6 Tips for Making a Health Insurance Claim

We have written extensively on this site about the importance of having insurance. Whether it is ‘Life’ Insurance or Health insurance, it is not enough to just have the policy, but if circumstances arise that need you to claim it, you should know what needs to be done.

Let us look today at the steps typically involved in making a claim for Health / Medical insurance (the procedure for availing cashless treatment is different; we are exploring the situation where the policyholder or his family is filing a claim for insurance after the bill has been settled with the hospital).


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Do keep in mind that claim can only be filed after patient is discharged from the hospital, which typically means settling the bill.as well. But that does not have to be a concern, as insurance companies do settle claims for Health Insurance in a quick time-frame provided the documentation is in order.

Keep all the receipts in order

This cannot be emphasised enough. Keep originals of every receipt you have, not just the final hospital receipt. You may be eligible to claim the cost of medicines used during the hospitalisation period as well as related medicines upto a month before and 3 months after, as well, so ensure to take and keep the receipt from the pharmacies. The bills should be proper bills with VAT of the Pharmacy, name of the patient and doctor / hospital, date, name of medicine. treatment etc. Maintain and submit these in date-wise orders. For your own records, keep copies and write serial numbers on them for easy retrieval in case required later.

Similarly, all reports / tests / X-rays

When filing a claim, you also have to submit originals or copies of the results of the diagnostic tests carried out on the patient. Once again, name of doctor, name of patient, date and name of the laboratory or hospital carrying out the test must be clearly visible.

Obtain the application form from the Insurer

Remember that you first have to make the application to claim the insurance in the proper form. Call the Insurance company’s contact number and ask them to email the form to you, or if you have an agent through whom the policy was purchased, ask him or her to do the same.

Read the instructions carefully and fill up this form honestly. Lying about any of the details on the form will not help you – if detected, your entire claim can be rejected.

Attach all documents needed with the form

As mentioned in points 1 and 2, the documents, bills and reports have to be submitted with the claim form. Retain a copy for yourself and submit the originals, except where the form clearly mentions photocopies are acceptable.

Submit the documents within the prescribed time limit

Your form and the accompanying documents need to reach the insurer’s office in correct time. Your policy document and your insurer’s website should be checked to ascertain the time limit, typically a claim has to be filed within 7 to 10 days of the patient being discharged.

Follow up

While there is a time limit for you to submit documents, there is no limitation for the Insurance Company to take their own sweet time about processing your claim. Keep checking with your agent and the company’s customer care so that you know the status of your claim. If any further documents or declarations are needed, provide them as soon as possible.

With everything in place, your claim should be accepted and processed in a timely manner. It will not take away the pain of loss or the suffering caused by the medical condition you might be suffering but at least your financial distress will be alleviated.

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Kunal is an ex-banker with a (largely self-proclaimed) flair for writing. He is an associate member of the Institute of Chartered Accountants of India and an MBA from Narsee Monjee Institute of Management Studies (NMIMS), Mumbai.

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