You will receive -

1. Approval message
2. Settled claim summary
3. Amount credited to bank account

Why Reimbursement Claims Get Rejected- Here Common Reasons

No one likes unexpected rejection. Here’s what to avoid -

Missing or incomplete documents

E.g., no discharge summary or missing original bills.

Treatment not covered under the policy

Cosmetic surgeries or exclusions.

Waiting period not completed

Incorrect information in claim form

Non-medical expenses billed as medical

E.g., gloves, masks, food charges, etc.

Planned treatment without intimation

Suspicious or inflated bills

Insurers verify charges strictly.

How to Avoid Claim Delays or Rejections ?

Follow these simple tips -

Intimate the insurer on time

Never skip this.

Keep all original bills safe

Use separate envelopes for each case.

Review the bill before leaving the hospital

Errors in documents can lead to rejection.

Maintain carbon copy of all documents

If somehow, originals get misplaced.

Respond quickly to queries

Delays slow down the settlement.

Ensure treatment is medically necessary

Elective or cosmetic procedures aren’t covered.

What Expenses Are Covered Under Reimbursement Claims ?

Most medically necessary treatment expenses are covered -

1. Room rent (as per entitlement)
2. Doctor fees
3. Diagnostic tests
4. Surgery charges
5. Medicines
6. ICU charges
7. Nursing fees
8. Ambulance charges (if included)

What Is NOT Covered in Reimbursement Claims ?

These items are usually excluded -

1. Registration charges
2. Food and refreshments
3. Attendant charges
4. Disposable items like gloves, syringes, cotton etc.
5. Non-medical equipment
6. Luxury room upgrades

Knowing this saves you from surprises.

How Long Does It Take to Get Reimbursed ?

On average, insurers settle reimbursement claims within -

1. 7–21 working days

If documents are incomplete or extra verification is required, it may take longer.

Reimbursement Claim vs Cashless Claim - Which Is Better ?

If you have the option, cashless treatment is easier.

But reimbursement gives more freedom.

When Should You Prefer Filing a Reimbursement Claim ?

Choose reimbursement when -

1. The hospital is not networked
2. You want to choose your preferred doctor
3. You are travelling
4. It was an emergency
5. Cashless approval didn’t come on time

Short Brief

Health insurance reimbursement claim forms are not complicated.

You simply need -

1. The right documents
2. Timely intimation
3. Properly filled forms
4. Clear communication with the insurer

If you follow the above written steps, you can expect a smooth reimbursement claim process with no stress.

After all, health insurance is designed to support you - not confuse you .

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