How to claim health insurance?

How to claim health insurance?

by 5paisa Research Team Last Updated: Aug 24, 2023 - 12:54 pm 1.6k Views
Listen icon

Buying the best health insurance would only make sense if the claim settlement process is smooth enough. In this article, we would be explaining how to claim health insurance.

 When a policyholder is hospitalised or has a medical emergency, his or her health insurance policy kicks in. The insured individual might then need to request the insurance provider to pay for their medical expenses at that point. This is known as filing a claim for health insurance coverage.

The best health insurance coverage can give the financial support required to receive medical care on time. However, medical bills might quickly deplete your savings. That is why learning how to file a health insurance claim may be quite beneficial. Continue reading to learn how to file a claim for your health insurance.

Claiming Health Insurance

Individuals with health insurance can choose between a direct claim settlement (cashless treatment) and compensation for health services received. An insurance company pays the claim amount straight to a network hospital under the cashless claims process of health insurance.

Only hospitals where the insurer has made prior arrangements to provide this option to are eligible for a cashless facility. They are referred to as network hospitals or empanelled hospitals. When using a reimbursement facility, you must pay all medical bills in full upfront and submit a claim for reimbursement to your health insurance provider later.

You can follow these steps to get a cashless claim with planned hospitalisation:

Step 1: Notify your insurer/TPA of your intended treatment at least 3 to 4 days in advance. 

Step 2: Obtain a pre-authorization form from a network hospital or online from the TPA's website. 

Step 3: Complete it and turn it into the insurer's/TPA desk at the hospital where you wish to be treated. 

Step 4: Bring all necessary documentation to the TPA counter. 

Step 5: If your application is approved, the insurer/TPA will send you an authorization letter and notify the hospital of your treatment. 

Step 6: To receive cashless treatment, present your health insurance ID card and pre-authorisation letter on the day of admission.

To file a claim for reimbursement, please follow these steps:

Step 1: Ensure that any medicines, medical records, and expenses accumulated while your treatment is carefully stored.

Step 2: Obtain the discharge certificate or discharge report from the hospital upon discharge.

Step 3: When filing claims for medical expenses, ensure that they are certified and signed by the hospital.

Step 4: Submit the claim form fully completed and signed, together with any pertinent original papers, to the insurance provider.

Step 5: Ensure that you submit your claim within 7 to 15 days after receiving hospital release.

How do you rate this blog?


Start Investing in 5 mins*

Rs. 20 Flat Per Order | 0% Brokerage


About the Author

Our research team is composed of some highly qualified research professionals, their expertise range across sectors.


Investment/Trading in securities Market is subject to market risk, past performance is not a guarantee of future performance. The risk of loss in trading and investment in Securities markets including Equites and Derivatives can be substantial.
Open Free Demat Account
Resend OTP
Please Enter OTP
Mobile No. belongs to

By proceeding, you agree to the T&C.

Latest Blogs
Weekly Outlook on Copper - 01 December 2023

Copper prices saw a modest 0.33% gain, reaching 722 on Thursday, as worries about a slowdown in Chinese manufacturing loomed large. The November's NBS Manufacturing PMI slipped to 49.4, the second consecutive monthly decline, heightened concerns, emphasizing the need for additional government support to fortify China's economic growth. The NBS Non-Manufacturing PMI at 50.2, reflecting the 11th month of service sector expansion, hinted at a softer pace.

Swing Trading Stocks: Week of 04 December 2023

Swing Trading Stocks for the Week

Weekly Market Outlook for 04 December to 08 December

Our markets started the truncated week on a positive note and it rallied higher throughout the week. The first day of the December month infact witnessed a new record as the Nifty surpassed its previous high and ended in uncharted territory above 20250 with weekly gains of almost two and a half percent.