In a cashless claim the hospital asks the insurer or its TPA to approve your treatment, and the insurer pays the hospital directly for the covered amount. You pay only for items the policy does not cover and any co-payment or deductible.
Last reviewed on 18 October 2026. Exact requirements depend on your policy, the insurer and the rules in force.
Who this guide is for
- Treatment at a hospital in the insurer's network
- Planned and emergency admissions
Step by step
- Confirm on the insurer's or TPA's list that the hospital is in the network.
- At the insurance desk, give the health card and identity proof; the hospital sends the pre-authorisation request.
- For a planned admission, request approval a few days before; in an emergency, the hospital requests it after admission.
- If the treatment changes or costs more, the hospital asks for an enhancement.
- At discharge, the hospital sends the final bill; check the approved amount and pay any part not covered.
Documents commonly asked for
| Document | Why it is needed |
|---|---|
| Health card or policy number | The hospital's insurance desk uses it to raise the request. |
| Photo identity of the patient | Identity check at admission. |
| Doctor's note on the illness and planned treatment | The basis of the pre-authorisation request. |
The insurer may ask for fewer or other documents depending on the case.
Common mistakes
- Assuming every branch of a hospital chain is in the network
- Leaving without a copy of the final bill and approval letter
What the rules say
- The insurer is to decide on a cashless request within one hour, and give final discharge approval within three hours of the hospital's request. [1]
- For cashless claims, the insurer or TPA collects the documents from the hospital; the policyholder is not required to submit them. [1]
Rules referred to
- IRDAI Master Circular on Health Insurance Business (Insurance Products Regulations, 2024) (IRDAI/HLT/CIR/PRO/84/5/2024, 29 May 2024)
Free-look period, grace period, moratorium period, cashless and discharge timelines.
Finobazaar read published copies of these rules on 19 October 2026. Rules change: check the current text on irdai.gov.in or with your insurer.
Important limitations
- Network lists change; check the current list before admission.
- This guide explains the usual process; it does not replace your policy wording or the insurer's instructions.
- Following these steps does not guarantee that a claim will be paid.
Official resources
- IRDAI policyholder website (opens in a new tab)IRDAI's site for policyholders: consumer education and how to complain.
- How to make a complaint (IRDAI) (opens in a new tab)Complain to the insurance company first. If it does not resolve the complaint within two weeks, or you are not satisfied, escalate to IRDAI.
- Bima Bharosa – IRDAI grievance portal (opens in a new tab)Register and track a complaint against an insurer after you have complained to the insurer.Toll-free 155255 or 1800 4254 732; email complaints@irdai.gov.in. IRDAI accepts complaints from the policyholder or claimant, not from agents or other people writing for them.
Addresses checked on 19 October 2026.
Related
- Health insurance claim: document checklistDocuments commonly asked for in a health claim. For cashless claims the hospital and the insurer or TPA exchange most of them.
- How to make a health insurance claimCashless or reimbursement: which route to take and what happens at each step.
- Reimbursement health claimsPaying the hospital first and claiming the money back: documents and time limits.
- Claim rejected? Complaints and the Insurance OmbudsmanHow to challenge a rejection or short payment: insurer, IRDAI's Bima Bharosa and the Ombudsman.