Health insurance plans aim to provide financial assistance for healthcare services. A health insurance claim must be raised for financial support during medical emergencies. In this blog, we will take you through the types of claims and the process for online claiming. Let us learn about the same.
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04 Aug 2025
Types Of Health Insurance Claims
There are two types of health insurance claims: cashless and reimbursement. Let’s break down each of them for better understanding:
- Cashless Claim: In a cashless claim, the policyholder directly settles all medical bills with the hospital. However, the policyholder must be admitted to the hospital only at a network hospital to avail of the hospitalisation benefit.
- Reimbursement Claim: In reimbursement claims, the insurer pays for the hospital expenses upfront at discharge and later requests that the company reimburse the bill. This type of claim can be raised at both network and non-network hospitals.
Step-By-Step Process For Online Claim Filing
Here’s the step-by-step process for filing online claims for both types of health insurance– cashless and reimbursement:
Cashless Health Insurance Claim Settlement Process:
Here’s the step-by-step process to avail a cashless claim:
Step 1: Choose A Network Hospital
You must get admitted to a network hospital that your insurance company covers.
Step 2: Inform The Insurer or TPA
Now, contact the insurance help desk at the hospital or the insurance company. You can show the health card issued by the insurance company to verify your identification. The hospital will verify your identity and issue a pre-authorisation form for cashless treatment.
Step 3: Submit Pre-Authorisation Form
Fill out the pre-authorisation form with all the mentioned details and submit it at the hospital insurance desk.
Step 4: Provide Required Documents
Provide all the necessary documents and the form for seamless process approval. The hospital will later submit the form and attached documents to your health insurance company.
Step 5: Wait For Claim Approval
The insurance company will review the form and documents and approve your cashless claim according to the terms and conditions of the health insurance policy. The insurance company will pay the claim amount directly to the hospital. At the time of the discharge, you will have to pay the medical expenses not covered under the policy.
Reimbursement Health Insurance Claim Settlement Process:
Here’s the step-by-step process to raise a reimbursement claim:
Step 1: Inform Before Hospitalisation
You must inform your health insurance provider about your hospitalisation immediately.
Step 2: Get The Treatment And Pay The Bill
Obtain treatment at the hospital where you were admitted. At discharge, pay the entire hospital bill and collect all the documents.
Step 3: Submit The Documents
Collect all the documents and submit them to your health insurance company. The insurer will review the documents and process the claim per the terms and conditions of the health policy.
Step 4: Wait For Claim Approval
Once your documents are verified, the insurer will approve the claim and the amount will be transferred to your bank account.
Documents Required To File A Health Insurance Claim
Here is the list of documents that you need to submit to file a health insurance claim:
- Health Card (Health Insurance ID Card)
- Consultation papers given by the doctor
- Filled-in claim form
- Investigation and diagnosis reports, such as CT scans, X-rays, blood reports, etc.
- Hospital bills, along with payment receipts
- Medico-Legal Certificate (MLC) and/or FIR (in case of accidents)
- Invoices of the pharmacy with respective prescriptions and payment receipts
- Discharge summary
- Other relevant documents requested by the insurer
Common Reasons For Claim Rejection
Here are some of the common reasons that lead to health insurance claim rejections:
- Not revealing the pre-existing diseases at the time of policy purchase.
- Filing a claim for illnesses that are not covered under your health policy.
- Do not file a claim within the designated time frame given.
- Raising a claim during the waiting period.
- Fraudulent claims.
- Claims that are raised under an expired health policy.
- The claims were raised for an amount more than the policy sum insured.
Things To Keep In Mind To Avail A Health Insurance Claim
Here are a few things that you should keep in mind to obtain the best health insurance claim:
- Fill out the pre-authorisation form correctly to ensure a seamless process. A lack of details might lead to rejection.
- Inform the insurance company about your hospitalisation as soon as possible.
- File the reimbursement claim within 30 days of the hospital discharge date.
- Revisit the exclusions, sub-limits, and other terms and conditions of your policy.
- Submit all the relevant documents within the stipulated time frame to make the claim available.
