Reimbursement Health Insurance Claims 2025 - Step-by-Step Process & Documents Needed

Not all hospitals are in your insurer’s cashless network - and that’s okay.
If you’ve paid for treatment out of pocket, you can still recover the full amount through a reimbursement health insurance claim.

The process is simple: pay the bills, submit documents, and your insurer reimburses you within days.

In PolicyBachat helps you with claim documentation, submission, and tracking through our Claim Assist Desk, ensuring your refund arrives without delay.

Here’s a complete guide on how reimbursement claims work, what paperwork is required, and how to avoid common mistakes.

When To File a Reimbursement Claim

  • tick When you’re treated at a non-network hospital.
  • tick When cashless claim request was denied or delayed.
  • tick When you paid medical bills upfront for faster discharge.

Step-By-Step Reimbursement Claim Process

Step 1: Pay Hospital Bills

Pay for treatment and collect all original bills, receipts, and medical documents.

Step 2: Inform Your Insurer

Intimate your insurer/TPA within 24-48 hours of admission (emergency) or 2-3 days before a planned treatment.

Step 3: Collect and Verify Documents

Ensure all documents are signed, stamped, and complete.

Step 4: Submit Claim Form

Fill insurer’s claim form (available on PolicyBachat or insurer site) and attach all required papers.

Step 5: Track Claim Status

Get tracking ID from insurer/TPA and follow progress online or via Claim Assist.

Step 6: Receive Reimbursement

Once verified, insurer credits the approved amount directly to your bank account.

Documents Required For Reimbursement Claim

  • tick Duly filled and signed claim form
  • tick Original hospital bills and discharge summary
  • tick Doctor’s consultation papers & prescriptions
  • tick Diagnostic reports and test results
  • tick Payment receipts with hospital seal
  • tick FIR/Accident report (for injury claims)
  • tick KYC documents (PAN, Aadhaar)
  • tick Cancelled cheque or bank account proof

Local Insights

  • tick Avg. reimbursement claim time: 15 days.
  • tick Most common claim type: Hospitalization.
  • tick Avg. amount reimbursed per claim: ₹50,000.
  • tick Top insurers for smooth reimbursement: HDFC ERGO, Bajaj Allianz, ICICI Lombard.

Claim Settlement Timeline

Claim Stage Typical Duration Responsible Party
Claim Submission Day 0 Customer
Document Verification 3-5 days Insurer/TPA
Claim Approval 5-10 days Insurer
Payment Credit 7-15 days Insurer to Customer
(Average total: 10-15 working days)

Common Reasons For Delay Or Rejection

  • tick Missing or unsigned documents.
  • tick Mismatch in diagnosis or bills.
  • tick Policy expired or premium unpaid.
  • tick Non-disclosure of pre-existing conditions.
  • tick Submitting claim beyond allowed timeframe (30 days).

How To Avoid Rejection

  • tick Always inform insurer before or during admission.
  • tick Submit documents within 30 days post-discharge.
  • tick Double-check that bills match treatment summary.
  • tick Keep photocopies of all documents submitted.
  • tick Renew your policy on time for uninterrupted coverage.

Policybachat Claim Assist Benefits

  • tick End-to-end help with form filling and submission.
  • tick Pre-verification of documents before you send them.
  • tick Real-time tracking with escalation support.
  • tick Average turnaround reduced by 40%.
  • tick Free service for all PolicyBachat customers.

Tax Note

Reimbursement received from a health insurer is not taxable. However, your premium payment still qualifies for Section 80D deduction.

Policybachat Tip

Always keep soft copies of bills and reports. Most insurers now accept scanned uploads - no need to courier original papers unless requested.”

Frequently Asked Questions

When you pay hospital bills first and insurer refunds later.

Within 30 days after discharge.

Yes, unless insurer accepts scanned copies.

Usually 10-15 working days after document submission.

No, as long as total claims don’t exceed your sum insured.

Yes, up to the policy limit.

Yes, you can convert it to reimbursement.

Not mandatory, but intimation to insurer is advised.

Yes, through PolicyBachat or insurer portal.

Only if covered under your plan or rider.

Customer Reviews

“Got my ₹70,000 reimbursement in 8 days!”

Ananya Rao, Bengaluru

“PolicyBachat handled document verification for me.”

Ravi Patel, Delhi

“Easy process, no hassle for non-network hospitals.”

Sneha Menon, Kochi

“Great support during reimbursement follow-up.”

Kavya Iyer, Mumbai

“Clear instructions - claim approved smoothly.”

Vikram Nair, Chennai

“Highly recommend using Claim Assist for faster refunds.”

Meera Desai, Pune

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