In a reimbursement claim you pay the hospital and then send the claim form with bills and reports to the insurer or TPA. The insurer pays the admissible amount into your bank account.
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 outside the network
- Cases where cashless was not requested or not approved
- Expenses before and after the hospital stay that the policy covers
Step by step
- Inform the insurer or TPA of the admission within the time the policy states.
- Collect every original bill, receipt, report and the discharge summary.
- Fill in the claim form and send it with the documents within the policy's time limit; keep copies and the acknowledgement.
- Answer any query from the insurer quickly and in writing.
- Check the settlement letter against your bills.
Documents commonly asked for
| Document | Why it is needed |
|---|---|
| Signed claim form | Your formal request for payment. |
| Original bills and payment receipts | Prove the amounts you paid. |
| Discharge summary | Shows the diagnosis, treatment and dates. |
| Investigation reports and prescriptions | Support the diagnosis and the medicines bought. |
| Cancelled cheque or bank details | For the payment. |
The insurer may ask for fewer or other documents depending on the case.
Common mistakes
- Sending photocopies when the insurer asks for originals
- Missing the policy's deadline for submitting documents
- Not keeping proof of what was sent and when
Rules referred to
- IRDAI Master Circular on Protection of Policyholders' Interests, 2024 (IRDAI/PP&GR/CIR/MISC/117/9/2024, 5 September 2024)
Complaint handling, claim timelines for life, health and general insurance, Ombudsman awards.
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
- The exact documents depend on the illness, the policy and the insurer.
- 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.
- Cashless health claimsHow cashless treatment is approved at a network hospital, and the time limits.
- Claim rejected? Complaints and the Insurance OmbudsmanHow to challenge a rejection or short payment: insurer, IRDAI's Bima Bharosa and the Ombudsman.