{"id":2382,"date":"2026-10-13T21:14:27","date_gmt":"2026-10-13T15:44:27","guid":{"rendered":"https:\/\/www.tiwaripedia.com\/index.php\/2026\/10\/13\/how-to-claim-health-insurance\/"},"modified":"2026-10-13T21:18:14","modified_gmt":"2026-10-13T15:48:14","slug":"how-to-claim-health-insurance","status":"publish","type":"post","link":"https:\/\/www.tiwaripedia.com\/index.php\/2026\/10\/13\/how-to-claim-health-insurance\/","title":{"rendered":"How to Claim Health Insurance: Cashless vs Reimbursement Step by Step"},"content":{"rendered":"<p><em>Last updated: October 2026 \u00b7 3 min read<\/em><\/p>\n<p>Knowing the claim process before an emergency makes a stressful time easier. Health insurance claims are either <b>cashless<\/b>, where the insurer pays the hospital directly, or <b>reimbursement<\/b>, where you pay and claim later.<\/p>\n<figure class=\"wp-block-image size-full\"><img decoding=\"async\" loading=\"lazy\" width=\"1200\" height=\"675\" src=\"https:\/\/www.tiwaripedia.com\/wp-content\/uploads\/2026\/10\/how-to-claim-health-insurance.png\" alt=\"Infographic: How to Claim Health Insurance: Cashless vs Reimbursement Step by Step\" class=\"wp-image-2381\" srcset=\"https:\/\/www.tiwaripedia.com\/wp-content\/uploads\/2026\/10\/how-to-claim-health-insurance.png 1200w, https:\/\/www.tiwaripedia.com\/wp-content\/uploads\/2026\/10\/how-to-claim-health-insurance-300x169.png 300w, https:\/\/www.tiwaripedia.com\/wp-content\/uploads\/2026\/10\/how-to-claim-health-insurance-1024x576.png 1024w, https:\/\/www.tiwaripedia.com\/wp-content\/uploads\/2026\/10\/how-to-claim-health-insurance-768x432.png 768w\" sizes=\"(max-width: 1200px) 100vw, 1200px\" \/><figcaption>How to Claim Health Insurance: Cashless vs Reimbursement Step by Step \u2013 infographic by Tiwaripedia<\/figcaption><\/figure>\n<h2>Cashless claim: step by step<\/h2>\n<ol><li>Choose a network hospital of your insurer or its TPA (third-party administrator).<\/li><li>Show your health card and ID at the insurance desk.<\/li><li>The hospital sends a pre-authorisation request with diagnosis and estimate.<\/li><li>For planned treatment, apply a few days in advance; for emergencies, within 24 hours of admission.<\/li><li>The insurer approves an initial amount and the final bill at discharge.<\/li><li>You pay only non-payable items, co-payment or amounts above limits.<\/li><\/ol><p>IRDAI&#8217;s 2024 master circular asks insurers to decide cashless requests within 1 hour and final discharge authorisation within 3 hours.<\/p>\n<h2>Reimbursement claim: step by step<\/h2>\n<ol><li>Inform the insurer about hospitalisation as soon as possible.<\/li><li>Pay the hospital and collect all original documents.<\/li><li>Submit the claim form with documents within the policy deadline (often 15-30 days of discharge).<\/li><li>The insurer verifies and pays to your bank account.<\/li><\/ol>\n<h2>Documents usually required<\/h2>\n<ul><li>Claim form signed by the insured.<\/li><li>Discharge summary.<\/li><li>Final hospital bill with break-up and payment receipts.<\/li><li>Doctor&#8217;s prescriptions and investigation reports.<\/li><li>Pharmacy bills.<\/li><li>Health card, ID proof and cancelled cheque.<\/li><li>FIR or MLC copy for accident cases.<\/li><\/ul>\n<h2>Common reasons claims are rejected<\/h2>\n<ul><li>Non-disclosure of pre-existing illness.<\/li><li>Treatment during a waiting period.<\/li><li>Excluded treatments or cosmetic procedures.<\/li><li>Hospitalisation not medically necessary.<\/li><li>Missing documents or late intimation.<\/li><li>Room rent above the limit leading to proportionate deduction.<\/li><\/ul>\n<h2>If your claim is unfairly rejected<\/h2>\n<ol><li>Ask the insurer for the reason in writing.<\/li><li>Complain to the insurer&#8217;s grievance officer.<\/li><li>If unresolved in 30 days, use IRDAI&#8217;s Bima Bharosa portal.<\/li><li>Approach the Insurance Ombudsman for free resolution.<\/li><\/ol>\n<h2>Frequently asked questions<\/h2>\n<h3>How long does a reimbursement claim take?<\/h3>\n<p>IRDAI requires insurers to settle claims within 30 days of receiving all documents (longer if investigation is needed).<\/p>\n<h3>Can I claim from two health policies?<\/h3>\n<p>Yes. You can claim from one policy first and the balance from another by submitting attested copies.<\/p>\n<h3>Is OPD covered?<\/h3>\n<p>Only if your policy has OPD cover; standard policies focus on hospitalisation.<\/p>\n<h2>Keep exploring<\/h2>\n<ul><li><a href=\"\/index.php\/2026\/10\/13\/health-insurance-basics-india\/\">Health insurance basics<\/a><\/li><li><a href=\"\/index.php\/2026\/10\/12\/ayushman-bharat-pm-jay-guide\/\">Ayushman Bharat PM-JAY<\/a><\/li><li><a href=\"\/index.php\/2026\/10\/13\/emergency-fund-guide\/\">Emergency fund guide<\/a><\/li><li><a href=\"\/index.php\/category\/insurance\/\">More Insurance articles on Tiwaripedia<\/a><\/li><\/ul>\n<p><em>This article is for general information, not financial, tax or legal advice. Rates, limits and rules change; always confirm on the official website or with a qualified advisor before you act. Spotted something that needs updating? <a href=\"\/index.php\/contact-us\/\">Let us know<\/a>.<\/em><\/p>","protected":false},"excerpt":{"rendered":"<p>How to make a health insurance claim in India: cashless and reimbursement process step by step, documents needed, timelines, common reasons for rejection and how to complain.<\/p>\n","protected":false},"author":1,"featured_media":2381,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"googlesitekit_rrm_CAow_YXIDA:productID":""},"categories":[333],"tags":[],"_links":{"self":[{"href":"https:\/\/www.tiwaripedia.com\/index.php\/wp-json\/wp\/v2\/posts\/2382"}],"collection":[{"href":"https:\/\/www.tiwaripedia.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.tiwaripedia.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.tiwaripedia.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.tiwaripedia.com\/index.php\/wp-json\/wp\/v2\/comments?post=2382"}],"version-history":[{"count":1,"href":"https:\/\/www.tiwaripedia.com\/index.php\/wp-json\/wp\/v2\/posts\/2382\/revisions"}],"predecessor-version":[{"id":2433,"href":"https:\/\/www.tiwaripedia.com\/index.php\/wp-json\/wp\/v2\/posts\/2382\/revisions\/2433"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.tiwaripedia.com\/index.php\/wp-json\/wp\/v2\/media\/2381"}],"wp:attachment":[{"href":"https:\/\/www.tiwaripedia.com\/index.php\/wp-json\/wp\/v2\/media?parent=2382"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.tiwaripedia.com\/index.php\/wp-json\/wp\/v2\/categories?post=2382"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.tiwaripedia.com\/index.php\/wp-json\/wp\/v2\/tags?post=2382"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}