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Health insurance claim process

A group health insurance claim is a request that a health insurance policyholder (employee) submits to a health insurance company to get the services mentioned in their health plan/policy during hospitalization or medical treatments. By sending this request, the health insurer is notified to initiate the claim process.

Types of claims in group health insurance

There are two types of claims in group health insurance. They are cashless claims and reimbursement claims.

Cashless claim

As the name suggests, it frees us from handling money during medical emergencies. In a cashless claim, the insurer settles the medical bills directly with the hospital itself. This is applicable only if the policyholder is admitted to a network hospital.

Read about network hospitals

Cashless claim during planned hospitalization

In the case of surgery, hospitalization is planned. Whenever a hospitalization is planned, the policyholder must inform the TPA or network hospital at least 72 hours prior.

Cashless claim for emergency hospitalization

For availing of a cashless claim for emergency hospitalization, you will have to inform the insurer or TPA within 24 hours of hospitalization.

Reimbursement claim

In a reimbursement claim, once the insured is admitted to a hospital, the bills are paid from your pockets. Later, the insurance company will reimburse the claim amount to you once you provide the necessary documentation.

This is mostly the case when the policyholder goes to a hospital that is not in the network hospital list of the insurer. However, the claims are settled by evaluating the credibility of the documents you provide.

This is why it is important to choose an insurer with an extensive hospital network and a high claim settlement ratio. A claim settlement ratio suggests the percentage of claims settled by the insurance company to the policyholders in a financial year. The higher the ratio, the higher the chance of your claims being settled.

Cashless claim process

The claim process might vary depending on your insurer. Below is the common claims process for cashless.

  1. The policyholder provides the details of the insurance policy taken along with the ID card provided by the insurer in the network hospital.
  2. The hospital will send the treatment and insurance details to the TPA.
  3. The TPA verifies and sends the pre-authorization letter to the hospital.
  4. When the patient gets discharged the bills are settled by the insurer. The policyholder will only have to pay if there are any minor expenses that are not covered in the policy.

The process remains the same for planned and emergency hospitalization. However, the claim intimation must be done within the time limit mentioned above.

Reimbursement claim process

The reimbursement claims can be initiated in a hospital of your choice. The general procedure includes

  • The insured or the policyholder has to pay all the medical bills and other costs involved in the hospitalization. Make sure you keep all the bills safely for the claim.
  • Submit the original bills to the insurer along with a duly filled claim form. The claim forms are mostly available on the website of the insurer or their offices.
  • After this, the claim request is verified and processed according to the terms and conditions of the policy.
  • Once the claim is verified and the bills are credible the insurer settles the payment to the account of the policyholder.

Download claim forms

HDFC Ergo claim form Download here
Medi Assist claim form Download here
Care Insurance claim form Download here
Vidal Health claim form Download here
Star Health Insurance claim form Download here
MDIndia claim form Download here
Religare health insurance claim form Download here
MediBuddy claim form Download here
Bajaj Health Insurance claim form Download here
ICICI Health Insurance claim form Download here
Apollo claim form Download here
MedSave healthcare claim form Download here

Documents required for reimbursement claim

  • Duly filled claim form. Available on the website or the offices of the insurer.
  • The health insurance ID card provided by the insurer.
  • After this, the claim request is verified and processed according to the terms and conditions of the policy.
  • A valid unique identity card like Aadhar, Voter Id, etc.
  • All the original medical bills and pharmacy bills.
  • Doctor consultation and prescription papers.
  • Investigation report
  • Discharge summary from the hospital.
  • A medical certificate signed by the doctor in charge.
  • For accidents, FIR or MLC (Medico-Legal Certificate) copy
  • Other relevant documents.

Claim intimation

Claim intimation is informing your insurer or TPA when you are going to raise a claim. This allows them to provide you with insurance services.

  • Immediately after the policyholder or the attendant of the insured intimates the claim to the insurance provider, the insurer verifies the policy and the coverage of that policy.
  • After the verification process by a field doctor, the pre-authorization form is submitted and the cashless claims are approved.
  • This authorization process can even get canceled if the details mentioned are incorrect.
  • The claims must be filed within 30 days of discharge from the hospital
  • The insured will have to pay for all other expenses which are not covered under their health insurance policy.

Check claim status

Insurer/TPA Where to check claim status How to check claim status
Health India TPA claim status Check claim status
  1. Choose your corporate policy.
  2. Choose the document you want to provide, i.e. HealthIndia ID or Employee ID.
  3. Fill in HealthIndia ID and date of discharge or your employee code, group code and date of discharge respectively.
  4. Click on submit to track your claim status.
MediBuddy claim status Check claim status
  1. Choose the relevant ID you want to use to fill in the details, namely, Claim ID, Medi Assist ID, Employee ID.
  2. Fill in the relevant details respectively. For eg: Claim ID, Beneficiary Name and Date of Hospitalization for Claim ID.
  3. Click on submit to successfully track your claim status.
Care Health Insurance claim status Check claim status
  1. Enter your policy number.
  2. Enter the captcha for verification.
  3. Click on next to track your claim status.
Acko insurance claim No online portal
  1. Write to health@acko.com for the claim settlement process.
MediAssist tpa claim status Send SMS to Medi Assist
  1. To track your claim status, SMS - "CLAIMS <claim number>" to +91 96631 49992
MedSave in claim status Check claim status
  1. Select policy type.
  2. Select search category.
  3. Click on search to track your claim status.
HDFC Ergo health insurance claim status Check claim status
  1. Authenticate your policy number, mobile number or email ID.
  2. Fill in the relevant details to track your claim status.
New India Insurance claim status Check claim status
  1. Login to
  2. Fill your order ID.
  3. Click submit to track your claim status.
ICICI Lombard claim status Check claim status
  1. Fill your claim No or AL no.
  2. Click on search to track your claim status.
Star Health claim status Check claim status
  1. Fill in any of the detail asked from dropdown
  2. Click on get claim status.
TATA AIG claim status check online Check claim status
  1. Login To Fetch Policy Details and enter your registered phone number to proceed.
  2. Click on confirm to track your claim status.
Niva Bupa claim status Check claim status
  1. Go to customer service.
  2. Choose claims and then choose claim status.
  3. Enter your registered phone number and click on submit to track your claims
Chola MS claim status Check claim status
  1. Enter reference No.
  2. Enter your policy No.
  3. Fill in employee ID or member ID.
  4. Click on continue to get your claim status.
Aditya Birla claim status Check claim status
  1. Login and enter the details asked
  2. Click on check claim status.
Bajaj Alliance claim status Check claim status
  1. Choose check claim status.
  2. Enter your claim number
  3. Click on proceed to track your claim status.
SBI General insurance claim status Check claim status
  1. Select product from the drop down menu.
  2. Enter captcha.
  3. Click on next to track your claim status.

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