Health Insurance Claim Process 2025 - Cashless & Reimbursement Explained Step-by-Step

A medical emergency is stressful - claiming your health insurance shouldn’t be.

Whether you’re getting treated at a network hospital or outside it, knowing the exact steps for filing a claim ensures fast settlement and zero confusion.

In this guide, we’ll explain both Cashless and Reimbursement claim processes, list all required documents, and share insider tips to help you get your claim approved faster - every time.

With PolicyBachat Claim Assist, you can even track your claim status and get help submitting documents online.

Types of Health Insurance Claims

Claim Type Description When to Use
Cashless Claim Insurer directly pays the hospital. When treatment is done at a network hospital.
Reimbursement Claim You pay first, insurer reimburses later. When treatment is at a non-network hospital.

Cashless Claim Process - Step-By-Step

  • tick Step 1: Visit a network hospital (check insurer’s hospital list on PolicyBachat).
  • tick Step 2: Show your health e-card / policy number at the hospital insurance desk.
  • tick Step 3: Fill the pre-authorization form (hospital sends it to insurer/TPA).
  • tick Step 4: Wait for approval (usually within 2–6 hours).
  • tick Step 5: Get admitted and receive treatment.
  • tick Step 6: Insurer settles the bill directly with the hospital.

You pay only for non-covered or excess items.

Reimbursement Claim Process - Step-By-Step

  • tick Step 1: Get treatment at any hospital and pay bills upfront.
  • tick Step 2: Collect all documents (bills, reports, discharge summary, etc.).
  • tick Step 3: Submit claim form + documents to your insurer within 7–15 days.
  • tick Step 4: Insurer verifies and processes the claim.
  • tick Step 5: Amount reimbursed directly to your bank account.

Documents Required for Claim Settlement

  • tick Claim form (signed)
  • tick Policy copy / ID card
  • tick Hospital discharge summary
  • tick Doctor’s prescriptions
  • tick Original bills and payment receipts
  • tick Diagnostic and test reports
  • tick FIR / accident report (if applicable)
  • tick Bank details (cancelled cheque / account proof)

Local Insights

  • tick Avg. cashless approval time: 4.5 hours
  • tick Top network hospitals: Apollo, Fortis, Manipal
  • tick Most common claim type: 82% cashless claims
  • tick Top 3 insurers with fastest claim turnaround: HDFC ERGO, Niva Bupa, Care Health

Claim Settlement Timeline

Claim Type Average Time (Days) Who Pays
Cashless Claim 2–5 days Insurer to Hospital
Reimbursement Claim 7–15 days Insurer to Customer

Policybachat Claim Assist - Your Support System

  • tick Free claim filing help via phone or chat.
  • tick Document checklist + submission assistance.
  • tick Real-time claim tracking updates.
  • tick Escalation support if delay occurs.
  • tick Average claim turnaround: 8 days (vs 12-day industry avg).

Common Reasons For Claim Delay Or Rejection

  • tick Missing or incomplete documents.
  • tick Policy lapsed or premium unpaid.
  • tick Non-disclosure of pre-existing illness.
  • tick Expenses outside policy coverage (e.g., cosmetic treatments).
  • tick Late claim submission after treatment.

How to Avoid Claim Rejections

  • tick Disclose all health conditions at purchase.
  • tick Renew your policy on time.
  • tick Always use a network hospital when possible.
  • tick Submit all original bills and documents.
  • tick Keep soft copies uploaded for future reference.

Policybachat Tip

Cashless is always faster and easier. Before hospitalization, check your insurer’s network hospital list on PolicyBachat - it could save you hours during emergencies.

Tax Benefit Note

Reimbursed medical claims are not taxable income. Your health insurance premium remains eligible for 80D deduction even if you claim benefits.

Frequently Asked Questions

When the insurer directly settles your hospital bill at a network hospital.

Only at hospitals tied up with your insurer (network hospitals).

Usually 7–15 working days after document submission.

Yes, most insurers and PolicyBachat support digital claims.

Insurer may need alternate proof; always keep scanned copies.

Yes, most modern policies cover 400+ procedures without 24-hour admission.

Either the insurer directly or a licensed Third-Party Administrator (TPA).

Yes - nominee or family member can initiate on your behalf.

You can switch to reimbursement claim using same documents.

Usually within 7–15 days post-discharge (check insurer policy).

Customer Reviews

“Cashless claim approved in 3 hours - smooth process!”

Ravi Deshmukh, Pune

“PolicyBachat Claim Assist handled everything for us.”

Sneha Iyer, Delhi

“Reimbursement credited in 8 days - impressive speed.”

Vikram Menon, Kochi

“Clear explanation of documents - no rejections.”

Kavya Sharma, Bengaluru

“Best claim experience I’ve had in 10 years.”

Nisha Kapoor, Mumbai

“Network hospital list helped us during emergency.”

Rohit Reddy, Hyderabad

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