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How To Make A Reimbursement Claim?

Published On Sep 01, 2021 12:00 PM By InsuranceDekho

After buying a health insurance policy, the most important process is claiming the health insurance cover. You must know the various aspects involved for claiming a health insurance policy to avail all the benefits of your purchased policy wisely. To claim a policy without any inconvenience you must carefully go through the policy terms and conditions within the 15 day free-look period provided by the insurer. You can only claim for the conditions that are included in your purchased policy otherwise the claim is not approved by the health insurer provider.

There are different types of claims that can be made on a health insurance policy namely, cashless claims and reimbursement claims. To make cashless claims, the customer has to seek treatment in one of the network hospitals of the insurer while in case of reimbursement claims, you can seek treatment in any hospital of your choice. With the advancements in technology you can claim your policy without much effort. To make sure that a health insurance provider has a good track record of claim settlements, you must check their claim settlement ratio which determines their ability to settle the claims of the customers annually.

How To Make A Reimbursement Claim?

About Reimbursement Claim Settlement Process

Reimbursement claim settlement process is a claim process which is filed when an insurer does not receive treatment in one of the network hospitals of the insurer. In this type of claim settlement process, the customer has to clear the medical dues from their pocket and later they can reimburse the expenses by filing for reimbursement claim. It takes more time to settle than a cashless claim settlement process and cannot be made for the previous financial year. Let us look at the eligibility criteria for getting a reimbursement claim on your purchased health insurance policy:

  • The money requested to be reimbursed must be spent on medical expenditures and other mentioned expenses only.
  • The cost of treatment must be spent on the policyholder or its family members like spouse, children, and dependent parents.

Must Read: Difference Between Incurred Claim Ratio And Claim Settlement Ratio

How To Make A Reimbursement Claim For A Health Insurance Plan?

Following are the basic steps involved in making a reimbursement claim for your purchased health insurance policy:

  • In case of planned hospitalization you must inform the insurer before getting admitted for the treatment
  • In case of an emergency, you must inform the insurer about the hospitalization as soon as possible or within the specified time frame mentioned by the insurer.
  • Receive your treatment and clear the medical dues before getting discharged.
  • At the time of discharge collect the documents like diagnosis reports, invoices, bills, discharge papers, medication bills, etc.
  • Collect a reimbursement form from the insurers official website and duly fill it with all the necessary information.
  • Attach the documents collected from the hospital with the reimbursement form and submit it to the health insurance provider.
  • Once all your documents are verified and checked by the insurer, the claim will be approved and the amount will be transferred to your bank account.

In case your documents are not valid or sufficient, the claim request can be denied, for which you must re-apply for the claim with the proper set of documents.

Documents Required For Reimbursement Claim of A Health Insurance Policy

Let us look at the list of documents that are necessary for making reimbursement claim for a health insurance cover:

  • Copy of health card issued by the insurer
  • Claim form
  • Hospital discharge summary
  • Diagnosis report
  • Receipts of chemists and hospital
  • FIR copy, in case of an accident
  • Consultation paper
  • Copy of KYC documents
  • NEFT details
  • Invoices of pharmacy


You can make any type of claim based on your financial budget, and other factors. Cashless claims are efficient and quick. You can make reimbursement claims on time by informing the insurer about your hospitalization as soon as possible. To avoid any confusion at the time of the claim settlement process, you must go through the terms of your policy carefully.

Also Read: Mediclaim Policy: Features, Benefits and Coverage

Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.

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