Health Insurance: Claim process

A claim is the moment of truth for any policy. Knowing the process in advance makes it far less stressful.

1. Inform the insurer or TPA. For planned admission, inform at least 48–72 hours ahead. For emergencies, within 24 hours of admission.
2. Show your health card at a network hospital. Submit the pre-authorisation form at the hospital’s insurance desk.
3. Wait for approval. The insurer reviews medical details and issues approval, or asks for more information. Approval amount can be revised.
4. Get treated, then clear the non-payables. At discharge, pay the non-payable items (such as consumables) and any co-pay.
5. For reimbursement claims. Pay the bill and submit original bills, discharge summary, reports and the claim form within the stated time (often 15–30 days of discharge).
6. Follow up in writing. If a claim is denied, ask for the reason in writing and escalate to the insurer’s grievance cell and then the Insurance Ombudsman if needed.