taxBenefit

Time Remaining to Avail Tax Benefits

(Under section 80C & 80D)
health

Get 90 Lakh Health Cover at Just ₹2K

arrow curve white
life

Buy Life Insurance Now!

arrow curve white

Health Insurance Claim Process in India (2025): Step-by-Step Guide for Cashless & Reimbursement Claims

Health Insurance Claim Process in India (2025): Step-by-Step Guide for Cashless & Reimbursement Claims

Making a health insurance claim can feel like a lot - lots of steps, lots of paperwork, and lots of fine print. But understanding how it works makes the whole thing much less stressful. In this guide, we’ll walk through what to expect, how to avoid common mistakes, and what you can do to make sure your claim goes through without unnecessary deductions or rejections.

First, let’s know how you’re going to make a claim. There are two ways to go about it:

➔ Cashless Claim (Handled through the Hospital)

This is usually the smoother option. You don’t have to pay anything upfront (unless something is not covered), and you skip a lot of the paperwork. But you may still need to follow up with both the hospital and the insurer while treatment is ongoing.

Just remember one thing: the hospital needs to be on your insurer’s list of approved "cashless" hospitals. If it’s not in the list of its network providers, this option won’t be available.

➔ Reimbursement Claim (Submitted Directly to your Insurer)

Here, you pay the hospital bill yourself, then apply for a reimbursement from your insurance company. You’ll have to collect and submit all the required documents, and the process usually takes more time. This type of claim is common if the hospital isn't tied up with your insurer’s network.

 

Health Insurance Claim Settlement Process

Now, let’s get into how the claim process usually works. Here’s how it typically goes when someone needs to be hospitalized:

Step 1

Choose a Hospital

In most cases, people prefer going to a hospital their doctor recommends, especially if the doctor practices there. If you can choose between a few, check your insurer’s website for the most recent list of cashless hospitals. That gives you the option to go cashless instead of paying upfront.

Step 2

Pick the Right Room Category

Health insurance often comes with a limit on how much room rent is covered. It might be a fixed amount or limited to a certain type of room. This is why you should try to pick a room within that range.

Ask the hospital for a rough cost estimate, including room charges. Then check your policy to see what kind of room rent is covered. If you go above your limit (like picking a deluxe room instead of a standard one), the insurance company may not just charge you the extra room rent, they might also reduce their share of other expenses. And yes, this can add up quickly.

If you have more than one policy, see if one of them doesn’t have a room rent cap. That could make a difference in how much you’ll get reimbursed.

Once you've picked the hospital and the type of room, the next step is handling the claim. This will either go through a cashless process or a reimbursement process. Here's how both work, in plain language.

Wrapping Up

This list pulls together everything we know about the cashless and reimbursement claim process – what works, what causes delays, and how to make sure things go smoothly.

WhatsApp Icon
icon
SMC Insurance
Insure wise. Be wise.
SMC Insurance

Welcome to SMC.
How may I assist you?