File a Reimbursement Claim in Health Insurance

Updated on - 04 Feb 2026

Filing a reimbursement claim under your health insurance policy can feel overwhelming, especially after dealing with a hospital stay or unexpected medical treatment. You may have already paid your bills and want to make sure your policy covers them smoothly. Whether it’s a planned procedure or an emergency, understanding how to file a claim, what documents to prepare and how to track your request can save time, reduce stress and ensure your health insurance policy works effectively for you.

When can you file a health insurance reimbursement claim?

You can file a reimbursement claim under your health insurance policy after paying all medical expenses.For planned hospitalisation, inform your insurer at least two days before admission.In case of emergency hospitalisation, notify them within 24 hours. Exact timelines may vary between insurers, so always check your policy documents for the specific requirements.

However, the exact timing for filing a claim can vary as per different insurance providers, so you must check your policy documents properly.

Steps to raise a reimbursement health insurance claim

Unlike a cashless claim, you have to take the initiative when it comes to making a reimbursement claim. Here is a step by step guide to make the reimbursement process smoother.

Step 1: You intimate the claim

Inform your insurance provider about the hospitalisation or medical treatment as soon as possible. Most insurers may offer different ways to do it, like contacting them through toll-free number, email, online portal, etc.

Step 2: Arrange your documents

Once you have made the payment at the hospital, arrange all the documents chronologically. Start from the original bills for doctor’s consultation, X-ray and other medical expenses to your discharge summary, medical reports and hospital bill.

Step 3: You fill out & submit the claim form

Next, you’ll have to download the claim form from the insurer’s website. Take a print and fill in the details in the required sections. Some parts of the form may also need to be filled by your doctor or hospital. After that, sign on the claim form and also get it signed by your treating doctor and submit it with other documents.

Step 4: Claim processing and tracking

Once the form is submitted, the insurance provider reviews the claim. The claim may be approved or declined or they can also request additional documents. You can also track your claim’s status online using the claim number, and once approved, the claim amount will be transferred to your bank account.

Documents required for reimbursement health insurance claim

When filing a reimbursement claim under a health insurance policy, you will need to submit the claim along with the documents listed below.

1. Duly filled claim form, filled and signed by you with section completed by the treating doctor or hospital.
2. Original discharge summary/daycare summary, providing details of diagnosis, treatment and hospital stay.
3. Original final hospital bill and other bills along with receipts showing payment.
4. Original payment receipts and other receipts supporting bills
5. Original investigation reports (Including ECG/ CT/ MRI/ USG/ HPE)
6. Original pharmacy bills
7. Original implant sticker/invoice
8. Photocopy of doctor’s prescriptions
9. Photocopy of the consultation paper
10. Photocopy of age proof (Driving license/ PAN card/ Passport/ Aadhar card)
11. Photocopy of indoor case paper
12. EFT (Copy of cancelled cheque/self-attested ID poof/Bank-attested copy of passbook with IFSC code)
13. KYC (Copy of ID proof, Residence proof, & 2 passport-size photos)
14. Pre and post hospitalisation bills including expenses of before admission and after discharge (if these expenses are covered in the policy)
15. MLC reports, FIR, police closure in accident related claims (if applicable)
16. In case of death- death summary, death certificate, nominee’s ID, bank details and documents.

Note: This is an indicative list. Please read the policy wordings for the complete list of inclusions/exclusions.

Things to keep in mind while filing a reimbursement claim in health insurance

To ensure you have a smooth and speedy reimbursement claim process, it's important to be thorough. Here are a few things to remember:

• Check your hospital bill before you sign and pay it for any errors or unexplained extra charges.
• Collect all your receipts, reports and relevant documents from the hospital at the time of discharge.
• Also, collect any bills for medical expenses incurred 30 days before and 60 days after hospitalisation.
• Don’t forget to submit the mandatory documents along with other necessary proofs like, prescriptions, payment receipts, diagnostic reports, etc.
• Take time out to go through the policy inclusions and exclusions when you make a reimbursement claim to avoid any confusion at a later stage.
• Keep copies of everything that you've submitted for your own records.
• Keep the claim submission timelines set by your insurer in mind.

Note: This is an indicative list. Please read the policy wordings for the complete list of inclusions/exclusions.

Common reasons reimbursement claims get rejected

Health insurance reimbursement claims can be rejected if they do not meet the insurer’s requirements. Common reasons include:

• Incomplete or missing documents: Not providing complete and original documents such as bills, discharge summaries, claim forms or medical reports.
• Non-disclosure of pre-existing conditions: If an illness or condition was not declared when purchasing the policy.
• Expenses outside the policy coverage: Costs for items not covered, like non-medical consumables, excluded treatments or cosmetic procedures.
• Policy lapse: If premiums are unpaid or the policy is inactive.
• Treatment from a non-recognised hospital: If the hospital is not registered with the insurer or does not meet required standards.

Note: This is an indicative list. Please read the policy wordings for the complete list of inclusions/exclusions.

How long does it take to settle a health insurance reimbursement claim?

The settlement time for a health insurance reimbursement claim depends on the insurer and how quickly you submit all required documents. The initial review usually takes 7-30 days to verify reports and documents.

Once approved, the claim amount is generally transferred to your account within 2-4 weeks. Timelines may vary across insurers, so always check your policy documents for specific details.

Tips to ensure a smooth reimbursement claim process

To ensure a smooth reimbursement claim process:

• Notify your insurance provider as soon as hospitalisation or treatment occurs.
• Keep all documents, including bills, prescriptions, discharge summaries and reports, organised before submission.
• Check your health insurance policy for inclusions and exclusions to avoid last-minute issues.
• Submit your claim within the timeline specified by your insurer to prevent delays or rejection.
• Use network hospitals when possible for faster treatment and claim processing.
• Maintain copies of all submitted documents for your records.

How to track your reimbursement claim status online?

You can track your health insurance reimbursement claim online using these methods:

• Insurance provider’s website: Most insurers have an online portal where you can check your claim status by entering your details.
• Mobile applications: Dedicated apps provide real-time updates and often allow you to submit documents and track progress directly from your phone.
• Third-party administrator (TPA) portals: If your policy is managed by a TPA, you can log in to their portal to see detailed claim information.
• Customer support: If online tracking isn’t available, you can contact your insurer’s customer support for updates and assistance.

Role of pre-authorisation in health insurance claims

Pre-authorisation, also called pre-approval, is an important step in many health insurance claims, especially for planned hospitalisations or high-cost treatments. Its key roles include:

• Coverage confirmation: The insurer checks and confirms before treatment that it is covered under your health insurance plan.
• Faster claim processing: Pre-approved treatments help speed up claim settlement and reduce delays at discharge.
• Correct documentation: The process ensures all documents are correct and clarifications are completed before treatment to avoid issues later.

Conclusion

Filing a reimbursement claim under your health insurance policy involves following a clear set of steps to make sure that the expenses are covered efficiently. Timely notifying your insurer, diligently collecting and submitting the necessary documents, and following the specified timelines are simple steps that save time later and ensure that the claim process is smooth.

Whether it’s an individual plan or a family health insurance policy, these practices help you make the most of your coverage. While you focus on your recovery and well-being, let us help you manage your finances. Get your customised health insurance advice and solutions by filling out the form provided on this page.

FAQs

1. How is a reimbursement claim different than a cashless claim?

A cashless claim allows the hospitals to settle the bills directly with your insurance provider so that you don't have to pay anything. Whereas, in a reimbursement claim, you have to pay the hospital first and then claim the expenses back from your insurance provider.

2. How long does a reimbursement claim take to process?

Reimbursement claims are typically processed within 15–30 days after submission of all required documents.

3. Can I file a reimbursement claim for treatment at any hospital?

In most cases, you can file a reimbursement claim for treatments received at any hospital, but it’s best to confirm with your insurer or check your policy terms.

4. What medical expenses can I claim back?

You can claim most of the hospital and treatment-related expenses, including doctor’s fees, diagnostic tests, surgery costs, pharmacy bills and pre- or post-hospitalisation costs. However, the exact list of expenses covered may vary across insurers and policy types, so it’s best to check your policy document for the complete list of inclusions and exclusions.

5. What are the types of reimbursement claims?

There are typically two types of reimbursement claims. One is a planned hospitalisation claim, which is for scheduled procedures where you know the treatment in advance.

Another one is the emergency hospitalisation claim, which is for unexpected medical emergencies needing immediate attention.

6. How to write a claim?

Writing a claim is simple, you just have to fill out the claim form provided by your insurer. You also need to attach all original bills, reports, etc., while including details like hospitalisation dates, treatment summary and payment proofs. Lastly, get your form signed and filled by the doctor or hospital and submit it to your insurer.

Disclaimer: The information provided in this blog is for educational and informational purposes only. It may contain outdated data and information regarding the topic featured in the article. It is advised to verify the currency and relevance of the data and information before taking any major steps. ICICI Lombard is not liable for any inaccuracies or consequences resulting from the use of this outdated information.