Insurance claims
Insurance Claims Hub
A claim usually turns on timing, documents and who you contact. Start with whichever of these you need.
nyvo insurance Services LLP, IRDAI Corporate Agent (Composite) CA1085Salaried advisors, no commission-based ranking
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
- 1Choose network hospital
- 2Request pre-authorization at admission
- 3Track approval amount & conditions
- 4Request enhancement if costs increase
- 5Pay remaining at discharge
Reimbursement claim
You pay the hospital first, then claim back from the insurer with documents. Works at any hospital.
Process
- 1Inform insurer if required
- 2Pay hospital and collect all documents
- 3Submit claim within deadline
- 4Respond quickly to query letters
- 5Receive settlement (understand deductions)
Essential document checklist
Keep copies (digital and physical) for every hospitalization.
- Claim form
- Discharge summary
- Final bill + itemized bills
- Pharmacy bills + prescriptions
- Diagnostic reports
- Doctor consultation notes
- ID proof + policy details
- Cancelled cheque (for reimbursement)
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 diseasesHigh risk
- Waiting period not completedHigh risk
- Room rent limit leading to proportionate deductionsMedium risk
- Non-medical items / consumables not coveredCommon
- Procedure not covered / excludedHigh risk
- Documentation gaps or late submissionMedium risk
Stuck? Here's how to escalate
Follow these steps if you hit a roadblock.
- Step 1
Insurer/TPA customer support
Start here. Call the toll-free number, explain your issue, and ask for a reference number.
- Step 2
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
- Step 3
Insurance 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.
Frequently asked questions
Why do cashless claims still require me to pay at discharge?
Because deductibles, co-pay, non-payables, and some items may not be covered. The insurer pays what's covered; you pay the rest.
What's a TPA?
A Third Party Administrator helps insurers process claims, especially for cashless. They handle pre-authorization, documentation review, and settlement.
What if the hospital says 'cashless isn't available' even though it's network?
Cashless can depend on policy type, insurer instructions, and real-time system availability. Ask for the exact reason and call the insurer/TPA directly.