Filing a health-insurance claim doesn’t have to be stressful - yet most delays happen because
people don’t know what to expect.
In 2025, both cashless and reimbursement claims are now
fully digital, but small errors in paperwork or timelines can still cause rejection.
This step-by-step guide explains how the claim process works, how to prepare documents, and
how to make sure your insurer approves payment quickly.
Whether you’re filing your first claim or helping a family member, these 2025-specific tips
will save time, money, and frustration - so you can focus on recovery, not paperwork.
Types of Health Insurance Claims
| Claim Type |
How It Works |
Ideal Use Case |
| Cashless |
Insurer settles bill directly with hospital |
Planned / emergency hospitalization in network hospitals |
| Reimbursement |
You pay first, insurer reimburses later |
Non-network hospitals, or when cashless not approved |
Step-by-Step Cashless Claim Process 2025
- Hospital Admission: Show e-card at network hospital.
- Pre-authorization: Hospital sends treatment estimate to insurer / TPA.
- Approval: Average approval time 2 - 6 hrs (emergency within 2 hrs).
- Treatment: Patient receives care; hospital updates insurer.
- Discharge & Final Bill: Insurer pays hospital directly.
- You Pay: Only non-admissible or excluded items (if any).
Step-by-Step Reimbursement Claim Process 2025
- Get treatment at any hospital (keep all bills & reports).
- Submit claim form + documents to insurer within 15 days of discharge.
- Insurer reviews & requests clarification (if needed).
- Claim approved → payment to bank account in 7 - 15 working days.
Required Documents (2025 Updated List)
- Policy e-card / number
- Claim form (filled & signed)
- Hospital discharge summary
- Itemized bills & payment receipts
- Doctor’s prescription & diagnostic reports
- KYC (PAN / Aadhaar)
- Bank details for reimbursement
- FIR (if accident case)
Typical Claim Timeline 2025
| Process |
Cashless |
Reimbursement |
| Pre-auth approval |
2 - 6 hrs |
N/A |
| Treatment duration |
Variable |
Variable |
| Final settlement |
6 - 12 hrs |
N/A |
| Reimbursement payout |
N/A |
7 - 15 working days |
Common Reasons for Claim Rejection
- Common Reasons for Claim Rejection
- Waiting period not completed.
- Room-rent limit exceeded (proportionate deduction).
- Treatment / procedure excluded.
- Bills or reports missing.
- Claim filed after deadline
How to Avoid Claim Delays
- Always inform insurer before / immediately after admission.
- Submit all originals and keep soft copies.
- Verify hospital uses your insurer’s TPA.
- Check sub-limits (room rent, maternity, cataract).
- Track claim status through PolicyBachat dashboard.
- Avoid multiple submissions through different agents.
Claim Settlement Ratios (CSR) of Top Insurers 2025
| Rank |
Insurer |
CSR % |
Avg. Turnaround Time |
| 1 |
HDFC ERGO |
96.8% |
3 - 5 days |
| 2 |
Care Health |
95.6% |
4 - 6 days |
| 3 |
Star Health |
94.7% |
2 - 4 days |
| 4 |
Niva Bupa |
93.9% |
5 - 7 days |
| 5 |
Aditya Birla |
93.5% |
4 - 8 days |
| 6 |
ManipalCigna |
92.8% |
5 - 7 days |
What To Do If Claim Is Denied
- Ask for written denial letter with reason.
- Submit missing documents or clarifications.
- Escalate to insurer’s grievance redressal officer.
- If unresolved → IRDAI complaint via Bima Bharosa Portal.
- For disputed cases → Insurance Ombudsman (free of cost).
Compare Claim Ratios →
Local Insights (Hyderabad)
- Avg. cashless approval time: 5 hours.
- Top cashless hospitals: CityCare Hospital, Prime Health Centre,
Lifeline Multispeciality.
- Most common claim reason: Emergency hospitalisation.
- Average reimbursement payout time: 17 days.
FAQs
Which is better - cashless or reimbursement?
Cashless is faster and more convenient; reimbursement suits non-network hospitals.
How much can I claim per year?
Up to your policy sum insured (plus restoration, if applicable).
What is the deadline to submit claims?
Within 15 days of discharge for reimbursement claims.
Can I claim for pre- and post-hospitalization?
Yes, up to 30 / 60 days depending on plan.
Do I need originals for cashless claims?
Hospital sends them directly; keep photocopies.
What if treatment cost exceeds sum insured?
You pay the balance; insurer covers up to limit.
Can I track claim online?
Yes - via insurer app or PolicyBachat Claim Assist.
Does No-Claim Bonus reduce after one claim?
Yes, proportionally (varies by plan).
Are OPD bills covered?
Only if your plan includes OPD rider.
Which insurer has fastest approvals in 2025?
Star Health - average 2 - 4 hrs cashless pre-auth.
Customer Reviews
- “Cashless approval within 4 hours - seamless process.” - Ravi Menon
- “Got reimbursement in 8 days through PolicyBachat.” - Sneha Iyer
- “Great checklist - helped me file my father’s claim easily.” - Vikram Desai
- “Transparent updates via Claim Assist dashboard.” - Kavya Sharma
- “No rejection issues after following the tips.” - Rajesh Rao
- “Saved time by verifying hospital in advance.” - Meera Nair
PolicyBachat Advantage
- Real-time claim tracking & support.
- 24×7 Claim Assist Desk (chat, call, email).
- Guidance for document preparation.
- Compare insurers by claim speed & CSR.
- 100 % digital submission - no paperwork delays.
PolicyBachat Tip
Claims don’t fail because of fine print - they fail because of missed details. Always verify documents twice before submission.
Tax Benefits (Section 80D)
Self + family = ₹25,000
Parents (< 60) = +₹25,000
Parents (60 +) = +₹50,000
Total possible deduction: ₹75,000 per year
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