Insurance Claims Hub
A claim usually turns on timing, documents and who you contact. Start with whichever of these you need.
Cashless vs Reimbursement
If possible, prefer cashless-but be prepared for partial approvals.
Cashless Claim
Hospital and insurer coordinate directly. You pay only non-payables, deductibles, and co-pay.
Process
- 1. Choose network hospital
- 2. Request pre-authorization at admission
- 3. Track approval amount & conditions
- 4. Request enhancement if costs increase
- 5. Pay remaining at discharge
Reimbursement Claim
You pay the hospital first, then claim back from the insurer with documents. Works at any hospital.
Process
- 1. Inform insurer if required
- 2. Pay hospital and collect all documents
- 3. Submit claim within deadline
- 4. Respond quickly to query letters
- 5. Receive settlement (understand deductions)
Essential Document Checklist
Keep copies (digital and physical) for every hospitalization.
Pro tip: Maintain a single "claim folder" (bills, reports, approvals, emails) for every hospitalization. This helps if you need to follow up or escalate.
Common Reasons Claims Get Rejected
Know these to prevent issues before they happen.
Non-disclosure / mismatch on pre-existing diseases
Waiting period not completed
Room rent limit leading to proportionate deductions
Non-medical items / consumables not covered
Procedure not covered / excluded
Documentation gaps or late submission
Stuck? Here's How to Escalate
Follow these steps if you hit a roadblock.
Insurer/TPA Customer Support
Start here. Call the toll-free number, explain your issue, and ask for a reference number.
Insurer Grievance Redressal
If customer support doesn't resolve, file a written complaint with the insurer's grievance cell. You can also email IRDAI at complaints@irdai.gov.in
IRDAI Ombudsman
If the insurer doesn't resolve within 30 days, escalate to IRDAI's Insurance Ombudsman. Visit cioins.co.in to file your complaint.
Health insurers: helplines, emails and claim portals
Direct access to helpline numbers, email addresses, and online claim portals for all major health insurers in India. Easily find your provider to initiate a claim.
Life and term insurers: death claim contacts
Quickly contact life insurance providers for death claims, maturity benefits, and policy support. Save time during difficult moments with direct portals.
Guides, checklists and templates
Everything you need to navigate the claims process.
