How to file a reimbursement health insurance claim in India

A reimbursement health insurance claim means you pay the hospital bill yourself and get the money back later. Inform your insurer as early as possible, collect your bills and receipts, and submit the claim usually within 15 to 30 days of discharge. Learn the steps and IRDAI rules.

By Qrates research desk · 2026-11-01

In a reimbursement claim for health insurance, you pay the hospital bill from your own pocket first, then submit your documents to your insurer to get the money back. Timelines start from the moment you are admitted to the hospital. If your hospital is in your insurer's network, you can instead file a cashless health insurance claim at a network hospital instead.

Quick answer: How to claim health insurance reimbursement

To get your hospital bills reimbursed, you must follow three main steps.

Tell your insurer about the hospital admission as early as possible. Many policies ask for this within 24 hours for emergencies, or at least 48 hours before a planned treatment.
Pay the hospital bill from your own pocket and collect all original receipts and the discharge summary before you leave.
Submit the filled claim form and your documents to your insurer or Third Party Administrator (TPA), usually within 15 to 30 days of discharge.

What you need before you start

You need specific documents before you can file. Many policy wordings ask for original bills and payment receipts. Some insurers let you upload scans and ask for the originals only if needed. IRDAI's Master Circular also says that once you intimate a claim, the insurer or TPA must collect the required documents from the hospital, and you should not have to submit them. Keep this set ready before you leave the hospital. Before you file, it is also wise to read a health insurance policy wording to understand specific clauses that might affect your reimbursement.

Hospital discharge summary: Policy wordings list this as a required document. It contains your admission date, discharge date, clinical history and the treatment given.
Original bills and receipts: You need the final hospital bill with a clear breakdown of room rent, doctor fees, and nursing charges. You also need the original payment receipts from the hospital. Be aware that if your room rent exceeds your plan's limit, you may face a proportionate deduction on your total claim.
Reimbursement claim form: This form has two parts. You fill Part A with your policy and hospitalisation details. The hospital fills Part B.
Pharmacy bills and prescriptions: Submit your pharmacy bills along with the prescriptions that support them.
Bank and KYC details: Give your bank account details so the insurer can transfer the money, and any proof such as a cancelled cheque that your insurer asks for. KYC rules vary. Niva Bupa, for example, requires KYC documents if the claim is ₹1,00,000 or more.

Step-by-step mediclaim reimbursement process

1. Inform the insurer or TPA

IRDAI's Master Circular asks you to intimate the claim to the insurer at the earliest possible time. Many policies ask for this within 24 hours of an emergency admission. The same circular says no claim shall be rejected or closed for want of documents or for delayed intimation, so tell your insurer even if you are late.

For planned hospital treatment, many policies ask you to inform the insurer at least 48 hours before admission, and some ask for 72 hours. You can do this online, through the TPA or through the insurer's call centre. Note the claim reference number your insurer gives you.

2. Collect original documents at discharge

Ask the non-network hospital for the discharge summary and all original bills before you leave. Ensure the hospital signs and stamps the final bill and all payment receipts. Check the bill breakdown carefully.

Indemnity policies usually exclude listed non-medical items, unless your policy covers them. You will bear these costs yourself.

3. Fill the reimbursement claim form

Download the reimbursement claim form from your insurer's website or ask the TPA for a copy. Fill Part A of the claim form yourself. You will need to enter your policy, patient and hospitalisation details, and sign the declaration.

Get the hospital to fill Part B.

4. Submit the paperwork to the TPA or branch

Organise your documents in the order listed on the claim form checklist. Follow your insurer's route, which may be courier, a branch or an upload on its website. Most insurers ask for the claim file within 15 to 30 days of leaving the hospital. Star Health and Care Health use 15 days, and Niva Bupa uses 30 days.

Always keep a photocopy or scanned copy of every document, including the filled claim form, for your own records.

How long it takes and what it costs

The regulator sets timelines for how quickly an insurer must process your claim once you submit the file.

The IRDAI Master Circular on Protection of Policyholders' Interests, 2024, requires insurers to settle reimbursement claims within 15 days of the claim being submitted. If the insurer delays the claim settlement beyond this time, they must pay you interest at 2 percent above the bank rate, on their own, from the date they received your intimation until the date of payment (IRDAI Master Circular on Protection of Policyholders' Interests, 2024).

Action	Time limit
Intimating an emergency admission	At the earliest. Many policies say within 24 hours
Intimating a planned admission	Many policies say at least 48 hours before admission
Submitting the claim documents	Usually within 15 to 30 days of discharge
Claim settlement	Within 15 days of claim submission

You can check your specific insurer's claim settlement ratio and complaint volume in the Qrates health insurance directory.

If it does not work: What to do if your claim is rejected

Check the rejection letter for the exact reason

If the insurer denies your claim or needs more information, they will send a query or rejection letter. Read this letter to see the exact reason. IRDAI requires the insurer to give full details with reference to the specific terms and conditions of your policy.

Submit missing documents or appeal to the grievance officer

Provide any missing paperwork requested by the TPA within the timeline mentioned in their letter. If you believe the rejection is unfair and you have provided all documents, write an appeal to the grievance officer of the insurance company. Under the IRDAI Master Circular on Protection of Policyholders' Interests, 2024, grievance officers must respond to complaints within 14 days.

Escalate to the Insurance Ombudsman

If the insurer rejects the appeal or does not reply in 14 days, you can escalate the issue. You can file a complaint on the IRDAI Bima Bharosa portal. This is the official IRDAI platform for tracking insurance grievances.

You can also approach the Insurance Ombudsman for your area. You must complain to your insurer first. You can go to the Ombudsman if the insurer rejects your complaint, you are not satisfied with its reply, or it does not reply within 30 days. File within one year. The Ombudsman charges no fee, and the claim amount must be up to ₹50 lakh. You can file online at cioins.co.in.

FAQs

What is the time limit to submit a reimbursement claim?

Most policies give 15 to 30 days from the date of discharge. For example, Star Health and Care Health use 15 days, and Niva Bupa uses 30 days. The exact window depends on your specific policy terms.

Can I claim health insurance without original bills?

Keep your originals. Many policy wordings ask for original bills and payment receipts. Some insurers let you upload scans first and ask for the originals only if needed, so check with your insurer.

Is a discharge summary mandatory for reimbursement?

Policy wordings list the discharge summary among the documents you must provide. It records your admission date, discharge date, history and treatment.

How to track health insurance claim status?

Use the claim reference number your insurer gives you. Check the insurer's website, the TPA portal or the insurer's mobile app. The exact route varies by insurer.

The short version

Inform the insurer as early as possible. Many policies ask for this within 24 hours of an emergency admission, or at least 48 hours before a planned one.
You pay the hospital bill yourself and keep all original bills, receipts, and the discharge summary.
You generally have 15 to 30 days from the date of discharge to submit the paperwork to the insurer or TPA. Check your policy.
Insurers must settle within 15 days of submission. If they delay, they must pay interest at 2 percent above the bank rate.
You can escalate rejected claims to the insurer's grievance officer, the IRDAI Bima Bharosa portal, and the Insurance Ombudsman.