Health claim reimbursement is the process of getting back the money you paid for medical expenses that are covered under your health insurance policy.

Reimbursable expenses typically include:

• Hospitalization costs

• Doctor consultation fees

• Prescription medicines

• Diagnostic tests

• Day-care procedures (as per policy terms)

Coverage depends on your specific policy.

• Cashless Claim: The insurer pays the hospital directly at a network hospital.

• Reimbursement Claim: You pay the expenses upfront and later submit documents to get reimbursed.

You should file the claim within the time limit specified in your policy (usually 7–30 days after discharge or treatment).

Commonly required documents include:

• Duly filled and signed claim form

• Original hospital bills and receipts

• Discharge summary

• Doctor’s prescriptions

• Diagnostic reports

• Pharmacy bills

• Bank account details (cancelled cheque)

Claims can be submitted:

• Online via the insurer/TPA portal

• By email (scanned copies)

• By courier or in person (original documents)

Check your insurer’s preferred submission method.

Once all required documents are submitted, claims are usually processed within 15–30 working days.

The approved amount will be credited directly to your registered bank account through NEFT/RTGS.

Common exclusions include:

• Pre-existing diseases (during waiting period)

• Cosmetic or elective procedures

• Non-prescribed medicines

• Expenses beyond policy limits

Refer to your policy document for full exclusions.

If a claim is rejected:

• Review the rejection reason shared by the insurer

• Submit additional documents if requested

• Raise a query or appeal within the specified timeline